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Dan MelkerSpectatorThis deserved a topic all of its own so I (Ron) moved it here from this previous thread. It was posted in response to my question “Danny, can you tell us more about how you figure out what that BW is in each tooth or position on a tooth (new thread in off topic perhaps)?”
Ron,
The BW just doesn’t want to cooperate with us. We like to use 3mm. as a safeguard but really we all know it can range from 1-5mm. Big variable!
The following factors affect the BW:
1. thickness of bone. If you have thick bone usually you will have less of a BW. The real problem comes from thin bone where I have seen 4-7mm. BW’s. I will send a case to you to demonstrate this problem.
2. position of tooth in ridge. Buccal position-thinner bone. Lingual position thicker bone. BW with buccal position less and with lingual version greater. Many times dehiscences really complicate trt. Long junctional epithelial attachment.
3. Thin or thick tissue. I have seen it both ways where the tissue is thick and minimal BW and where the tissue is thin with minimal BW. Big problem with thin tissue is usually the bone is thin also. Thick tissue far superior obviously than thin tissue to protect underlying bone.
4. Root shape a big factor. After we do root conditioning the roots are moved back into the boney housing usually creating the opportunity for a greater BW.
Bone sounding is a factor unless you have perio disease, then it is not a great tool.
Many times I will simply feel the bone through the tissue and by the above comments know whether the BW will be possibly long or short.(1-5mm.) Looking at the tissue also helps as discussed above.
There are times unfortunately particularly in the anterior where You need to be exact. Flap surgery(scalpel or laser) sometimes is the only method to get it right. Routinely I have a real problem with lingually positioned teeth in the front of the mouth. Even when I take more bone away or make the tooth longer than adjacent teeth many times the tooth after healing the clinical crown is still to short.
After all I have said the bottom line is there are just so many variables with the BW that you do the best you can going by the bone and tissue makeup.
If this confuses everyone I can try to clear things up with questions. I lose myself when typing and thinking. sorry
Danny(Edited by Dan Melker at 4:20 pm on April 29, 2004)
(Edited by Dan Melker at 5:54 pm on April 29, 2004)
AnonymousGuestDanny, thanks for the post. Hope you don’t mind I moved it. I have some more questions but am out of time now. I’ll post later.
AnonymousGuestOk, Danny a few questions before the hockey game starts.
In statement 1.you said thicker bone then smaller BW and yet a buccally positioned tooth that has thinner bone would have less BW according to statement 2. Seems contradictory, is there a reason the thinner boned buccally positioned tooth has less BW?
Can I assume to figure out the actual BW you are using the difference between pocket depth and probe depth to bone? If so can you expect the same BW after surgery is done in that area, e.g. say the presurgery BW is 4mm and crown lengthening is done, after the crown lengthening can you expect to get back the same 4mm BW or will it change depending on what changes in shape you make to the bone? What I’m thinking about here is the situation where you have thin kinda pointed bone on the labial and during the lengthening it becomes proportionally less pointed (which I would expect especially w/ a closed laser procedure), tending more to more blunted point, would you then expect less BW than preop ? or is it more a function of thickness as opposed to shape or form?
Hope that makes some kind of sense. Thanks for helping w/ my perio education here 🙂
Dan MelkerSpectatorIn statement 1.you said thicker bone then smaller BW and yet a buccally positioned tooth that has thinner bone would have less BW according to statement 2. Seems contradictory, is there a reason the thinner boned buccally positioned tooth has less BW?
Ron,
Sorry for the confusion
When a tooth is in buccal version the bone is thinner. I have seen BW that encompass from cej to bone a 5mm. distance. At times I see a BW when doing AG procedures of 1mm. The point is to me is that there are factors we can use but many times they do not fall into the categories we would like. Thicker bone usually has thicker tissue. I see excellent growth of BW when dealing with these two factors. Meaning the BW tends to be greater and more stable.(Ron, to me the key is dense connective tissue-great stability)I am a very strong believer of connective tissue and its benefits to stabilization of an area.(long term prevention of recession and bone loss)
As to when I see thin bone buccally(usually thin tissue also) I have seen teeth with dehiscences with huge BW if you can call them BW-7mm. Then I have seen the 1mm. BW with thin tissue and bone.
This my feeling. VISABILITY-that why I am such a big proponent of doing flap surgery(laser or scalpel). You do not guess-you see and deal with the situation. What I am saying is that I am not that good and to help me do the right procedure I need to see.
I will try to answer the next question after I get home.
We try and it is important to give ourselves general information to go by when dealing with our trt. of patients. 1mm. thickness for margins when doing Empress crowns. .3mm when doing Feldspathic rest. etc.
The difference is we are dealing with a dynamic situation the body-BIOLOGY. The whole world is different and by and large every tooth is different. So using a #3mm. for biologic width just just a #. Trying to deal with thw BW is really hard!
Danny -
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