VIOLATIONS OF BIOLOGIC WIDTH

The concept of biologic width refers to the necessary space that must be maintained between the crest of the alveolar bone and the margin of any dental restoration. This space is occupied by the connective tissue attachment and the junctional epithelium, which are essential for the health of the periodontium. Violation of biologic width can occur when restorative dental procedures encroach upon this space, leading to a series of adverse effects such as gingival inflammation, bone resorption, and ultimately, the loss of the tooth or restoration's longevity. It is crucial for dental professionals to assess and respect the biologic width during treatment planning and execution to prevent such complications. Failure to do so is dental negligence.

Such outcomes not only compromise the integrity of the periodontium, but also affect the stability and longevity of any dental restorations involved. Therefore, maintaining the integrity of biologic width is paramount in dental procedures to prevent these adverse effects.

Violating the biologic width can lead to a cascade of detrimental effects on periodontal health. The immediate consequence is typically an inflammatory response, which can manifest as gingival inflammation and bleeding on probing. This inflammation, if persistent, can progress to more severe conditions such as gingival recession, the formation of periodontal pockets, and chronic inflammation around the restoration. Over time, these issues can result in the loss of clinical attachment and progressive alveolar bone loss.

Illustrations of biologic width

Dentists can avoid violating biologic width by adhering to precise clinical procedures, radiographs and maintaining a thorough understanding of periodontal anatomy. The biologic width is the necessary space required by the junctional epithelium and connective tissue attachments to remain healthy around the tooth. To preserve this space, careful planning of restorative margins is essential. When preparing a tooth for restoration, it's crucial to ensure that the margin does not encroach upon the biologic width. If the margin placement is closer than 2mm to the bone, it may lead to gingival inflammation or bone resorption as the bone cells migrate away from the offending restoration. In cases where the biologic width is compromised, corrective measures such as crown removal, surgical crown lengthening or orthodontic extrusion may be employed to re-establish a safe boundary between the restoration and the patient’s alveolar bone.