Gingival esthetics

Charles J. Goodacre, D.D.S., M.S.D.*

Indiana University, School of Dentistry, Indianapolis, Ind.

Achieving the most desirable gingival appearance enhances the esthetic result
achieved with fixed prosthodontic restorations and is most often realized when
gingival health is optimized before treatment and gingival trauma is minimized
during treatment. Methods of optimizing gingival appearance by avoiding soft
tissue contact are discussed as are factors considered important to maintaining
good gingival appearance when subgingival margins are necessary. (J PROSTEET
DENT 1990;64:1-12.)

T he word esthetic denotes beauty as opposed to the
merely pleasing, indicating that the most desirable at-
tributes are present.l Achieving optimal oral beauty in-
volves many factors, one of which is gingival appearance.
The goal of gingival esthetics is to maintain normal
healthy gingival appearance around teeth that must be re-
stored. Achieving this goal requires that gingival health be
optimized and trauma be minimized during fixed pros-
thodontic procedures.
AVOIDING GINGIVAL CONTACT
The best way to enhance gingival health and minimize
trauma is to avoid contact of the gingiva with restorative
materials. This goal can be accomplished in several ways.
Partial veneer crowns can be used to avoid contact with
facial gingival tissue, which is more sensitive to tooth
preparation procedures2 and the presence of restorative
materials. In many situations, these restorations can be
designed to avoid display of metal and tooth discoloration
by not covering visible or thin translucent surfaces of the
tooth (Fig. 1).
Gingival contact can also be avoided by using supragin-
gival margins in preference to subgingival margins wher-
ever possible.3 Supragingival margins increase the poten-
tial for achieving optimal gingival health around restored
teeth.4M’2It is particularly important in adolescent patients
to avoid subgingival finish lines because they are more
likely to accelerate gingival recession or interfere with the
normal cervical relocation of the gingiva as adolescents
mature (Fig. 2). Both of these factors may create biologic
and esthetic problems that often cannot be eliminated even
with replacement of the restoration.
Supragingival finish lines can also meet esthetic de-
Presented before the Academy of Denture Prosthetics, Corpus
Christi, Tex.
*Chairman, Department of Prosthodontics.
10/1/10377
mands. It has been shown that in 33% of the people
studied, the gingival aspect of their most visible anterior
teeth did not show during a normal smile.i3 With an exag-
gerated smile, 16% of those studied did not show the gin-
gival portion of their most visible anterior teeth.13 Poste-
rior teeth were found to be less visible than anterior teeth.14
Some patients will accept supragingival margins even if
they are visible, and many patients prefer the potential of
optimal gingival health over esthetics-l5 It is possible to
design metal ceramic restorations, even with cervical col-
lars of metal, that do not extend subgingivally and yet are
esthetic because the collars are not visible during speaking
or smiling (Fig. 3).
For those patients who display the cervical aspect of
their teeth, it is possible to avoid gingival contact and meet
esthetic requirements by using collarless metal ceramic
restorations with finish lines located at the gingival crest
(Fig. 4). This design is particularly advantageous when the
attached gingiva is minimal, since even minor procedural
trauma during placement of a subgingival finish line may
cause recession.16,l7
In situations where gingival recession or periodontal dis-
easehas resulted in exposed root surfaces, it can be esthet-
ically and biologically advantageous to use collarless metal
ceramic restorations with supragingival finish lines.
Donaldson2 indicated that the more recession found on a
tooth before treatment, the greater the possibility of
further recession if the tooth is restored with subgingival
margins. A supragingival collarless metal ceramic restora-
tion margin can simulate the cervical line (Fig. 5). This
placement avoids the difficult task of establishing a sub-
gingival finish line on the root where less tooth structure is
available for reduction and fragile soft tissue may be
present.
SUBGINGIVAL FINISH LINES
While subgingival finish lines are not periodontally ad-
vantageous, they are required in certain situations to gain
sufficient retention, cover existing restorations or fracture
sites, eliminate caries, or achieve a better esthetic result.

TEE JOURNAL OF PROSTHETIC DENTISTRY 1


Fig. 1. A, Maxillary canine prepared for partial veneer
crown without covering mesial cusp arm to avoid metal
display and tooth discoloration. B, Occlusal view of ce-
mented prosthesis showing reduced incisal coverage. C,
Facial view of fixed partial denture using partial veneer
crown retainer on maxillary canine that does not cover me-
sial cusp arm.
Gingival health and position can be maintained in the
presence of subgingival finish lines, but it requires careful
execution of clinical procedures and the presence of excel-
lent restorations.‘*-20 Achieving this goal requires careful
consideration of several factors.
GOODACRE
Fig. 2. A, Accelerated gingival recession in adolescent
patient was caused by crown with subgingival margins. B,
Ceramic restoration that interfered with normal cervical
relocation of gingiva in an adolescent.
Preprosthetic periodontal health
Patients with existing periodontal abnormalities often
have exaggerated responses to the slightest tissue insults,‘6
whereas slight trauma will not produce lasting effects if the
gingiva is healthy before the procedure.17 It is imperative
that optimal tissue health be established before fixed
prosthodontic procedures are initiated and that extreme
care be exercised during all stages of treatment.la l7
Assessing periodontal health requires a thorough evalu-
ation of periodontal probing depths and the condition of
the gingiva. The gingival index described by Loe2i is a
valuable tool in assessing gingival condition. It considers
qualitative gingival changes such as color, presence of
edema, and tendency to bleed when a probe or blunt
instrument is run along the soft tissue wall at the entrance
of the gingival crevice.
When gingival inflammation is noted by color changes,
edema, or bleeding on probing, adequacy of brushing and
flossing must be evaluated and corrective instruction
implemented as needed.l6 When fixed prostheses are
JULY 1990 VOLUME 04 NUMBER 1
GINGIVAL ESTHETICS

Fig. 3. A, Metal ceramic restorations with cervical collars of metal. B, Metal collars were
not visible because cervical aspect of teeth was not exposed during maximal smiling.
Fig. 4. A, Posterior teeth prepared with finish lines located at gingival crests. Existing
metal ceramic crown on maxillary canine has subgingival finish line. B, Collarless metal
ceramic crowns with margins located at gingival crest have been cemented. Gingival
response is more favorable than that present around canine restoration that has subgin-
gival margin.

involved, the patient’s knowledge of and adequacy in using
floss threaders and interproximal brushes must be ascer-
tained and appropriate instruction provided. Only when
optimal tissue health is present should prosthodontic
treatment begin.
Tooth preparation
Care must be exercised not to injure the gingival tissues
during subgingival tooth preparation, especially where the
gingiva is thin and delicate.‘” When there is minimal
attached gingiva, injuries are more likely to cause
recession.r6*l7 The epithelial attachment is the most vul-
nerable of all the supporting structures and procedural
trauma can initiate its apical migration and result in peri-
odontitis or recession.i6 Subgingival finish lines should be
terminated at least 0.5 mm short of the epithelial
attachment.16, l7 In most instances the deeper the subgin-
gival extension, the greater is the risk to the epithelial
attachment.‘l* l6
Rotary instruments can severely injure or obliterate the
gingiva, resulting in esthetically poor soft tissue contours,
which can produce problems in maintaining periodontal
health. The interdental papilla is particularly susceptible
and easily traumatized (Fig. 6).
To ensure optimal gingival appearance around ceramic
restorations with subgingival margins, the restoration must
be a continuation of normal tooth contour and not be over-
contoured, a condition that promotes plaque accumulation
and resultant gingival inflammation.3+ l’j When the gingival
surface of a tooth has insufficient axial reduction, color in
the thin porcelain cannot be controlled, or the crown must
be overcontoured, resulting in poor gingival esthetics
(Fig. 7).
Adequate tooth reduction is required to provide space
for both an esthetic thickness of ceramic material and nor-
mal tooth contour.22 The use of depth-guide cuts in the
early stages of preparation ensures adequate and uniform
tooth reduction (Fig. 8). The deepest parts of the cuts can

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 GOODACRE

Fig. 5. A, Maxillary central incisor prepared with supragingival finish line that simulates
cervical line location and curvature. B, Cemented prosthesis shows use of collarless metal
ceramic crown retainer on central incisor. Margin simulates cervical line. C, Considerable
gingival recession has occurred on maxillary left central incisor. Collarless metal ceramic
crown retainer was used with facial margin located at level of cervical line. Cervicoincisal
dimension of ceramic material is approximately the same on both central incisor retainers.
(Courtesy of G. A. Ecker.)

be compared with the unprepared surface, measurements Use of retraction cord

made when needed, then the entire surface reduced.
The type of subgingival finish line being formed is
related to the potential for gingival trauma. A shoulder
finish line can be established subgingivally while keeping
the entire rotary instrument diameter within peripheral
tooth contours where there is less chance of gingival con-
tact. The formation of chamfers and beveled shoulders re-
quires that part of the rotary instrument diameter be
located outside peripheral tooth contours, with greater po-
tential for gingival trauma (Fig. 9). This relationship does
not mean that greater gingival trauma will always occur
with chamfers and beveled shoulders but it does indicate
the need for extra care when these finish lines are being
formed subgingivally.
Gingival retraction cord and hand instruments can be
used to minimize soft tissue trauma from rotary instru-
ments as subgingival finish lines are formed.
Retraction cord can be placed in the gingival sulcus to
displace the gingiva temporarily and reduce the soft tissue
injury often observed during tooth preparation when a
finish line is extended into the gingival sulcus. When used
in a careful manner on healthy gingival tissue, retraction
cord produces no prolonged harmful effect on the peri-
odontal tissuess3
One procedure in using retraction cord is to prepare the
tooth first, establishing preparation form and reduction
depths at or slightly in&alto the gingival crest sothat rotary
instruments do not contact soft tissue (Fig. 10, A). Retrac-
tion cord is placed in the sulcus, displacing the gingiva
laterally and apically (Fig. 10, B). Rotary instruments are
then used to extend the finish line farther cervically to the
level of the displaced gingivalcrest (Fig. 10,C). When the cord
is removed and the gingiva returns to its normal position the
finish line will be located subgingivally (Fig. 10, D).

JULY 1990 VOLUME 94 NUMBER 1

GINGIVAL ESTHETICS

Fig. 6. A, Interdental papilla between maxillary right central and lateral incisors severed
during tooth preparation. B, Approximately 1 month after cementation of restorations,
patient complained of severe gingiva bleeding when it was touched. Examination revealed
that new tissue granulated into injured area and displaced original gingiva. New tissue was
irregular in form, exhibited prolonged bleeding on contact, and resulted in poor gingival
esthetics. C, Interdental papilla was obliterated and tissue that granulated into area pro-
duced poor gingival form. Patient’s chief complaint was dark shadow that was present in
facial cervical embrasure between two central incisors. She wanted two crowns replaced for
this reason. D, Tissue was extensively damaged during tooth preparation and existing res-
torations have poor margin adaptation and interproximal contour. Normal gingival health
unlikely even with crown replacement.

An alternative order of procedure is to place the retrac-
tion cord in the sulcus and then complete the entire tooth
preparation. This procedure is not likely to produce exces-
sive trauma when the tooth is prepared quickly. It could
cause excessive trauma when a time-consuming, difficult
tooth preparation is encountered and retraction time is in-
creased. There is a direct relationship between the time
that retraction cord is in the sulcus and the potential for
adverse gingival responses such as recession.17It has been
suggested that total cord retraction time ideally should not
exceed 15 to 20 minutesz4
Loe and Silness23found that retraction cords caused ne-
crosis of the crevicular epithelium in dogs after 10minutes
of retraction but the wound was lined with epithelial cells
in 6 to 9 days. Harrison% found that increasing the retrac-
tion time in dogs increased the relative degree of injury
when comparing 5, 10, and 30 minutes of retraction time
with different chemicals used in the retraction cords.
Healing occurred histologically in 7 to 10 days for all but
one of the chemicals tested. However, in both of these
studies the tissue healed against intact tooth surfaces.
Factors other than time deserve consideration in using
retraction cord and attempting to minimize soft tissue
trauma.
Too large a retraction cord or too many cords can cause
excessive trauma.16 With healthy tightly adapted anterior
gingival tissue, one small diameter cord usually produces
adequate retraction without excessive trauma.
Placing retraction cord in the gingival sulcus often sev-
ers the epithelial attachment,i7 but healing occurs in a few
days with no prolonged harmful effects if the procedure was
carefully executed. i7*23 The use of excessive instrument
pressure when placing cord into the sulcus can produce ex-
cessive damage and recession.16,17,23,24~261n When the

THE JOURNAL OF PROSTFIETIC DENTISTRY


Fig. 7. A, Overcontoured crowns resulted in abnormal
gingival color. B, Removal of restorations reveals inade-
quate cervical tooth reduction, which promoted overcon-
touring to achieve adequate thickness of ceramic material.
proper cord size is selected and careful instrument pressure
used, the tissue blanching often observed immediately af-
ter placement of the cord rapidly disappears.
A histologic studyzs showed that removing retraction
cord when the cord and tissue were entirely dry tore away
the entire epithelial layer from the underlying connective
tissue.
Studies25p2gwhich evaluated the chemicals used in
retraction cord are limited but have determined that zinc
chloride caused unacceptable levels of gingival injury, par-
ticularly in high concentrations. Other tested chemicals
injured the sulcular epithelium but adequate healing
occurred in 7 to 10 days. In neither of these studies were the
teeth prepared and provisional restorations placed. The
tissue healed in contact with clean smooth tooth surfaces.
Retraction cord impregnated with epinephrine produced
no permanent histologic gingival changes, but increase in
the patient’s heart rate and blood pressure have been ob-
6 JULY
Fig. 8. Two facial-depth cuts have been placed in mazil-
lary right central incisor to ensure adequate and uniform
facial tooth reduction.
Fig. 9. Three types of subgingival finish lines: left, shoul-
der; center, beveled shoulder; right, chamfer. Formation of
beveled shoulder and chamfer require part of diameter of
rotary instrument to be located outside peripheral tooth
contours where gingival contact is more likely.
served. Epinephrine impregnated retraction cords did not
produce a change in heart rate or blood pressure in dogs
when intact gingiva was present.2g However, when the tis-
sue was deliberately traumatized there was systemic ab-
sorption. Three inches of cord containing 1 mg of epineph-
rine per inch produced an increase in heart rate in all the
dogs and an increase in the blood pressure of some of the
animals. Larger doses produced severe changes in both
heart rate and blood pressure.29 A knowledge of this neg-
ative effect is imperative when treating individuals with
cardiovascular disease.29
One report advised against using epinephrine-impreg-
nated cord around large numbers of teeth.30
19SO VOLUME 64 NUMBER 1
GINGIVAL ESTHETICS

Fig. 10. A, Initial reduction of maxillary right central incisor. Finish line has only been
extended cervically to gingival crest, thereby avoiding contact between rotary instrument
and gingiva. B, Retraction cord used to displace gingiva. C, Rotary instrument used to ex-
tend finish line cervically to level of displaced gingival crest. D, Retraction cord removed
and subgingival finish line is present. Note minimal damage to gingiva by rotary instru-
ments.

Fig. 11. Use of flat blade hand instrument to hold gingiva

laterally and prevent contact with rotary instrument. Fig. 12. Maxillary provisional fixed partial denture preserv-
ing gingiva form, with proper embrasure form permitting
accessto interproximal gingiva with o:ral hygiene devices.

Hand instrument technique Impression procedure

Hand instruments with flat blades can also be used to
retract the gingiva instead of or in addition to retraction
cords while a subgingival finish line is being formed,
thereby preventing the gingiva from being abraded with
rotary instruments (Fig. 11).
An impression must provide detailed information about
the prepared teeth, surrounding teeth, and associated soft
tissues. The impression must record the form of all
prepared surfaces and some of the unprepared tooth cer-
vical to the finish line.

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 COODACRE

Fig. 13. A, Maxillary right central and lateral incisors prepared for ceramic restorations
after traumatic injury. Note preexisting recession on lateral incisor and canine. Finish line
not extended into gingival sulcus in center of labial surface of lateral incisor. B, Definitive
restorations provide environment for maintenance of existing gingival form, color, and po-
sition.
Fig. 14. A, Early clinical sign of unfavorable gingival response. Visible blood vessels in
marginal gingiva of maxillary left central incisor cause reddish zone to develop. B, Red-
dened zone present in marginal gingiva is larger and more generalized. Some edema is
present, gingival margin is not as sharp as normal, and there has been some loss of stip-
pling.
Fig. 15. A, Preparation of maxillary right central incisor resulted in gingival trauma.
When patient returned for cementation of definitive restoration, gingival tissue was still
red and edematous. B, Patient practiced good oral hygiene and gingiva returned to rea-
sonably normal level of form and color in 2 weeks.

JULY 1990 VOLUME 64 NUMBER 1

GINGIVAL ESTHETICS
Fig. 16. A, After removal of provisional restoration, gingiva exhibited edema and thick-
ened rounded form. B, Three weeks later gingiva has returned to acceptable form as a re-
sult of sustained effective plaque removal.
Gingival retraction cord is often used during impression
procedures to (1) help control fluid seepage and/or bleed-
ing and (2) to help provide space so that the impression
material can record subgingival finish lines and unprepared
tooth structure cervical to the finish line. The cord is
sometimes left in the sulcus during impression making to
help control fluid seepage. When possible, however, it is
advantageous to remove the cord so that the impression
material can record the maximal amount of unprepared
tooth contours. The die is then most helpful in developing
a restoration that is a continuation of natural tooth
contours and not overcontoured.
After removal of an impression from the mouth, it is im-
portant to check the gingival sulcus and remove all rem-
nants of retained impression material. Adverse tissue
reactions from impression materials retained in and around
the gingival tissues have been reported.31-56The gingival
response can be so severe as to produce permanent gingi-
val changes and esthetic problems. Aqueous and nonaque-
ous elastomeric materials alike have been shown to affect
soft tissue when left in the sulcus. Periodontal hazards of
retained impression materials were reviewed and each ma-
terial’s potential for producing inflammatory reactions by
mechanical or chemical means have been reported.54 The
radiopacity and color of elastomeric impression materials
should be controlled to facilitate the detection of material
left behind.57
The provisional restoration
Provisional restorations serve many purposes, one of
which is to preserve the position, form, and color of the
TIiR JOURNAL OF PROSTHETIC DENTISTRY
gingiva while the definitive restoration is being made.24To
accomplish this goal, the soft tissue must rest in its normal
location against a provisional restoration that is properly
contoured,2 is well adapted to the finish line,16 and has a
smooth surface.t6 Provisional fixed partial dentures must
exhibit all of these attributes plus pontic and cervical em-
brasure forms that provide accessto the soft tissue by oral
hygiene aids (Fig. 12). Gingival recession has been associ-
ated with improperly contoured provisional crowns,2 and
rough surfaces have been shown to promote plaque
accumulation.17s 58
After cementation of the provisional restoration, it is
important to remove all traces of provisional cement from
the gingival sulcus to prevent unfavorable gingival
healing.5g
The patient must receive instructions on how to properly
clean provisional restorations; meticulous attention to the
prescribed regimen is necessary. The timing of clinical ap-
pointments and laboratory fabrication should be arranged
so that provisional restorations are in position for as little
time as possible3 preferably no more than 2 to 3 weeks. One
study of gingival recession associated with provisional res-
torations found that the longer a provisional restoration
was in place, the greater was the recorded recessi0n.s”
When provisional restorations must be used for longer than
usual time periods, the level of home care practiced by the
patient is extremely important. Many adverse soft tissue
reactions observed around definitive restorations have
been initiated by faulty provisional restorations or good
provisional restorations that were poorly cleansed and/or
left in the mouth too long.

Fig. 17. A, Chronic abnormal gingival form reveals pres-
ence of crown on maxillary right central incisor. B, Left
central incisor crown is revealed by chronic abnormal gin-
gival color and alteration in gingival form and position.
One final comment regarding provisional restorations
is necessary. Nothing will improve the quality of provi-
sional restorations as much as inspecting them on the
die to ensure accurate marginal adaptation and proper
contour.
The definitive restoration
The quality of the definitive restoration must provide an
environment that promotes long-term maintenance of op-
timal gingival health (Fig. 13). The restoration should have
good marginal fit because marginal defects permit plaque
formatio# and have been associated with reduced peri-
odontal bone leve1s.62Facial, lingual, and interproximal
surfaces should be normally contoured3, 16*63 and should
not impinge on the soft tissue because overcontouring pro-
motes plaque accumulation”* 64*65 and resultant gingival
inflammation.ss The profile of the restoration as it emerges
from the gingival sulcus is particularly important.67-6g All
10
GOODACRE
restoration surfaces should be smooth, especially those
that contact the gingiva. 58The normal intensity, location,
and form of proximal contacts must be presen@ l7 and
marginal ridges of adjacent teeth should be of even
height.17
Pontics and their relationship to soft tissue health have
been described.3*I6117*70-76Pontic design was found to be
the most important factor in obtaining inflammation-free
pontic-ridge relationships. 7o Minimal soft tissue contact
designs are biologically advantageous70-74and the sanitary
or hygienic design should be used whenever esthetics
permit. 70,75 Embrasures should be opened as much as
practical to permit access with oral hygiene aids.71 In vis-
ible surfaces, a “modified ridge lap” design that minimizes
pontic-ridge contact lingually and eliminates concavities
has been suggested.70Some authors prefer glazed porcelain
for ridge contact73, 75whereas others indicate that after 6
months there is no difference in soft tissue response to ei-
ther porcelain, gold, or resin.
Postplacement care
A definitive restoration must routinely receive thorough
cleansing. Proper oral hygiene should be verified at post-
cementation appointments and instructions reemphasized
when needed. Inadequate oral hygiene can produce detri-
mental biologic and esthetic changes even in the presence
of excellent restorations and careful execution of technical
procedures. The finest subgingival restoration is not as
smooth and easy to clean as an intact tooth surface.
Particular attention must be focused on the marginal
gingiva because unfavorable gingival responses begin here.
A progression of clinical signs occur in unfavorable gingi-
val responses. The blood vessels in the marginal gingiva
become visually apparent, a reddened zone forms around
the restoration, the gingiva becomes edematous and blunt-
ed, and there is a loss of gingival stippling (Fig. 14). If these
signs are related to margin adaptation, contour, or smooth-
ness, a new restoration should be made. If early gingival
problems are a result of trauma produced during treatment
or inadequate oral hygiene, they can be alleviated by
detection and effective plaque removal (Figs. 15 and 16).
Sulcular brushing with soft toothbrush bristles using a
gentle vibratory motion and the use of unwaxed dental floss
are essential to proper hygiene. The gingiva cleansed thor-
oughly two to three times a day will usually return to nor-
mal within a few weeks.
If early symptoms are undetected or patient cooperation
is not achieved, chronic poor gingival form and color
develop. After a few months poor gingival form and/or color
frequently cannot be totally reversed, even in the presence
of adequate oral hygiene (Fig. 17). Early detection of gin-
gival problems is the responsibility of the dentist who ini-
tially places a restoration with a subgingival finish line
because it is that individual’s execution of treatment pro-
cedures and postcementation observations that often de-
termine long-term gingival esthetics.
JULY 1990 VOLUME 04 NUMBER 1
GINGIVAL ESTHETICS
SUMMARY AND CONCLUSIONS
The goal of gingival esthetics is to maintain normal
healthy gingival appearance around restored teeth by op-
timizing gingival health before treatment and by minimiz-
ing soft tissue trauma occurring during treatment. Gingi-
val contact should be avoided whenever possible through
the use of partial veneer crowns, supragingival margins, or
collarless metal ceramic restorations with margins located
at the gingival crest.
When subgingival finish lines are required, particular
attention must be paid to several factors: (1) achieving op-
timal preprosthetic gingival health; (2) minimizing gingival
trauma from rotary instruments during tooth preparation;
(3) careful use of gingival retraction cord; (4) SUICUS
inspection following impression making to remove any re-
sidual impression material; (5) well fitting, properly con-
toured, and smooth provisional and definitive restorations;
and (6) postplacement observations of oral hygiene ade-
quacy and re-emphasis as needed.
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THE JOURNAL OF PROSTHETIC DENTISTRY
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10.
29. Woycheshin FF. An evaluation of the drugs used for gingival retraction.
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31. Kanarek B. Foreign body in the antrum. Br Dent J 1965;118:214.
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33. Myall RW, Robinson AC. A buccal swelling simulating subperiosteal
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11

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The effect of 25% tannic acid on prepared dentin:
electron microscope-methylene blue dye study
Norman C. Bitter, D.D.S.*
University of Southern California, School of Dentistry, Los Angeles, Calif.
The effect on the permeability of prepared dentin treated with 26% tannic acid and
6% citric acid was compared with the untreated dentinal surface. Methylene blue
was applied to the dentin surface after treatment to evaluate penetration
dentinal tubules. The tannic acid solution reduced or prevented dye penetration
the dentinal tubules. Citric acid treatment permitted severe penetration.
tannic acid solution removed the smear layer while inhibiting penetration of the
dye. (JPRosTHETDENT~SS~;~~:~~-~.)
T he presence and importance of the smear layer
after reduction of dentin with rotary instruments has been
a subject of investigative concern.’ The residue remaining
on the surface of prepared dentin consists of particles of
dentin and debris and may contain microorganisms.2-4
Removal of the smear layer with acids and demineraliz-
ing solutions increases the permeability of prepared dentin
and may result in pulpal injury and an increase in the po-
tential for bacterial invasion of the dentinal tubules. Tan-
nit acid, a protein coagulant, is a vegetable tanning agent
*Clinical Associate Professor, Restorative Dentistry Department.
10/1/17195
12
GOODACRE
67. Wagman SS. The role of coronal contour in gingival health. J PROSTHET
DENT 1977;37:280-7.
68. Stein RS, Kuwata M. A dentist and a dental technologist analyze cur-
rent ceramo-metal procedures. Dent Clin North Am 1977;21:729-49.
69. Jameson LM, Malone WFP. Crown contours and gingival response.
J PROSTHETDENT 1982;47:620-4.
70. Stein RS. Pontic-residual ridge relationship: a research report. J PROS-
THET DENT 1966;16:251-85.
71. Henry PJ, Johnston JF, Mitchell DF. Tissue changes beneath fixed
parthd dentures. J PROSTHETDENT 196&l&937-47.
72. Eissmann HF, Radke RA, Noble WH. Physiologic design criteria for
fixed dental restorations. Dent Clin North Am 1971;15:543-68.
73. Cavasos E. Tissue response to fixed partial denture pontics. J PROSTHET
DENT 1968;20:143-53.
74. Hirshherg SM. The relationship of oral hygiene to embrasure and pon-
tic design-a preliminary study. J PROSTHETDENT 1972;27:26-38.
75. Smith DE. The pontic in fixed bridgework. Dent Digest 1937;43:16-20.
76. Podshadley AG. Gingival response to pontics. J PROSTHETDENT
1968;19:51-7.
Rep& requests to:
DR. CHARLESJ. GOODACRE
DEPARTMENTOF PROSTHOLlONTlCS
INDIANA UNIVERSITYSCHOOLOFDENTISTRY
1121 WEST MICHIGAN ST.
INDIANAPOLIS,IN 46202
A scanning
into
of
The 25%
that attaches itself to collagen by means of hydrogen
bonds.5*6 Tannic acid reinforces the organic and inorganic
constituents of dentin, constricts the orifices of the tubules,
is well tolerated by the pulp, and offers a beneficial method
of smear removab7>8The effectiveness of a 25 5%tannic acid
solution for smear layer removal has been rep0rted.s 7
Dilute citric acid has been advocated for removal of the
smear layer. The citric acid enlarges the apertures of the
dentinal tubules, which permits formation of composite
tags and improved bonding.8 However, the application of
6 5%citric acid for 15 seconds increases the permeability of
the remaining dentin and should be considered hazardous
to the p~lp.~
This investigation describes the influence of two smear-
removal agents on the permeability of the dentin.
JULY lO@O VOLUME 64 NUMBER 1