The role of the prosthodontist in the treatment of periodontal disease.

The inter-relationships between the periodontal situation of a patient and a prosthetic appliance should be regarded in particular from the aspect of oral hygiene. Creating or maintaining a high standard of oral hygiene is thus the joint objective characterizing cooperation between the periodontist and the prosthodontist. The tasks falling to the prosthodontist during initial therapy are: removal and temporary replacement of restorations that are not conducive to good oral hygiene, temporary replacement of teeth with hopeless prognoses, and temporary prosthetic planning in conjunction with the periodontist. In the phase of surgical periodontal treatment, the creation of new attachments should be accompanied by morphologic corrections; these are essential to the oral hygiene of patients with prosthetic appliances. The prosthodontist has therefore to advise the periodontist on what corrections are desirable and where. This applies firstly to gingival corrections at abutment teeth and secondly to mucosal corrections on the edentulous alveolar ridge. On conclusion of the periodontal treatment, the prosthodontist will have to come to terms with three problems: the indication for prosthetic treatment, the decision between fixed bridges and removable partial dentures, and the periodontal problem zones occurring with crowns and bridgework. The indications for prosthetic treatment can now be more restricted, following recent findings on oral function with shortened dental arches. When deciding between fixed bridges and removable partial dentures, it is the oral hygiene aspect that is decisive. In existing or threatened free-end situations preference should be given to bridgework. This can be implemented with: cantilever bridges, bridges abutted at each end by the distal movement of a premolar, and bridges abutted at each end by hemisectioning of a periodontally damaged molar. With crowns and bridges, prospects for oral hygiene are determined by the following: the position of the crown margin, the contour of the crown in the marginal area, and the contour of the under-surface of the pontic. If optimum prospects for oral hygiene have been created by good coordination between the periodontist and the prosthodontist, the prognosis in the maintenance phase is considerably improved.