At the base of the gingival sulcus (crevice) is the epithelium-tooth interface, also known as the den-togingival junction (DGJ). This structural relationship between hard and soft tissues is unique in the body. At the ultrastructural level, it is made up of hemidesmosomes and a basal lamina, which anchor the epithelial cells to the enamel and cemental surfaces4-11
The depth of the sulcus varies in healthy individuals, averaging 1.8 mm.12 In general, the shallower it is, the more likely the gingiva will be in a state of health. Sulcular depths up to 3 mm are considered maintainable. The continued maintenance of the gingiva in a state of health depends on tight, shallow sulci, which in turn depend on optimal plaque control, and will ensure the success of periodontal therapy as well as affording a good prognosis for subsequent restorative treatment.
i 10 .Section 1 Planning and Preparation ^DISEASES OF THE PERIODONTIUM
The general term periodontal disease is used to describe any condition of the periodontium other than normal. It covers such pathologic states as gingival hyperplasia, juvenile periodontitis (also known as periodontosis), and acute necrotizing ulcerative gingivitis-all distinct clinical entities that warrant specific treatment. For information concerning these disease states, refer to any of the standard peri-odontal texts. Periodontal disease must be recognized and treated before fixed prosthodontics so that the gingival tissue levels can be determined to proper margin placement, esthetics, and gingival displacement (with an AICl3-impregnated or plain cord, see Chapter 14). Only when the gingiva and periodontium are in an optimal state of health can these determinations be made with ease or predictability.
This discussion is limited to the etiology and progression of the inflammatory gingivitis-periodonti-tis lesion, which affects the majority of adults 13 and constitutes the bulk of pathologic disorders needing treatment before restorative dentistry.
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