After the teeth are prepared and a provisional restoration has been made (see Chapter 15), the health of the surrounding soft tissues must be reevaluated. Careful preparation will result in minimal tissue damage; however, if a subgingival margin is needed, some tissue trauma in the sulcular area may be unavoidable. The effects of this trauma can be transient as long as the patient receives a properly made provisional restoration and maintains adequate oral hygiene. However, if the provisional is poorly contoured, not polished, or has defective margins, plaque retention will lead to a localized inflammatory response. The combination of such tissue trauma in the presence of preexisting periodontal disease can produce disastrous results.
Periodontal disease must be treated and resolved before fixed prostheses are placed.
On occasion, a defective restoration will contribute to the inflammatory sulcular response. If this is the case, a properly adapted and well-contoured polished provisional must be fabricated and cemented on the prepared teeth; the focus must shift from the teeth to the soft tissues, which must be re turned to a state of optimum health before impression making is even considered.
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