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S. Nares (ed.)Advances in Periodontal Surgeryhttps://doi.org/10.1007/978-3-030-12310-9_4
4. Biologic Shaping in Periodontal Therapy
Biologic shapingCrown lengtheningFurcationsBiologic width
4.1 Introduction
Periodontal surgery involves modification of hard and/or soft tissues to achieve a therapeutic goal. These goals include treatment of periodontal defects, including furcation involvement of molars, and crown lengthening procedures to facilitate restoration of a tooth or teeth. Traditionally, resective and regenerative techniques focus on osseous structures with little attention given to modification of tooth surface. Unfortunately, this could lead to excessive removal of the bone and/or creation of an environment that is not cleansable and biologically incompatible. Further, regenerative techniques can yield unpredictable results in furcation lesions thus predisposing molars to further attachment loss. Biologic shaping is intended to create a cleansable, biologically compatible root surface that is manageable by both patients and dentists/hygienists. Here modification of tooth surface is the primary focus with removal of the bone performed only when absolutely necessary to create a biocompatible environment. This chapter will focus on biologic shaping during the course of periodontal therapy.
4.2 Indications and Rationale for Biologic Shaping

Removal of developmental groove. (a) Developmental groove present on the right central incisor illustrating the problem when a margin finishes in a developmental groove (black arrow). There is a lack of adequate seal, and bonding material is located in the groove causing severe inflammation. (b) Removal of the developmental groove to allow for maintenance of the area (white arrow)

This patient was referred for correction of biologic width invasion. Prior treatment involved removal of existing restorations and decay and placement of cores and provisionals. (a) Provisionals removed. Note Durelon cement still present on the teeth. Antimicrobial effects of this cement are protective. (b) Reflection of a full thickness flap followed by a partial thickness dissection apical to the mucogingival junction. (c) Of critical importance is the location of the existing margin approximating the furcation. In essence there is no space for the biologic width. (d) After biologic shaping 100% of the tooth structure is perfectly smooth from the bone to the occlusal surfaces. Note that there is absolutely no margin present after biologic shaping. Critical is the actual location of the bone in the furcation. Removal of furcation results in coronal movement of the bone (arrow). No matter how much bone is removed, space for the biologic width cannot be achieved. By removing the previous margin and allowing a new biologic width to establish, the new margin can be placed coronal to the gingival collar. (e) The flap is sutured with 5–0 chromic gut just coronal to the bone. Primary closure helps to decrease postoperative discomfort. (f) The day of impressions. A chamfer margin is placed with a 0.3 mm thickness and placed just coronal to the gingival collar (arrow). Note the large amount of tooth structure remaining. (g) Final restorations cemented. All margins are supragingival. The furcation on #3 is perfectly contoured to follow the shape of the underlying tooth structure. The barreling in of the furcation is extended to the occlusal surface. The material for these restorations is Feldspathic porcelain. This case has now passed the 15-year period of stability and function. Restorations by Dr. William Strupp Jr
Rationale for biologic shaping [5]
1. |
Replacing or supplementing the current indications for clinical crown lengthening |
2. |
Minimizing osteotomy |
3. |
Facilitating supragingival or just slightly intrasulcular margins (when there is a dark substructure) to preserve the biologic width |
4. |
Eliminating developmental margins |
5. |
Eliminating previous subgingival restorative margins |
6. |
Reducing or eliminating furcation anatomy, thus facilitating margin placement |
7. |
Allowing supragingival or intrasulcular impression techniques |
8. |
Removing all CEJs |

(a) Case with three teeth requiring new restorations with chronic inflammation present on the first premolar (white arrow). (b) Restorations removed and decay excavated. (c) Core buildup (DenMat (Lompoc, CA, USA) enamel shade core paste) adds restorative volume to the teeth and helps determine placement of the final restorative margins. Connective tissue graft in place on the first premolar (black arrow). (d) Final restorations fabricated with Feldspathic porcelain with margins placed supragingival. Healing of the connective tissue graft provides a thick band of keratinized tissue an elimination of the chronic inflammation (arrow). Note that the new crown margin on the first premolar is now supragingival to the previous crown margin. The case is now in function for 11 years. Restorations by Dr. William Strupp Jr

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