This course discusses scientific evidence regarding the full-coverage restoration (FCR) margin placement and periodontal health.

Upon completion of this course, participants should be able to do the following:

1. Discuss the literature related to full coverage restoration and its effect on the periodontium.
2. Describe the clinical circumstances requiring an intracrevicular full coverage restoration.
3. Define the indications and contraindications for intracrevicular full coverage restoration.
4. Discuss the procedure for FCR.

The full-coverage restoration (FCR) and its effect on the periodontium have been controversial over the last half-century. This conflict relates to whether the margin of the FCR should be placed at or above the gingival crest, or into the gingival crevice. Clinicians and researchers alike have focused their attention primarily on the mechanistic aspects of fixed prosthetic design (i.e., marginal configuration and fit). Although marginal quality and form are factors in the fabrication of the FCR, they alone will not determine periodontal health and restorative success. What determines the success of the FCR is its ability to restore form and function to the masticatory system, without adversely affecting its biology. Each technical phase of treatment (i.e., tooth preparation, impression-taking, the provisional restoration, and the final restoration) must be performed within the limits of biologic adaptation. The literature review in this course discusses the scientific evidence regarding FCR margin placement and periodontal health.

1. Introduction
   
   
2. Restorative Dentistry Comes of Age
   
   
3. Supragingival VS. Subgingival
   
   
4. Periodontal Prosthesis
   
   
5. Crown Contour and Gingival Architecture
   
   
6. The Biologic Width
   
   
7. Intracrevicular Restorative Dentistry
   
   
8. Summary

1. Black GV. Operative dentistry. In: Pathology of the Hard Tissues of the Teeth. Vol 1. Chicago: Medico-Dental Publishing Company; 1908.
2. Gottlieb B, Orban B. Metal crowns. In: Diamond M, translator & ed. Biology and Pathology of the Tooth and Its Supporting Mechanism. New York, NY: Macmillan; 1938:117.
3. Loe H. Reactions of marginal periodontal tissues to restorative procedures. Int Dent J. 1968; 18:759-778.
4. Waerhaug J. Histologic considerations which govern where the margins of restorations should be located in relation to the gingiva. Dent Clin North Am. 1960; 5:161-176.
5. Stein RS, Glickman I. Prosthetic considerations essential for gingival health. Dent Clin North Am. 1960; 4:177-188.
6. Silness J. Fixed prosthodontics and periodontal health. Dent Clin North Am. 1980; 24:317-329.
7. Newcomb JG: The relationship between the location of subgingival crown margins and gingival inflammation. J Periodontol. 1974; 45:151-154.
8. Hunter AJ, Hunter AR. Gingival margins for crowns: a review and discussion. Part II: Discrepancies and configurations. J Prosthet Dent. 1990; 64:636-642.
9. Harrison JD. Crown and bridge preparation design and use. Dent Clin North Am. 1966; 10:185-193.
10. Marcum JS. The effect of crown marginal depth upon gingival tissue. J Prosthet Dent. 1967; 17:479-487.
11. Lang NP. Periodontal considerations in prosthetic dentistry. Periodontol 2000. 1995; 9:118-131.
12. Karlsen K. Gingival reactions to dental restorations. Acta Odontol Scand. 1970; 28:895-904.
13. Richter WA, Ueno H. Relationship of crown margin placement to gingival inflammation. J Prosthet Dent. 1973; 30:156-161.
14. Felton DA, Kanoy BE, et al. Effect of in vivo crown margin discrepancies on periodontal health. J Prosthet Dent. 1991; 65:357-364.
15. Preston JD. Rational approach to tooth preparation for ceramometal restorations. Dent Clin North Am. 1977; 21:683-698.
16. Valderhaug J. Periodontal considerations and carious lesions following the insertion of fixed prosthesis: A 10-year follow-up study. Int Dent J. 1980; 30:296-304.
17. Koth DL. Full crown restorations and gingival inflammation in a controlled population. J Prosthet Dent. 1982; 48:681-685.
18. Amsterdam M, Abrams L. Periodontal prosthesis. In: Goldman H, Cohen DW, eds. Periodontal Therapy. 4th ed. St. Louis, Mo: Mosby; 1964: 762-813.
19. Amsterdam M. Periodontal prosthesis: twenty-five years in retrospect. Alpha Omegan. 1974; 67:8-52.
20. Amsterdam M, Fox L. Provisional splinting—principles and techniques. Dent Clin North Am. 1959; 73-99.
21. Ochsenbein C, Ross S. A concept of osseous surgery and its clinical application. In: Ward HL, ed. A Periodontal Point of View. USA: Chas C Thomas; 1973.
22. Weisgold AS. Contours of the full crown restoration. Alpha Omegan. 1977; 70:77-89.
23. Weisgold AS, Feder M. Tooth preparation in fixed prosthesis: part I. Compend Contin Educ Dent. 1980; 1(6):375-383.
24. Weisgold AS, Feder M. Tooth preparation in fixed prosthesis: part II. Compend Contin Educ Dent. 1981; 2(1):34-46.
25. Garguilo AW, Wentz FM, Orban B. Dimensions of the dentogingival junction in humans. J Periodontol. 1961; 32:261-267.
26. Ingber JS, Rose LF, Coslet JG. The biologic width—a concept in periodontics and restorative dentistry. Alpha Omegan. 1977; 10:62-65.
27. Maynard JG, Wilson RD. Intracrevicular restorative dentistry. Int J Periodontics Restorative Dent. 1981; 1:35-49.
28. Kramer GM. Rationale of periodontal therapy. In: Goldman H, Cohen DW, eds. Periodontal Therapy. 6th ed. St. Louis, Mo: Mosby; 1980:378-400.