Fixed Prosthetic Restorations and Periodontal Health: From Fabrication to Supracrestal Tissue Attachment Preservation and Clinical Outcomes

Background and Objectives: Periodontal health represents a condition characterized by homeostasis between the teeth and the surrounding supporting tissues and implies the absence of inflammation, confirmed by the lack of bleeding, epithelial attachment loss, mobility, or periodontal pocket formation. Fixed prosthetic restorations may compromise periodontal health already during the fabrication phase, given that decisions made during their planning and placement affect long-term clinical outcomes. The aim of this manuscript was to provide insight into the interaction between periodontal tissues and fixed prosthetic restorations. Materials and Methods: A narrative literature review was conducted using a structured search of the PubMed/MEDLINE, Scopus, and Google Scholar databases to identify studies addressing periodontal health in relation to fixed dental prostheses. The impacts of tooth preparation, gingival retraction methods, supracrestal tissue attachment, periodontal phenotype, crown emergence profile, and marginal fit of various biomaterials were analyzed. Results: According to the literature data, subgingival margin placement and violation of the supracrestal tissue attachment (biological width) induce chronic inflammation, loss of epithelial attachment, and alveolar bone resorption. Gingival retraction agents, used in chemomechanical retraction procedures, particularly ferric sulfate-based agents, may lead to a transient but significant spike in inflammatory markers and dysbiosis of the subgingival microbiome. Contemporary approaches, such as the biologically oriented preparation technique and the use of CAD/CAM (Computer-Aided Design and Computer-Aided Manufacturing) technology, may improve the precision of marginal fit. Zirconia restorations exhibit significantly better biocompatibility and reduced microbial adhesion compared to metal–ceramic restorations. Conclusions: Biological response of the periodontium to fixed prosthetic restorations depends on the complex interaction between the material, position of the marginal line, and oral hygiene control. Regardless of the material used or the fabrication technique employed, adequate plaque control and regular maintenance remain key factors in preserving periodontal health.