Enhancing Gingival Health and Stability Through Vertical Preparation Technique

A clinical case by our Community member Dr Stefano Conti

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

The design of finish lines for fixed prostheses can be categorized into several types: horizontal (including straight shoulder, bevel shoulder, curved chamfer, and flat chamfer), vertical (such as feather edge finish line), and without a defined finish line. The approach without a finish line is also referred to as the biologically oriented preparation technique (BOPT). In this method, instruments are used to eliminate the crown’s anatomic emergence profile at the cementoenamel junction (CEJ), creating a new prosthetic junction tailored to the gingival margin. This protocol aims to craft a new anatomical crown with a prosthetic emergence profile mirroring the natural tooth’s shape.

aidite style italiano styleitaliano
aidite style italiano styleitaliano
style italiano styleitaliano initial situation indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.1
A 57-year-old individual, presented with concerns regarding an unsatisfactory smile characterized by gingival inflammation and poor quality crowns. Upon clinical evaluation, a treatment plan was formulated to undertake a full mouth rehabilitation with a focus on enhancing aesthetics and restoring function.
Central to this tailored intervention is the integration of zirconia crowns, chosen for their durability and aesthetic versatility. Additionally, the plan incorporates vertical tooth preparation techniques and the BOPT concept, prioritizing gingival health and natural function alongside aesthetic enhancement.

style italiano styleitaliano Digital Smile Design DSD

Fig.2
The first phase entails Smile Design, a process aimed at redefining the dimension, shape, and position of the teeth, alongside achieving an ideal gingival architecture. This stage sets the groundwork for subsequent treatment steps, ensuring a tailored approach to meet the patient’s aesthetic and functional goals effectively.

style italiano styleitaliano Digital Smile Design DSD

Fig.3
Silicone guides are utilized to create mock-ups and temporary crowns in alignment with Digital Smile Design (DSD) principles. These guides serve as invaluable tools in visualizing and refining the proposed treatment plan, allowing for precise adjustments to achieve the desired aesthetic outcome.

style italiano styleitaliano Temporary crowns

Fig.4
Following Smile Design principles, temporary crowns are crafted to align with the envisioned aesthetic outcome. These temporary crowns serve as an essential intermediary step, providing a preview of the proposed final result and allowing for any necessary adjustments before the permanent restorations.

style italiano styleitaliano day 0 indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.5
On Day 0, the treatment commences with a comprehensive assessment, including probing and sounding to evaluate the periodontal condition and tooth structure.

style italiano styleitaliano Vertical tooth preparation

Fig.6
Vertical tooth preparation is performed, adhering to precise guidelines to ensure optimal compatibility with the planned restorations. This critical step lays the foundation for successful rehabilitation, facilitating proper alignment and stability of the final restorations within the oral environment.

style italiano styleitaliano The newly established gingival architecture

Fig.7
A thorough assessment of the newly established gingival architecture is conducted approximately one month later. This interval allows for the gums to settle and adapt to the temporary crowns. During this evaluation, any discrepancies or irregularities in the gingival contour are addressed to ensure optimal harmony with the temporary crowns.

style italiano styleitaliano Zirconia framework

Fig.8
Zirconia framework and controlled invasion of sulcus (biodynamic soft tissue shaping).
First, the zirconia framework is meticulously crafted and applied to evaluate the soft tissue adaptation.

style italiano styleitaliano Shaping of the soft tissue

Fig.9
A controlled invasion of the sulcus is conducted to initiate biodynamic soft tissue shaping. This process involves carefully manipulating the soft tissue around the prepared teeth to encourage natural gum recontouring and adaptation to the new framework.
By strategically shaping the soft tissue, a harmonious gingival contour was achieved that complement the planned restorations.

style italiano styleitaliano Aidite Zirconia framework indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.10
Zirconia framework (Aidite, China) and controlled invasion of sulcus.

aidite style italiano styleitaliano
aidite style italiano styleitaliano
style italiano styleitaliano BOPT concept indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.11
In this step, the zirconia framework was seamlessly done with the BOPT concept. This innovative approach involves positioning the new crown margin 0.5 mm apical to the free gingival margin, promoting superior tissue health and stability.
By adhering to BOPT principles, the long-term success of the restorations was ensured while prioritizing the overall health and resilience of the surrounding soft tissues.

style italiano styleitaliano Definitive zirconia indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.12
The definitive zirconia crowns are crafted to exact specifications.

style italiano styleitaliano Final crowns indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.13
Before placement, thorough verification procedures are conducted to assess fit, aesthetics, and functional alignment, ensuring that the final crowns meet the highest standards of excellence.

style italiano styleitaliano Final crowns indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.14
Final crowns.

style italiano styleitaliano Final situation indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.15
Details in the aesthetic zone with zirconia crowns and new healthy gingival architecture. The patient’s smile has undergone a remarkable transformation, characterized by diligent attention to detail within the aesthetic zone.

style italiano styleitaliano Final situation indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.16
The integration of zirconia crowns has not only restored dental aesthetics but has also contributed to the creation of a durable and visually pleasing dentition.

style italiano styleitaliano Final situation indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.17
Of notable significance is the cultivation of new, healthy gingival architecture, which enhances the overall aesthetic appeal and functionality of the treated area.

style italiano styleitaliano Final situation indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.18
This achievement underscores the efficacy of the BOPT approach, which prioritizes not only aesthetic outcomes but also the preservation of gingival health and natural function.

style italiano styleitaliano Final situation indirect restoration Vertical Preparation Technique Aidite zirconia crown DSD Digital Smile Design BOPT

Fig.19
Final situation.

Conclusions

Through a planned and executed treatment protocol, encompassing vertical tooth preparation, BOPT concept integration, and the utilization of zirconia crowns, this case exemplifies the transformative potential of modern dental techniques.
This successful outcome underscores the significance of a comprehensive approach to full mouth rehabilitation, one that prioritizes not only the restoration of dental structures but also the preservation of gingival health and natural function. It reaffirms the value of interdisciplinary collaboration and patient-centered care in achieving outstanding results in modern dentistry.

Bibliography

  1. Agustín-Panadero R, Solá-Ruíz MF. Vertical preparation for fixed prosthesis rehabilitation in the anterior sector. The Journal of Prosthetic Dentistry. 2015 Oct 1;114(4):474-8.
  2. Castelo-Baz P, Freire-Álvarez-Blázquez M, Pereira-Lores P, Álvarez-Nóvoa P, Dablanca-Blanco A, Miguéns-Vila R, Martín-Biedma B. Vertical preparation: a new technique for analogical and digital impressions. Journal of Clinical and Experimental Dentistry. 2023 Jul;15(7):e590.
  3. Agustín-Panadero R, Solá-Ruíz MF, Chust C, Ferreiroa A. Fixed dental prostheses with vertical tooth preparations without finish lines: A report of two patients. The Journal of prosthetic dentistry. 2016 May 1;115(5):520-6.

RELATED CASES

styleitaliano style italiano Indirect digital overlay deep subgingival cavity

Indirect digital overlay

From digital workflows to precise hand skills, ensuring long-lasting results is the ultimate goal for a good adhesive restoration.