Verti prep. A case report

Tooth preparations for fixed prosthetic restorations can be accomplished using two different techniques: horizontal preparation, where the margin of the future restoration is defined, or vertical preparation, with or without a finishing line.
The Biologically Oriented Preparation Technique (BOPT) is a vertical preparation technique without a finishing line, aimed at creating a new anatomical crown with a redefined emergence profile.
In this case, we present a prosthetic technique for periodontally healthy teeth using vertical preparation, achieving high-quality clinical and aesthetic results in terms of soft tissue stability around the prosthesis in the short and long term.

style italiano styleitaliano rest position and smile

Fig.1
During the first appointment, a 30-year-old man presented seeking to improve the aesthetic of his smile. To perform a comprehensive facial analysis, we evaluated his resting position and his widest smile display.

style italiano styleitaliano old crowns and discolored tooth

Fig.2
The patient presented with two metal-ceramic crowns on both central incisors, which had undergone previous root canal treatments due to trauma. We discussed various treatment options and ultimately decided to begin with endodontic retreatment to address the periapical lesion. Afterward, we opted to replace the crowns on both teeth to improve aesthetics. A vertical preparation technique was used to conceal the dark root discoloration on tooth 21. External bleaching was applied to enhance the color of the remaining teeth, followed by the placement of feldspathic veneers spanning from tooth 15 to 22.

style italiano styleitaliano close up on old crowns

Fig.3
Close-up view for the analysis of the gingival margins and dark root discoloration.

style italiano styleitaliano abutments after removal of the old crowns

Fig.4
After removing the metal crown, we gently removed the metal post with a scaler to minimize mechanical stress on the tooth’s root.

style italiano styleitaliano metal post removal

Fig.5
After placing a rubber dam, we performed the retreatment of both teeth 11 and 21 (performed by Dr. Frederico Morais). We then proceeded with the build-up using a glass-fiber post and composite.

style italiano styleitaliano intensiv style indiretto burs

Fig.6
Styleitaliano and Intensiv collaborated to develop a set of burs, enabling us to conduct efficient and controlled vertical preparations.

style italiano styleitaliano intensiv burs styleINDIRETTO banner
style italiano styleitaliano intensiv burs styleINDIRETTO banner
style italiano styleitaliano vertical preparation for crown

Fig.7
The aim of this tooth preparation technique is to eliminate the emergence profile of the tooth’s crown anatomy and the preexisting finishing line. This enables the creation of a finishing area, within which the crown margin can be displaced coronally or apically, depending on how the provisional restoration is conceived.

style italiano styleitaliano vertical crown preparations

Fig.8
This dental preparation protocol was designed to facilitate the formation of a blood clot within the gingival sulcus during tooth preparation. Subsequently, this blood clot is captured by the provisional crown, which will later define the gingival limit. The healing process relies on the proliferation of fibroblasts, which aids in the reinsertion and thickening of the gingival tissue. This newly formed tissue will then adapt to the new emergence profile created by the provisional restoration.

style italiano styleitaliano provisional crowns

Fig.9
Modifying the temporary crowns to achieve an ideal emergence profile.

style italiano styleitaliano crown preparations side view

Fig.10
Lateral view showing healed keratinized gingiva around the prepared tooth (maxillary right central incisor).

style italiano styleitaliano smile with mock up

Fig.11
This is the mock-up placed in our patient’s mouth. We utilized Protemp 4 in color A1 for this procedure. During this appointment, it’s important to evaluate the patient’s expectations and obtain his approval regarding the new shape of their teeth.

style italiano styleitaliano bur for guided preparation

Fig.12
The first set of burs will determine the thickness of the veneers. Depending on the volume of the wax-up and the level of tissue preservation required, we select the most suitable burs for each case.

style italiano styleitaliano guide grooves during veneer preparation

Fig.13
Using a pencil, we marked the grooves created by the initial burs. This technique allows us to precisely control the depth of the preparation.

style italiano styleitaliano color match for layered zirconia crowns

Fig.14
Teeth prepared without finishing lines. Color selection.

style italiano styleitaliano try in of zirconia crowns

Fig.15
The optimal choice of ceramics for a BOPT technique is zirconia crowns, as it is extremely challenging to condition the tooth so deep in the sulcus for adhesion.

style italiano styleitaliano cementing ceramic veneers

Fig.16
We prepared for cementation of the feldspathic veneers by etching them with 10% Hydrofluoric acid for 60 seconds, followed by cleaning them with alcohol and orthophosphoric acid. Subsequently, we applied silane and heated it for 1 minute. On the tooth, we performed standard conditioning for dental adhesion and then applied Variolink Neutral LC for cementation.

style italiano styleitaliano after crown and veneer cementation

Fig.17
Final outcome.

style italiano styleitaliano view of ceramic veneers and crowns

Fig.18
Final outcome.

style italiano styleitaliano surface texture of lab work

Fig.19
Emergence profile of definitive prosthetic crowns.

style italiano styleitaliano before and after esthetic prosthodontic

Fig.20
Before and after cementation.

Conclusions

The BOPT technique, when compared to other preparation techniques such as chamfer or shoulder, is simpler and faster. The most crucial aspect of this technique is understanding how to fabricate the temporary crowns, as relining and creating the crown’s profiles will ultimately define the final prosthetic restoration.

Bibliography

  1. Walton TR. An up to 15-year longitudinal study of 515 metal-cera- mic FPDs: Part 2. Modes of failure and influence of various clinical characteristics. Int J Prosthodont. 2003;16:177-82.
  2. Pelaez J, Cogolludo PG, Serrano B, Lozano JF, Suarez MJ. A prospective evaluation of zirconia posterior fixed dental prostheses: three- year clinical results. J Prosthet Dent. 2012;107:373-9.
  3. Loi I, Di Felice A. Biologically oriented preparation technique (BOPT): a new approach for prosthetic restoration of periodontically healthy teeth. Eur J Esthet Dent. 2013;8:10-23.
  4. Agustin-Panadero R, Serra-Pastor B, Fons-Font A, Sola-Ruiz MF. Prospective Clinical Study of Zirconia Full-coverage Restorations on Teeth Prepared With Biologically Oriented Preparation Technique on Gingival Health: Results After Two-year Follow-up. Oper Dent. 2018;43:482-7.
  5. Gjelvold B, Chrcanovic BR, Korduner EK, Collin-Bagewitz I, Kisch J. Intraoral Digital Impression Technique Compared to Conventional Impression Technique. A Randomized Clinical Trial. J Prostho- dont. 2016;25:282-7.
  6. Fasbinder DJ. Digital dentistry: innovation for restorative treatment. Compend Contin Educ Dent. 2010;31 Spec No 4:2-11; quiz 2.
  7. Joda T, Bragger U. Patient-centered outcomes comparing digital and conventional implant impression procedures: a randomized crossover trial. Clin Oral Implants Res. 2016;27:e185-e9.
  8. Luthardt RG, Walter MH, Weber A, Koch R, Rudolph H. Clinical parameters influencing the accuracy of 1- and 2-stage impressions: a randomized controlled trial. Int J Prosthodont. 2008;21:322-7.

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