Gingival margin stabilization using the final prosthetic restoration (BOPT). A case report

Abstract

One of the most contentious and extensively discussed topics in the field of dentistry when fabricating prosthetic restorations is the location and design of the finishing line in relation to the gingival tissues. Upon completion of the temporary crown and subsequent fabrication of the final restoration, two potential issues may arise: 1) the analog or digital impression may not accurately reflect the shape of the gingiva obtained with the temporary crown due to gingival collapse upon crown removal, even in the presence of retraction cords; and 2) the desired gingival shape may not have been achieved with the temporary crown. The objective of this article is to describe the stabilization of gingival tissues following twelve weeks of clinical observation. During this period, the provisional crown is recontoured twice in the apical-coronal direction with a four-week interval. This approach allows for the growth of sufficient gingival tissue in the horizontal direction at the point of the vestibular emergence profile, which will then stabilize once more following a slight recontouring of the final restoration, which will be performed in the clinic. The amount of gingival adaptation is not quantifiable in a numerical sense; rather, it is directly proportional to the amount of tissue that can be obtained with the new emergence profile of the temporary crown. The outcome is contingent upon the operator and there is no fixed quantity that can be achieved in every instance. In essence, there is no fixed numerical value that can be relied upon to lower the gingival parabola in the apical-coronal direction through the adaptation of tissues to the new shape of the temporary crown emergence profile. Key words:Vertical preparation, BOPT technique, tissue stabilization, final restoration.

Figure 1

a-c) Initial clinical photos showing the apical displacements of the gingival tissue. d) Temporary bridge.

Figure 2

a) Scheme of the horizontal-vertical platform; b) Neo angiogenesis; c) Adaptation of the gingival parabola to the new emergence profile, reduction of gingival thickness in the horizontal direction; d) Amount of tissue that was obtained in a horizontal direction; e) The contour of the final prosthesis was lowered in an apical-coronal direction.

Figure 3

a) The bridge before ceramic recontouring; b) Juncture of ceramic recontouring; c) At 12 months, the gingival parabola adapts the to the new prosthetic shape, because there is adequate tissue availability in the horizontal direction; d and f) A symmetry is observed at the level of the gingival parabolas of 13 and 23; e) Juncture at which ceramic recontouring takes place; g) The first temporary bridge; h) Situation at 12 months.