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found with slight reddening and swelling of the gingiva. However, theaestheticoutcomeofthemod- ified gingival contour had been maintained (Figs.44–47). Discussion Shaping the transmucosal con- touraroundimplantsusingprovi- sional crowns has been frequent- ly used in implant dentistry. By using an individualised transfer coping, the collar-like soft-tissue contour around an implant can be replicated on the working model accurately.3,16,17 Inthismanner,the contour of the final restoration will fit the exact contour of the soft tissue, thus assuring the long- term stability of the shape and position of the soft tissue around the implant. In this case, the treatment pro- tocol was drawn from the expe- rience of the restorative process of implant-supported crowns. Taking advantage of the relatively deep gingival sulcus and thick biotype, the gingival contours around the abutment teeth were modified by the provisional restorations; therefore, the gingi- val contour was reshaped in 3-D and the ideal aesthetic outcome was achieved. Throughout the relatively long- termfollow-upperiod,thegingiva around the maxillary right lateral incisor and left central incisor with their larger transgingival depth and convexity was quite stable. The stability of the gingi- va around these two teeth was greaterthanaroundthemaxillary right central incisor with its rela- tively shallow transgingival depth and smaller convexity. In addition, the gingiva was healthy, proving the effectiveness of the treatment protocol applied. In this case, the treatment pro- tocol lay between the concept of the biologically oriented prepara- tion technique (BOPT) and biolog- ical tissue adaptation (BTA), both of which have gained gradual ac- ceptance.TheBOPTapproachsug- gests modification of the gingival contour by provisional restora- tions. Once the ideal gingival contour has been achieved, the gingival contour is replicated to the final restorations precisely. The BOPT approach suggests fin- ishingthetoothpreparationwith- out a defined shoulder so that the gingival margin can be modified freely. In the present case, the maxillary right lateral incisor and maxillary left central incisor were preparedwithoutadefinedshoul- der, thus fulfilling BOPT’s require- ments for tooth preparation.18 However, for BOPT, the convexity of the final restoration should be similar to that of the natural teeth and could play a role in remodel- ling the cemento-enamel junc- tion. For the present case, the con- vexity of the final restorations was greater than that of the nat- ural teeth and in that manner the current treatment protocol differed from BOPT. The BTA protocol suggests cut- ting and modifying the gingiva in order to achieve an ideal gingival contour, and thereafter fabricat- ing provisional restorations with a larger cervical convexity to re- model the gingiva. Once the gingi- valcontourisstableandmeetsthe requirement, the final restoration with the same transgingival con- tour is placed to maintain the gingival contour.19 According to the BTA approach, cuttingpartofthegingivadirectly may damage the biologic width; thus, the gingiva is stimulated to regrow. However, the larger labial cervical convexity of the provi- sional or final restoration will in- terfere with the regeneration of gingiva in the vertical direction. The gingiva will only be able to re- generate along the contour of the restorations, and thus a gingival sulcus with a sealing function will develop and the gingival contour will be consistent with the shape of the restorations.19 In the BTA approach, the gin- gival–alveolar relationships are defined as 3-D biologic widths and the relationship between the gingival contour and restorations is deemed to be a stable relation- ship.19 In the present case, the treatment protocol differed from BTA; however, the outcome of the final restorations was simi- lar. Both BOPT and BTA are creative aesthetic gingival treatment con- cepts that have been established in recent years. The protocol ap- plied in the current study lay somewhere between these two approaches. After seven years of follow-up, the maxillary right lateral incisor and maxillary left central incisor demonstrated bet- ter final aesthetic outcomes com- pared with the maxillary right central incisor, for which the restorative procedure was close to conventional restoration. Such a result encourages some consid- eration. Editorial note: A complete list of refer- ences is available from the publisher. 13 Dental TribuneAsia Pacific Edition | 3/2016 TRENDS&APPLICATIONS Dr Feng Liu is a Clinic Professor and Vice Direc- tor of Clinical Division of Pe- king University School and Hos- pital of Stoma- tology.Heisalso the director of the Clinical Division Esthetic Dentistry Training Center. AD “In this case, the treatment protocol lay between the concept of the biologically oriented preparation technique (BOPT) and biological tissue adaptation (BTA), both of which have gained gradual acceptance.” DTAP0316_10-13_Liu 04.03.16 11:58 Seite 3 DTAP0316_10-13_Liu 04.03.1611:58 Seite 3