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ePaper created 2016-03-29, 15:23:51 | version 1.38.0
shaping the gingival contour case report | 15 cosmetic dentistry 1 2016 Inthiscase,thetreatmentprotocollaybetweenthe conceptofthebiologicallyorientedpreparationtech- nique (BOPT) and biological tissue adaptation (BTA), both of which have gained gradual acceptance. The BOPT approach suggests modification of the gingival contour by provisional restorations. Once the ideal gingival contour has been achieved, the gingival contourisreplicatedtothefinalrestorationsprecisely. The BOPT approach suggests finishing the tooth preparation without 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 prepared without a defined shoulder,thusfulfillingBOPT’srequirementsfortooth 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 remodelling the cemento-enamel junction. For the present case, the convexity of the final restorations was greater than that of the natural teeth and in that manner the current treatment protocol differed from BOPT. The BTA protocol suggests cutting and modifying the gingiva in order to achieve an ideal gingival con- tour, and thereafter fabricating provisional resto- rationswithalargercervicalconvexitytoremodelthe gingiva.Oncethegingivalcontourisstableandmeets the requirement, the final restoration with the same transgingival contour is placed to maintain the gin- gival contour.19 According to the BTA approach, cutting part of the gingiva directly may damage the biologic width; thus,thegingivaisstimulatedtoregrow.However,the larger labial cervical convexity of the provisional or final restoration will interfere with the regeneration of gingiva in the vertical direction. The gingiva will only be able to regenerate 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 IntheBTAapproach,thegingival–alveolarrelation- ships are defined as 3-D biologic widths and the relationship between the gingival contour and re- storations is deemed to be a stable relationship.19 In thepresentcase,thetreatmentprotocoldifferedfrom BTA; however, the outcome of the final restorations was similar. Both BOPT and BTA are creative aesthetic gingival treatment concepts that have been established in recent years. The protocol applied 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 better final aesthetic outcomes com- pared with the maxillary right central incisor, for whichtherestorativeprocedurewasclosetoconven- tional restoration. Such a result encourages some consideration._ Editorialnote:Acompletelistofreferencesisavailablefrom thepublisher. Fig. 43: One-week post-op photograph of the right lateral view of the patient’s smile. Fig. 44: The gingiva around teeth #21, 11 and 12 was healthier than the gingiva around any other teeth. The photograph was taken seven years after restorative treatment. Figs. 45 & 46: The seven-year follow-up showed that the gingiva of the anterior maxillary teeth was healthy. Figs. 47a & b: When comparing the seven-year post-op photograph (left) to the immediate post-op photograph (right), the gingival contour and position around teeth #21 and 12 were evidently stable. about Dr Feng Liu is a Clinic Professor and Vice Director of Clinical Division of Peking University School and Hospital of Stomatology. He is also the director of the Clinical Division Esthetic Dentistry Training Center. Fig. 43 Fig. 44 Fig. 45 Fig. 46 Fig. 47a Fig. 47b dentistry 12016