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ePaper created 2016-12-07, 11:04:42 | version 1.38.0
25 dentistry 4_2016 cosmetic other teeth. Around teeth #21 and 12, the gin- giva was healthy and the gingival contour was stable without noticeable gingival recession. Around tooth #11, slight gingival recession was found with slight reddening and swelling of the gingiva. However, the aesthetic outcome of the modified gingival contour had been main- tained (Figs. 44-47). _Discussion Shaping the transmucosal contour around implants using provisional crowns has been fre- quently 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 In this manner, the contour of the final resto- ration will fit the exact contour of the soft tis- sue, thus assuring the long-term stability of the shape and position of the soft tissue around the implant. In this case, the treatment protocol was drawn from the experience of the restorative process of implant-supported crowns. Taking ad- vantage of the relatively deep gingival sulcus and thick biotype, the gingival contours around the abutment teeth were modified by the provisional restorations; therefore, the gingival contour was reshaped in 3-D and the ideal aesthetic outcome was achieved. Throughout the relatively long-term fol- low-up period, the gingiva around the maxillary right lateral incisor and left central incisor with their larger transgingival depth and convexi- ty was quite stable. The stability of the gingiva around these two teeth was greater than around the maxillary 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 pro- tocol applied. In this case, the treatment protocol lay between the concept of the biologically ori- ented preparation technique (BOPT) and biolog- ical 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 contour is replicated to the final restorations precisely. 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, thus fulfilling BOPT’s requirements for tooth prepara- Fig. 40_One-week post-op photograph of the maxillary anterior teeth. Fig. 41_Frontal view of the patient’s smile after treatment. Fig. 42_One-week post-op photograph of the left lateral view of the patient’s smile. Fig. 43_One-week post-op photograph of the right lateral view of the patient’s smile. Fig. 40 Fig. 42 Fig. 41 Fig. 43 case report _ shaping the gingival contour