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ePaper created 2016-12-07, 11:04:42 | version 1.38.0
dentistry 4_2016 cosmetic 26 tion.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 remodeling 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 mod- ifying the gingiva in order to achieve an ideal gingival contour, and thereafter fabricating pro- visional restorations with a larger cervical con- vexity to remodel the gingiva. Once the gingival contour is stable and meets the requirement, the final restoration with the same transgingival contour is placed to maintain the gingival con- tour.19 According to the BTA approach, cutting part of the gingiva directly may damage the bi- ologic width; thus, the gingiva is stimulated to regrow. However, the larger labial cervical con- vexity 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 func- tion will develop and the gingival contour will be consistent with the shape of the restorations.19 In the BTA approach, the gingival–alveolar relation- ships are defined as 3-D biologic widths and the re lationship between the gingival contour and restorations is deemed to be a stable relation- ship.19 In the present case, the treatment proto- col differed from BTA; however, the outcome of the final restorations was similar. Both BOPT and BTA are creative aesthetic gingival treatment concepts that have been es- tablished 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 out- comes compared with the maxillary right central incisor, for which the restorative procedure was close to conventional restoration. Such a result encourages some consideration. Editorial note: A complete list of references is available from the publisher. L’articolo è stato pubblicato su Cosmetic Dentistry International, n. 1, 2016. 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. 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. Fig. 44 Fig. 45 Fig. 46 Fig. 47a Fig. 47b case report _ shaping the gingival contour