Esthetic and Functional Rehabilitation: Retreatment of Anterior Fixed Dental Prothesis With Biologically Oriented Preparation Technique and Digital Workflow

Journal of Esthetic and Restorative Dentistry
CLINICAL ARTICLE OPEN ACCESS
Esthetic and Functional Rehabilitation: Retreatment of

Anterior Fixed Dental Prothesis With Biologically Oriented
Preparation Technique and Digital Workflow
Belén Morón-Conejo1 | Alfonso Gil2 | Mónica Bonfanti-Gris1 | Maria Paz Salido1 | Francisco Martínez-Rus1
1 Analysis of Techniques, Material and Instruments Applied to Digital Dentistry and CAD/CAM Procedures Research Group, University Complutense of
Madrid, Madrid, Spain | 2 Associate Faculty at University International of Catalunya and University of Southern California, Los Angeles, California, USA
Correspondence: Maria Paz Salido ([email protected])
Received: 28 October 2024 | Revised: 9 December 2024 | Accepted: 10 December 2024
Funding: The authors received no specific funding for this work.
ABSTRACT
Objective: This clinical case describes a multidisciplinary retreatment of a patient with anterior fixed dental prostheses (FDPs)
using minimally invasive restorations and a biologically oriented preparation technique (BOPT).
Clinical Considerations: A 56-year-old female patient, treated 30 years ago with a metal-ceramic FDP due to dental agenesis,
presented a misfit prosthesis at the gingival margin, black spaces, and food retention at the pontics. Notably, tooth number 2.6
was absent, and she exhibited a left crossbite. Her chief complaint was the compromised esthetics of her restorations. Given
her coagulation disorder, von Willebrand disease, she declined mucogingival surgery. A diagnostic wax-up and mock-up was
performed to establish treatment goals. The initial phase involved periodontal, orthodontic, and implant treatment. The ortho-
dontic treatment with aligners to correct the crossbite. Subsequently, bleaching and a second mock-up were conducted to guide
prosthetic treatment. In the prosthodontic treatment, the abutment teeth were prepared using a vertical BOPT to remodel the
gingival tissues, achieving the esthetic goal of repositioning the gingival margin without surgery. The provisional phase was
critical for soft tissue remodeling and ensured clinical success. After stabilization of the soft tissues, a monolithic zirconia FDP
was delivered, with a follow-up of 2 years.
Conclusions: A multidisciplinary treatment plan, utilizing a digital workflow, resulted in stable clinical and esthetic outcomes
at the two-year follow-up, effectively retreating an anterior bridge using BOPT in a patient with a coagulation disorder that con-
traindicated complex surgical interventions.
1   |   Objective feather, knife-edge, or no finish line, where the biologically ori-

ented preparation technique (BOPT) protocol among others
Fixed dental prosthesis (FDP) remains a common solution for re- [3–5]. A horizontal preparation is a clearly delineated line on the
storing damaged teeth, as well as for restoring their form, func- tooth, determined by the clinician, and reproduced in the im-
tion, and esthetics, or for replacing missing teeth [1, 2]. Various pression and working model. For many years, horizontal finish
tooth preparation techniques have been described for the fabri- lines have been the preparation of choice, demonstrating good
cation of FDP. These finish lines can be broadly classified into clinical survival of the restoration [6–9]. Regardless of whether
two main categories: (1) horizontal finish lines, which include the preparation is vertical or horizontal preparation technique,
chamfers or shoulders; and (2) vertical finish lines, which include ensuring both gingival margin adaptation and stability is crucial
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© 2024 The Author(s). Journal of Esthetic and Restorative Dentistry published by Wiley Periodicals LLC.
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for fixed dental restorations [10]. Apical migration of the gingiva compromised esthetics appearance and food retention with her
can result in unsatisfactory esthetics, which may be considered old restoration. She requested retreatment of a metal-ceramic
a major complication [3, 7, 11]. FDP placed 30 years ago due to dental agenesis. A diagnosis of
von Willebrand disease (vWD) was revealed through the pa-
The BOPT represents a protocol that includes a specific type tient's medical history. This coagulation disorder, characterized
of vertical tooth preparation, introduced to promote long-term by bleeding due to defects in von Willebrand factor (VWF),
periodontal tissue stability [3, 5, 12–14]. In this approach, the plays a crucial role in platelet adhesion to exposed subendothe-
tooth is prepared without a finishing line, and rotary curettage lial collagen at sites of vascular injury [19]. The most recent clin-
of the gingival sulcus is performed simultaneously. This results ical guidelines recommend the administration of concentrates
in bleeding in the area, which forms a blood clot that fills the or special medications prior to dental surgery, which were con-
area of the supracrestal attached tissue [10, 12, 15]. Immediate sidered in our treatment plan [19].
placement of an interim prosthesis, 0.5–1 mm subgingivally,
with a new prosthetic emergence profile, stabilizes the coag- Clinical evaluation revealed partial edentulism due to agenesia
ulum, which eventually matures into connective tissue. This in the following teeth: mandibular and maxillary third molars,
technique can potentially reshape the gingival contour of the right maxillary canine and lateral incisor, and left maxillary
teeth to achieve optimal gingival architecture. Close collabora- lateral incisor. The teeth right maxillary second molar and left
tion with the dental technician is essential to ensure the success maxillary first molar were absent due to dental caries. An old
of this approach. As it is a vertical preparation without a finish- FDP from the right maxillary first premolar to left maxillary
ing line, the new prosthetic margin can be placed in a finish- central incisor exhibited a misfit at the gingival margin level
ing area from the gingival margin to the bottom of the gingival of the abutments, with black spaces where the patient reported
sulcus, as originally described by Dr. Loi [5]. This allows for a food retention at the pontic level, and a rounded shape of the
significant increase in gingival thickness and long-term tissue central incisors (Figure 1). Periodontal assessment revealed
stability [4, 5, 16–18]. localized gingivitis, with no clinical attachment loss, but with
evidence of localized bleeding on probing. Radiographic exam-
This case report describes the replacement of an old and mis- ination revealed the absence of periapical or periodontal lesions
fitting metal-
ceramic FDP with a monolithic zirconia FDP (Figure 2). Occlusal analysis revealed a crossbite on the right
using BOPT and a minimally invasive approach. The treatment maxillary second molar and between the second and third quad-
was conducted alongside orthodontic treatment with aligners rants. Nevertheless, the patient did not report any discomfort in
and bleaching treatment, following a comprehensive digital the head or neck nor did she experience clicking or tenderness in
workflow. the temporomandibular joint (TMJ).
The treatment plan was discussed in detail with the patient,

2   |   Clinical Considerations emphasizing the necessity of a multidisciplinary approach.
The initial recommendation was for orthodontic treatment,
A 56-year-old female patient was referred to the restorative den- supported by a preliminary wax-up to demonstrate the need
tistry based in the New Technologies clinic of the University for correcting the occlusal crossbite and creatin an optimal
Complutense of Madrid. The patient's chief complaint was the prosthetic plan. The missing left maxillary first molar would
FIGURE 1    |    Initial clinical situation: (A) frontal photograph in occlusion; (B) initial situation of the anterior FDP in a frontal view; and (C) initial
situation of the anterior FDP in a lateral view.
2 of 10 Journal of Esthetic and Restorative Dentistry, 2024

FIGURE 2    |    Panoramic X-ray of the initial clinical situation.
be replaced with an implant-supported crown, achieving an designed (Dental System, 3Shape, Denmark). The zirconia
optimal occlusal plane and mesiodistal space for stable occlu- crown was cemented to the titanium abutment (Variobase
sion. To avoid corrective mucogingival surgery due to her co- WN, Straumann, Switzerland) with a resin cement (Multilink
agulation condition, the plan was to replace the existing FDP Hybrid Abutment, Ivoclar Vivadent, Liechtenstein) and sub-
with BOPT, aiming to reposition the gingival margin of the sequently placed, confirming the clinical and radiographic fit
prosthesis and the edentulous ridge. A six-month periodontal with a torque of 35 N.
maintenance program was proposed to ensure plaque control
and resolution of gingivitis before for annual maintenance.
The patient consented to the proposed plan. 2.2   |   Prosthodontic Treatment
Upon completion of the initial treatment phase and establishment

2.1   |   Periodontal, Orthodontic, and Implant of the new occlusal position, a novel esthetic diagnosis was con-
Treatment ducted (Figure 4A). In the lip-resting position, 1 mm of exposure
of the incisal edge of the right maxillary lateral and central inci-
The treatment began with the periodontal phase, during which sors and 2 mm of exposure of the incisal edge of the left maxillary
oral hygiene instructions were provided, and dental prophy- central incisor were observed (Figure 4B). In a social smile, the
laxis was performed to correct the gingivitis. The orthodontic patient exhibited a high smile line with near-complete exposure
phase was planned as a 12-month-long treatment using align- of the upper incisors and canines. In a lateral view, black spaces
ers (Invisalign Comprehensive, Align Technology, USA) to were still visible at the pontics level in the right maxillary lateral
achieve the desired correction of the occlusal plane, teeth, and incisor and canine positions (Figure 4C). In a wide and sincere
gingival margins alignment, and to establish optimal space smile, the high smile line was confirmed, showing ≥ 10 mm of
for the rehabilitation of the left maxillary first molar with an soft tissue exposure and a smile exposure from right to left max-
implant-supported crown (Figure 3A–F). Treatment was con- illary with engaged buccal corridors (Figure 4D).
ducted at both the maxillary and mandibular levels to achieve
stable occlusion. The teeth splinted by the previous FDP were A new set of digital impressions was taken (Trios 3, 3Shape,
used as reference points, as they showed no transverse occlu- Denmark) to create a diagnostic wax- up (Dental System,
sion alterations. After 10 months of orthodontic treatment, a 3Shape, Denmark), establishing new incisal edges and restor-
10-m illimeter (mm) mesiodistal space was obtained for an ative gingival margins (Figure 4A). The digital model with the
implant-supported crown in the left maxillary first molar po- wax-up was 3D printed (Formlabs 3B+, Formlabs, USA), and a
sition (Figure 3E). A digital wax-up was produced to guide the silicone index was used to create a direct clinical mock-up with
optimal prosthodontic position of the implant. The DICOM bis-acrylic resin (Structur, VOCO, Germany) (Figure 5B–D).
files obtained from a Cone Bean CT (CBCT) (Carestream, The diagnostic mock-up included the vestibular anatomical con-
USA) were overlaid with the STL digital models (Trios 3, version, such as the 2.3 to a 2.2 and the 2.4 to a 2.3. The patient
3Shape, Copenhagen) using the BlueSky Plan 4 software reported high levels of satisfaction with the esthetic outcome.
(BlueSky Bio, USA). A 4.8 × 8 mm tissue-level implant (WN However, she only consented to the replacement of the existing
SP, Straumann, Switzerland) was placed using a transmucosal FDP restorations. The occlusal pattern was adjusted and then
technique without flap elevation, minimizing surgical soft tis- transferred to the intraoral scanner to create the provisional
sue damage due to the patient's systemic condition. Following restoration.
the completion of orthodontic treatment after 3 months, the
implant achieved osseointegration. A digital impression of the The previous restorations were removed using preparation
implant position was obtained using a Medentika scan body burs, and periodontal probing was performed to measure
(Medentika, Germany), and a monolithic zirconia crown was the gingival sulcus depth, which determined the extent of
3 of 10
FIGURE 3    |    Orthodontic treatment sequence: (A) occlusal view of the maxillary diagnostic situation; (B) occlusal view of the mandibular diag-
nostic situation; (C) occlusal view of the maxillary jaw before the refinement treatment with clear aligners; (D) occlusal view of the mandibular jaw
before the refinement treatment with clear aligners; (E) occlusal view of the maxillary final situation after orthodontic treatment and implant place-
ment; and (F) occlusal view of the mandibular final situation after orthodontic treatment.
dental preparation (Figure 6A). The purpose of BOPT was maintained with the silicone index during polymerization to
to eliminate the pre-existing preparation of the finish line. acrylic resin to control any bleeding.
The internal wall of the sulcus and the tooth were concur-
rently prepared with a conical diamond bur (BOPT burs set, Once the acrylic resin had set, two margins were observed: the
Sweden&Martina, Italy) to create a smooth and refined ver- intrasulcular margin of the prepared teeth and the external
tical finish area, within which the crown margin could be margin of the gingival margin (Figure 6D). The space between
moved coronally [5, 12]. The intrasulcular preparation in- these margins was filled with fluid acrylic resin to form a new
volved the removal of not only the previous horizontal finish emergence for the FDP, stabilizing the soft tissue and promot-
line but also the epithelial tissue and junctional epithelium of ing maturation of tissue with a new angular component at a
the sulcus. This procedure was carried out without significant depth of 0.5–1 mm into the sulcus (Figure 6E). The primary
bleeding complications. objective of the interim FDP during this phase was to stabilize
and mature the blood clot formed after the abutment prepara-
In accordance with the diagnostic mock-up, the dental techni- tion, facilitating its eventual maturation into stable gingival
cian had previously fabricated a hollowed, milled PMMA in- tissue. The provisional profile effectively sealed the gingival
terim FDP with a contour that embraced the abutments 1 mm margin in the desired position. On the day of preparation,
supragingivally. The interim restoration served as an impression the emergence profile was nearly horizontal, allowing slight
tray for the accurate recording of the gingival sulcus following pressure to stabilize the blood clot, which was particularly
tooth preparation. (Figure 6B). Once the fit had been verified important given the patient's coagulation disorder. The right
and abutments isolated with glycerin, the interim FDP was re- maxillary lateral incisor and canine were defined as ovate
lined with acrylic resin (Sintodent C&B A2, Sintodent, Italy) and pontics to guide the soft tissue remodeling through targeted
placed using a silicone index to ensure the optimal positioning gingival pressure points. The interim FDP was temporarily
during the curing phase (Figure 6C). Constant pressure was cemented (TempBond NE, Kerr, Germany), and any excess

FIGURE 4    |    Novel prosthodontic and esthetic diagnosis after de completion of the first phase of the treatment: (A) frontal photograph in occlusion;
(B) lateral view of the social smile: the patient exhibited a high smile line; and (C) frontal view of the wide and sincere smile: soft tissue exposure of
≥ 10 mm and a smile exposure of 1.6–2.6.
FIGURE 5    |    Diagnostic mock-up with bis-acrilic resin: (A) digital diagnostic wax-up (dental system, 3shape, denmark); (B) lip-resting position
with the diagnostic mock-up; (C) social smile with the diagnostic mock-up; and (D) wide and sincere smile with the diagnostic mock-up.
cement material was carefully removed (Figure 6F). After a consisted of three files: (1) a digital impression of the interim
4-week maturation period, the provisional restoration was FDP in place; (2) a digital impression of the abutment teeth, with
redefined to reduce its width, adapt the angle of emergence special attention of capturing the internal aspect of the gingi-
at the gingival margins, open space for papillae, and further val sulcus and the finishing area; and (3) a digital impression of
shape the ovate pontics to apply pressure at the edentulous the interim FDP, capturing the prosthetic margin's depth and
area (Figure 7A–C). angulation. The superimposition of these digital files in the lab-
oratory allowed the technician to identify the location of the fin-
Final impressions were taken 10 weeks after teeth prepara- ish area, ensuring proper placement of the finishing line for the
tion, once the soft tissues had fully matured and stabilized in definitive restorations and achieving an ideal prosthetic contour
the desired position (Figure 8). The final digital impressions (Figure 9).
5 of 10
FIGURE 6    |    Abutments preparation and interim FDP relining following the BOPT: (A) teeth abutments after the remotion of the old metal-
ceramic restorations; (B) digital design of the hollowed milled PMMA interim FDP with a contour that follows the gingival margin; (C) silicone index
to assure the optimal position during the curing and relining of the interim FDP; (D) margins reading with the interim FDP relining: the intrasulcu-
lar margin of the prepared teeth and the external margin of the gingival margin; (E) relined interim with the new gingival contour, angular compo-
nent and insertion of 0.5–1 mm into the sulcus; (F) Interim FDP placed after the preparation of the abutment with the BOPT.
FIGURE 7    |    (A) Teeth abutments situation after 4 weeks of maturation of the soft tissues; (B) lateral view of the interim FDP after some morpho-
logical adjustments; and (C) frontal view of the interim FDP after some morphological adjustments.
A 3D-printed temporary resin FDP (GC Temp Print Medium, Excess cement at the gingival margin was thoroughly removed
GC, Japan) was created as a trial to check the fit, reproduction of both on the day of cementation and at the one-week follow-up. The
the prosthetic margins, occlusion, and esthetic parameters with patient was instructed in the correct oral hygiene techniques, in-
the patient (Figure 10). The definitive restoration was fabricated cluding the use of dental floss (Superfloss, Oral-B, USA).
from monolithic zirconia (ZirCAD Prime A2, Ivoclar Vivadent,
Liechtenstein) and cemented under partial isolation with dual- At the one-week follow-up, the soft tissues were completely
curing self-adhesive resin cement (Relyx Universal A1, 3 M, USA). adapted to the new prosthetic contours (Figure 11A,B). The

FIGURE 8    |    Teeth abutments and soft tissues fully matured and sta-
ble in the desired position after 10 weeks. FIGURE 10    |    3D-printed try-in with temporary resin (GC Temp Print
Medium, GC, Japan) of the definitive design and soft tissue adaptation.
at 6, 12, and 24 months following the placement of the definitive

prosthesis, with no mechanical, esthetic, or biological compli-
cations reported (Figures 12 and 13). Periodontal evaluation of
the tooth abutments showed probing depths ranging from 1 to
3 mm.
3   |   Conclusions
The optimal method for tooth preparation remains a topic of

debate within the scientific community. Both horizontal and
vertical preparation lines have been associated with a range of
advantages and disadvantages. The efficacy of vertical prepara-
tions has been investigated, demonstrating their effectiveness in
periodontal patients with up to 20 years of follow-up. The goal
was to avoid creating horizontal finishing lines at the root level
[8, 20]. Vertical preparation techniques, such as feather edge or
BOPT, have been shown to improve the marginal fit of resto-
rations and foster a favorable environment for long-term soft tis-
sue stability [3, 5, 11, 21, 22]. BOPT allows for the creation of a
new prosthetic contour located subgingivally within the sulcus,
without invading the epithelial junction, thereby guiding the
soft tissues while respecting the biological width, as illustrated
in this case report. This is achieved by considering esthetic pa-
rameters, such as gingival contours, the presence of the distal
zenith, and the closure of the interproximal spaces [23]. This is
possible due to the absence of horizontal finishing lines, which
forces the emergence of the restoration at a specific level.
The preparation of the interim prosthesis to guide this tissue

maturation for a minimum of 4 weeks, as originally described,
has been the subject of extensive study within this technique
[4, 5, 12]. However, new protocols are explored that shorten
FIGURE 9    |    Digital design of the monolithic zirconia FDP: (A) cross- these periods, with positive results observed in posterior regions
section of the files superimposition with the diagnostic mock-up and [21]. In cases with high esthetic demand, such as the case pre-
interim prosthesis; (B) superimposition of the diagnostic mock-up, the sented the role of the interim FDP is critical in guiding the gingi-
interim FDP and abutments impression; and (C) digital design of the val margins and zeniths of the teeth. Additionally, other vertical
final BOPT FDP. preparation techniques, performing gingitage, have been docu-
mented, showing favorable long-term outcomes following the
use of provisional restorations to control the novel prosthetic
patient's esthetic expectations were met, as evidenced by the im- contour during the tissue maturation process [11].
proved gingival adaptation of the new prosthesis, the closure of
the black spaces at the pontic level where food retention had pre- The apical migration of soft tissues around the margins of
viously occurred, and a reduction in gingival exposure during crowns or FDPs has long been a significant concern in restor-
the smile. This approach avoided the need for invasive surgical ative dentistry. Gingival recession is associated with various eti-
procedures. Subsequent follow-up evaluations were conducted ologic factors, including gingival biotype, chronic inflammation,
7 of 10
FIGURE 11    |    One-week follow-up of the definitive FDP: (A) gingival margin profiles of 1.1. and 2.1. with the definitive prosthesis; and (B) lateral
view of the definitive FDP with the new soft tissue contours.
FIGURE 12    |    Before and two-year follow-up of the prosthetic treatment: (A) frontal view before the prosthetic treatment; and (B) two-year follow-
up frontal view.
FIGURE 13    |    Panoramic X-ray at the two-year follow-up.
and inadequate prosthetic marginal fit [4, 7]. One of the primary involve certain limitations in the final esthetic result, based on
motivations for many patients seeking prosthetic retreatment the analysis of soft tissue levels.
is to address esthetic concerns related to gingival recessions.
Gingival recessions can be managed through mucogingival sur- BOPT has been extensively documented in clinical cases of re-
gery, which also facilitates the management of soft tissue vol- treatment, where the pre-existing preparation line is eliminated,
ume around adjacent pontics and the creation of pseudopapillae and a new gingival insertion is formed with new prosthetic emer-
[24, 25]. In consideration of the patient's systemic condition, it gence profiles [4, 5, 15]. In many cases, the prosthetic treatments
was determined that invasive surgical procedures involving sig- being replaced were metal-ceramics FDPs or crowns, which
nificant soft tissue hemorrhage, such as connective tissue grafts, have been shown to present higher probing depths and greater
should be avoided. The BOPT, when performed carefully and recession compared to zirconia frameworks in vertical prepara-
following accurate probing of the patient's gingival sulcus, rep- tions [6, 15, 21]. However, veneering zirconia frameworks with
resents a less invasive technique for achieving the desired out- ceramic has been associated with a notable increase in mar-
comes of improved gingival emergence profiles at the abutment ginal misfit, which is linked to an elevated risk of periodontal
and pontic levels [13]. Consequently, it was decided to manage problems and greater microleakage [26]. It can be reasonably
this case prosthetically, understanding that this approach would concluded that selecting monolithic zirconia as a restorative

material in direct contact with the gingival tissue, with superior 2. S. Sirous, A. Navadeh, S. Ebrahimgol, and F. Atri, “Effect of Prepara-
fit and tissue response, represents an optimal solution in such tion Design on Marginal Adaptation and Fracture Strength of Ceramic
clinical cases [9, 21]. Occlusal Veneers: A Systematic Review,” Clinical and Experimental
Dental Research 8 (2022): 1391–1403, https://doi.org/10.1002/cre2.653.
The vertical preparation technique without a finishing line, as 3. C. Abad-Coronel, J. Villacís Manosalvas, C. Palacio Sarmiento, J.
described in the BOPT, has some limitations. These include Esquivel, I. Loi, and G. Pradíes, “Clinical Outcomes of the Biologically
Oriented Preparation Technique (BOPT) in Fixed Dental Prostheses: A
the technique's inherent complexity and the additional time
Systematic Review,” Journal of Prosthetic Dentistry 132 (2024): 502–508,
required for clinical implementation. It is crucial for the clini- https://doi.org/10.1016/j.prosdent.2 022.07.010.
cian to have precise control over the preparation technique, the
handling of the interim relining phase, and the management of 4. R. Agustín-Panadero, B. Serra-Pastor, A. Fons-Font, and M. Solá-
Ruíz, “Prospective Clinical Study of Zirconia Full- Coverage Resto-
the prosthetic contours to ensure clinical success. Moreover, the
rations on Teeth Prepared With Biologically Oriented Preparation
technique requires a proper understanding of the protocol by the Technique on Gingival Health: Results After Two-Year Follow-Up,” Op-
laboratory technician [5, 23]. Although the technique was ini- erative Dentistry 43 (2018): 482–487, https://doi.org/10.2341/17-124-C.
tially described using silicone impressions and the manipulation
5. I. Loi and A. Di Felice, “Biologically Oriented Preparation Technique
of definitive restorations on cast models, novel digital protocols
(BOPT): A New Approach for Prosthetic Restoration of Periodontically
are being introduced [16, 17, 27]. Further clinical studies are re- Healthy Teeth. Eur,” Journal of Esthetic Dentistry 8, no. 1 (2013): 10–23.
quired to evaluate and compare the two working methods with
6. I. Sailer, N. A. Makarov, D. S. Thoma, M. Zwahlen, and B. E. Pje-
this specific technique, providing deeper insights into the long-
tursson, “All-Ceramic or Metal-Ceramic Tooth-Supported Fixed Dental
term outcomes. Prostheses (FDPs)? A Systematic Review of the Survival and Compli-
cation Rates. Part I: Single Crowns (SCs),” Dental Materials 31 (2015):
In such multidisciplinary cases, long-term follow-up is essential 603–623, https://doi.org/10.1016/j.dental.2 015.02.011.
for monitoring the stability of the soft tissues, occlusion, and res-
7. G. Paniz, J. Nart, L. Gobbato, A. Chierico, D. Lops, and K. Michal-
torations. At the two-year follow-up, the patient exhibited stable akis, “Periodontal Response to Two Different Subgingival Restorative
gingival margins, optimal integration of the dental restorations, Margin Designs: A 12- Month Randomized Clinical Trial,” Clinical
and high satisfaction with the esthetic and functional outcomes. Oral Investigations 20 (2016): 1243–1252, https://doi.org/10.1007/s 0078
4-015-1616-z.
Through meticulous diagnostic planning, incorporating a 8. G. Di Febo, A. Bedendo, F. Romano, F. Cairo, and G. Carnevale, “Fixed
full digital workflow and orthodontic treatment, along with Prosthodontic Treatment Outcomes in the Long-Term Management of
minimally invasive implant surgery and advanced restorative Patients With Periodontal Disease: A 20-Year Follow-Up Report,” Inter-
techniques following BOPT, a successful clinical and esthetic national Journal of Prosthodontics 28 (2016): 246–251, https://doi.org/
outcome was achieved. At the two- year follow-
up, minimal 10.11607/ijp.3995.
complications were observed in the retreatment of a patient 9. S. Shihabi and B. R. Chrcanovic, “Clinical Outcomes of Tooth-
with severe gingival recession. Soft tissue management was ef- Supported Monolithic Zirconia vs. Porcelain-Veneered Zirconia Fixed
fectively performed without the need for advance surgical in- Dental Prosthesis, With an Additional Focus on the Cement Type: A
tervention, due to the patient's blood coagulation disorder as a Systematic Review and Meta-A nalysis,” Clinical Oral Investigations 27
(2023): 5755–5769, https://doi.org/10.1007/s 00784 -023-05219- 4.
systemic condition.
10. D. Palombo, M. Rahmati, F. Vignoletti, et al., “Hard and Soft Tissue
Healing Around Teeth Prepared With the Biologically Oriented Prepa-
ration Technique and Restored With Provisional Crowns: An In Vivo
Acknowledgments Experimental Investigation,” Journal of Clinical Periodontology 50
The authors thank Sr. Christian Castaño, dental lab Dental Evolution (2023): 1217–1238, https://doi.org/10.1111/jcpe.13825.
(Madrid, Spain), for the support with prosthetic treatment of the patient 11. F. Scutellà, T. Weinstein, G. Zucchelli, T. Testori, and M. Del Fabbro,
and the technical support. “A Retrospective Periodontal Assessment of 137 Teeth After Feather-
edge Preparation and Gingittage,” International Journal of Periodontics
Disclosure and Restorative Dentistry 37 (2017): 791–800, https://doi.org/10.11607/
prd.3274.
The authors have nothing to report.
12. R. Agustín-Panadero, M. F. Solá-Ruíz, C. Chust, and A. Ferreiroa,
“Fixed Dental Prostheses With Vertical Tooth Preparations Without
Conflicts of Interest
Finish Lines: A Report of Two Patients,” Journal of Prosthetic Dentistry
The authors declare no conflicts of interest. 115 (2016): 520–526.
13. F. Galli, M. Deflorian, and G. Zucchelli, “The Biologically Oriented
Data Availability Statement Preparation Technique (BOPT) Approach for Preventing Gingival Re-
cessions in Fixed Prosthodontics,” International Journal of Esthetic Den-
The data that support the findings of this study are available on request
tistry 9 (2024): 112–124.
from the corresponding author. The data are not publicly available due
to privacy or ethical restrictions. 14. A. Al-Haddad, N. A. A. Arsheed, A. Yee, and S. Kohli, “Biological
Oriented Preparation Technique (BOPT) for Tooth Preparation: A Sys-
tematic Review and Meta-A nalysis,” Saudi Dental Journal 36 (2024):
References 11–19, https://doi.org/10.1016/j.sdentj.2 023.10.0 04.
1. J. Tanner, H. Niemi, E. Ojala, M. Tolvanen, T. Närhi, and J. Hjerppe, 15. B. Serra-Pastor, N. Bustamante-Hernández, A. Fons-Font, M. Fer-
“Zirconia Single Crowns and Multiple-Unit FDPs—An up to 8 -Year nanda Solá-Ruíz, M. Revilla-L eón, and R. Agustín-Panadero, “Peri-
Retrospective Clinical Study,” Journal of Dentistry 79 (2018): 96–101, odontal Behavior and Patient Satisfaction of Anterior Teeth Restored
https://doi.org/10.1016/j.jdent.2 018.10.012. With Single Zirconia Crowns Using a Biologically Oriented Preparation
9 of 10
Technique: A 6-Year Prospective Clinical Study,” Journal of Clinical
Medicine 10 (2021): 3482, https://doi.org/10.3390/jcm10163482.
16. T. Rinaldi, A. Santamaría-Laorden, J. Orejas Pérez, L. Godoy Ruíz,
C. Serrano Granger, and C. P. Gómez, “Periodontal Healing With Fixed
Restorations Using the Biologically Oriented Preparation Technique
Combined With a Full Digital Workflow: A Clinical Case Report,”
Health 11 (2023): 1144, https://doi.org/10.3390/healthcare11081144.
17. T. Andrea, L. M. Giolanta, and P. R. Roberto, “Biologically Oriented
Preparation Technique Through a Digital Workflow, a Case Report Part
1,” Journal of Esthetic and Restorative Dentistry 36 (2024): 1657–1665,
https://doi.org/10.1111/jerd.13318.
18. A. Mohammad, S. Abraham, and A. Nada, “The Effect of Biolog-
ically Oriented and Subgingival Horizontal Preparation Techniques
on Periodontal Health: A Double-Blind Randomized Controlled Clin-
ical Trial,” Saudi Dental Journal 35 (2023): 727–733, https://doi.org/10.
1016/j.sdentj.2 023.0 6.0 03.
19. P. James, F. Leebeek, C. Casari, and D. Lillicrap, “Diagnosis and
Treatment of von Willebrand Disease in 2024 and Beyond,” Haemo-
philia 30 (2024): 103–111, https://doi.org/10.1111/hae.14970.
20. M. Amsterdam, “Periodontal Prosthesis. Twenty-Five Years in Ret-
rospect,” Alpha Omegan 67 (1974): 8–52.
21. M. Gonzalez-Bonilla, S. Berrendero, B. Moron-Conejo, F. Martinez-
Rus, and M. Salido, “Clinical Evaluation of Posterior Zirconia-Based and
Porcelain-F used-to-Metal Crowns With a Vertical Preparation Tech-
nique: An up to 5-Year Retrospective Cohort Study,” Journal of Dentistry
148 (2024): 104953, https://doi.org/10.1016/j.jdent.2 024.104953.
22. M. Comlekoglu, M. Dundar, M. Ozcan, M. Gungor, B. Gokce, and C.
Artunc, “Influence of Cervical Finish Line Type on the Marginal Ad-
aptation of Zirconia Ceramic Crowns,” Operative Dentistry 34 (2009):
586–592, https://doi.org/10.2341/08-076-L .
23. A. Di Felice, C. Abad-Coronel, V. Giovane, I. Loi, and G. Pradies,
“The Importance of Esthetic Integration Through Laboratory Adapta-
tion Profiles in the Biologically Oriented Preparation Technique,” Inter-
national Journal of Esthetic Dentistry 17 (2022): 76–87.
24. M. Marzadori, M. Stefanini, C. Mazzotti, S. Ganz, P. Sharma, and
G. Zucchelli, “Soft-Tissue Augmentation Procedures in Edentulous Es-
thetic Areas,” Periodontology 2018, no. 77 (2000): 111–122, https://doi.
org/10.1111/prd.12210.
25. M. Patel, A. Guni, L. Nibali, and R. Garcia-Sanchez, “Interdental
Papilla Reconstruction: A Systematic Review,” Clinical Oral Investiga-
tions 28 (2024): 101, https://doi.org/10.1007/s 00784 -023-05409- 0.
26. K. Torabi, M. Vojdani, R. Giti, M. Taghva, and S. Pardis, “The Effect
of Various Veneering Techniques on the Marginal Fit of Zirconia Cop-
ings,” Journal of Advanced Prosthodontics 7 (2015): 233–239, https://doi.
org/10.4 047/jap.2 015.7.3.233.
27. I. García-Gil, C. Perez De La Calle, C. Lopez-Suarez, P. Pontevedra,
and M. Suarez, “Comparative Analysis of Trueness Between Conven-
tional and Digital Impression in Dental-Supported Fixed Dental Pros-
thesis With Vertical Preparation,” Journal of Clinical and Experimental
Dentistry 12 (2020): e896–e901, https://doi.org/10.4317/jced.56967.

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