CLINICAL RESEARCH

Biologically oriented preparation

technique (BOPT): a ne\A/ approach
for prosthetic restoration of
periodontically healthy teeth
Ignazio Loi, MD, DDS
Private Practice, Cagliari, Italy

Antonello Di Felice, CDT

Private Practice, Rome, Italy

Correspondence to: Dr Ignazio Loi

Via Alghero 4, 09127, Cagliari, Italy;

Tel: +39 070 670365; E-mail: loi.igiatiscali-it

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Abstract terior areas with ceramomefal and zirco-

nia resforafions, achieving high quality
Tooth preparations for fixed prosthetio clinical and esthefic results in ferms of
restorations can be done in different soff fissue sfabilify af the prosfhefic/fis-
ways, basically of two kinds: preparation sue interface, both in fhe short and in
with a defined margin and fhe so-oailed the long term (clinical follow-up up to
verticai preparation or feather edge. The fifteen years). Moreover, the BOPT tech-
latfer was originaiiy used for prosfhefics nique, if compared to other preparation
on feeth treafed wifh resective surgery techniques (chamfer, shoulder, etc), is
for periodontai disease, in this article, simipler and faster when in preparation
the aufhor presents a prosthetic tech- impression taking, temiporary crowns'
nique for periodonfaliy heaifhy feeth relining and creating the crowns' profiles
using feather edge preparation in a flap- up to the final prosthetic restoration.
less approach in both esthefic and pos- (Eur J Esthet Dent 2013;8:1O-23)

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Introduction Horizontal preparations are preferred

when clinical and anatomical crown
One of the main clinical complications in coincide and there is good periodontal
fixed prosthodontics on natural teeth is health. Prosthetic margins are located
the unsatisfactory esthetic result due to near the cementoenamel junction (CEJ).
the apical nnigration of the gingival mar- Preparations without finish lines are
gin.12 more conservative and are used when
The tendency of the gingival margin the clinical crown does not coincide with
to migrate apically in time, is related to the anatomic crown for the loss of sup-
different factors: port due to periodontal disease. In these
• Inadequate quality and quantity of cases, the crown's margin is located on
keratinized gingiva (thin biotypes are the root area.6-10
more likely to have recessions). The difference between horizontal
• Reaction to a trauma during pros- and vertical preparations is that in the
thetic work (preparation, gingival first ones the margin is positioned by the
retraction). dentist and leaves a well-defined line on
• Chronic inflammation due to pros- the tooth, which is then replicated in the
thetic errors (technical problems like impression and the working model. This
open margins, violation of the biolog- is probably the reason that has made
ical width, horizontal overcontour). prosthodontists prefer horizontal prep-
• Trauma due to inadequate tooth arations. For vertical preparations, the
brushing. margin is positioned by the laboratory
technician based on the gingival tis-
Among factors related to restorative sue information. For the absence of a
procedures one is particularly relevant: well-defined line, for the difficulties in
preparation technique and the corre- obtaining good esthetic results, for the
sponding geometry of the finish line. possible risk of distortion of the metallic
Traditionally, there are two types of margin during porcelain firing and func-
dental preparations:^ preparations with tional load and for the resulting "over
finishing lines, also called horizontal; contour," some authors have considered
and preparations without finishing lines, this preparation a possible cause of in-
described as feather edge. flammation and gingival recession."! "'"'2
Even if there is no universally accept-
ed classification, in time different types BOPT
of preparations and margin definitions
have been proposed:4.5 Clinical advantages:
• Shoulder. • Erasure of anatomical cementoe-
• Shoulder with bevel. namel junction (CEJ) in unprepared
• Inclined shoulder (5O degrees and teeth and deletion of the previously
135 degrees). existing finish lines in already pre-
• Chamfer. pared teeth.
• Chamfer with bevel. • The possibility to position the final
finish line at different levels, either

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Fig l a The prosthetic crown on the left central Fig 1 b A thorough periodontai probing is made to
Incisor needs to be replaced. Note the asymmetry of "map" the intrasuicular space.
the crown's dimension and gingival margin's archi-
tecture.

more coronally or more apically, BOPT technique

within the gingival sulcus (controlled
description
invasion of sulcus), without affecting
the quality of marginal adaptation of
Preparation
the restoration.
• The possibility to modulate the crown Before starting the procedure, an accu-
emergence profiles to create the rate intrasuicular mapping is made with
ideal esthetic gingival architecture a periodontai probe in order to assess
(adaptive forms and profiles). In this the level of the epithelial attachment
way, a new prosthetic cemientoe- (Figs 1a and 1b). If the tooth is intact,
namel junction (PCEJ) will be cre- the initial phase is the preparation of the
ated.15,16 extragingival part of the tooth using a
• Saving of dental structure. diamond flame shaped bur (100/1 20 mi-
• Easy and fast to execute. cron granulometry). Then the intrasuicu-
• Ease in relining and finishing tempor- lar preparation is started by entering the
ary cro\A/ns. sulcus with the bur tilted obliquely, so
• Ease in impression taking. that it cuts with its belly and not with the
tip, working at the same time on the tooth
Biological advantages: and gingiva (gingitage technique) and
• Increase in gingival thickness. connecting this preparation plane with
• Increased stability of the gingival the axial one, into a single and even ver-
margin over timie. tical surface (finishing area) (Fig 2). In
• Possibility to coronalize the gingival this way, the existing CEJ is erased and,
margin by remodeling emergency in prepared teeth, the same is done with
profiles. existing finishing lines. The bur interacts

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Fig 2 With a 120 microns grit flame shaped bur, Fig 3 The tooth surfaoe is then smoothed with a
the existing chamter preparation is eiiminated, leav- 30 microns grit bur. Note the intrasulcular bleeding
ing a margin-free surfaoe. due to the intentional "gingitage" procedure. The
blod olot formation will initiate the gingival tissue
biologio response, guided by the crown's profile.

Fig 4 The hollowed temporary crown is tried on Fig 5 The temporary crown is relined with self-
the abutment. curing methacrylate resin.

at the same time with the sulcular inter- the dental anatomy or any pre-existing
nal wall and with the epithelial compo- preparation margin. This \/v\\\ allow the
nent of the gingival attachment. While creation of a finish area within which the
the gingitage technique proposed by In- crown margin can be moved coronally.
graham using a chamfer bur, 1314 leaves The final step of the preparation is refin-
a neat finish line and is intended only ing the entire surface with a 20-micron
to open the sulcus and help in impres- diamond bur to smooth out the surface
sion taking, with BOPT the purpose is (Fig 3).
to eliminate the emerging component of

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Temporary crown relining

Based on a diagnostic wax-up, the

technician has previously prepared a
hollowed acrylic crown \A/ith a contour
that follows the gingival margin. After
verifying the fit (Fig 4), the crown is re-
lined with cold cure metacrylate resin
after isolating the abutment with glyc-
erin (Fig 5). Once it has set, the crown
clearly shows two distinct margins: a
thin internal one, which reads the in-
Fig 6 Slightly before the finai setting of the resin,
trasulcular part of the prepared tooth, the crown is removed from the abutment.
while the thicker external one follows
the external portion of the gingival mar-
gin. The space between the two mar-
gins is the negative image of the gin-
giva (Figs 6 and 7).
The space between the two portions
will be filled with fluid acrylic resin or
with a light cured flowable composite
resin to thicken the coronal margin and
allow the creation of the crown contour
(Figs 8a—8c). The excess material is re-
moved, connecting the crown margin
with the coronal profile at the gingival
margin (Fig 9). In this way, a new angu-
lar component will be formed together
with a ne\A/ CEJ that will be positioned in
Fig 7 Details of the relined orown's margin: the
the sulcus, no deeper than 0.5 to 1 mm, thin internai intrasulouiar wali and the thicker exter-
fully respecting the biologic width (con- nal one delimit the negative image of the gingival
profile.
trolled invasion of the gingival sulcus)
(Fig 10).
After an accurate polishing, the crown
is cemented and the excess cement ma-
terial is easily removed.
As previously stated, gingitage prep- tially, allo\A/ing the clot stabilization into
aration, together with the reduction of a fully structured gingival tissue (clot
the tooth, will create a space that will be preservation). The healing process will
filled by a clot resulting from intrasulcu- determine the reattachment and thick-
lar bleeding. The intrasulcular portion of ening of the gingival tissue, which will
the temporary crown's margin will sup- mold and adapt to the new emergence
port the gingival margin circumferen- profile (Figs 1 1 a—11 e).

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Fig 8 The space between the two walls is filled

either with a flowable light-cure composite (a} or
a fluid mix of acrylic resin fb) After the setting, the
internal nnargin is evidenced with a sharp pencil f c ) .

Fig 9 The excess resin is trimmed away with a Fig 1 0 The finished and polished crown that in-
paper disc and the emergence profile is shaped in corporates the new CEJ with a new angular compo-
order to support the gingival margin. nent of the emergence profile.

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Fig 11 After 4 weeks the blood clot, protected by the crown's margin, has developed into new connective
tissue and appears thickened and healthy, but still in maturation f a - c ) . Now the reshaping of the gingival
margin can start. The crown's margin is shortened, mirroring the contour of the adjacent tooth fd). Within
one more week the gingival margin moves in a coronal direction and the ideal scalloped architecture is
completed fe).

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Impression teohnique area between the two lines, the black

and the blue ones, is called the "finish-
After a minimum of 4 weeks, the gingival ing area" and the technician will mark
tissue will be stabilized and it will be the "finishing line" with a red pencil, on
possible to take the impression to final- which will fall the coronal margin (Fig 13).
ize the restoration. The absence of any Positioning this line more apically or
finish line will make the procedure faster coronally will depend on the depth of
and simpler The use of two retraction the sulcus and on the esthetic needs,
cords is strongly suggested in order to but the crown margin will never invade
have a good reading of the sulcus and the epithelial attachment. The red line is
to help the technician during laboratory now the reference margin for the ditch-
procedures. ing procedure and for eliminating the
underlying unuseful segment.

Laboratory prooedures As opposed to what other authors

have proposed for restorations \A/ith
The development of the impression will feather edge preparations,15,16 the
allow the technician to identify the fin- BOPT technique introduces a new con-
ish area on the working model. Since cept based on an observation that it is
an improved control over the gingival the gingival profile that adapts itself in a
levels is needed before exposing the specular way to the coronal emergence
finishing area, a black mark is traced profile and not the opposite (adaptation
with a 0.5 mm pencil over the gingival forms and profiles concept).
contour projecting it on the abutment's Based on this concept, the creation
wall (black line). of the profiles is done on the master cast
Afterwards, the gingival part around without the gingival component, creat-
the abutment is removed, showing the ing a morphofunctional and esthetic
subgingival area of the preparation re- ideal contour (Fig 14). The prosthetic
produced on the model (Fig 12). The restoration is then transferred on the
apical part of the model is now exposed model with the gingiva (Figs 15a—15e)
and it will be marked with a blue line. The to evaluate the contours tridimensional-

Fig 1 2 The biack line projects the gingivai margin Fig 1 3 Markings of the thee lines in the finishing
on the abutment. Then the gingiva is removed to ex- area and ditching of the abutment.
pose the finishing area as recorded in the impression.

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Fig 1 4 First ceramic bake on the master model without the gingival anatomy.

Fig 1 5 The crown contours, esthetioally shaped, cannot be seated on the "anatomic" model reproducing
the gingiva (a). With a scalpel the technician removes the interferences until the crowns are fully seated
(b). Filling with ceramic the new parabolic volume (c and d). The new contours finished and polished fe}.

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ly. In order to fit the crown on the model,

the technician removes any small inter-
ference with the marginal gingiva using
a sharp scalpel, simulating the interac-
tion bet\A/een the prosthetic contours
and the gingiva that exists in vivo with
the oral tissuesi7-i9 (Figs 16-18).

Discussion
The results achieved in the last 15 years
Fig 16 The case before treatment.
with the BOPT technique allow the au-
thors to make some clinical and biologi-
cal considerations.
The coronal seal is definitely better on
feather-edge preparations than on hori-
zontal ones. This is due, as it has been
demonstrated by many authors,20-22 ^
the decreased space between the teeth
and crown as a result of vertical geom-
etry. It results in a better fit, a lesser ce-
ment exposure and a diminished bac-
terial penetration.
Some authors have also demonstrat-
ed that a bad periodontal response de-
pends more on a poor crown's margin
Fig 17 The case completed.
adaptation rather than on the placement
of the finishing margin inside the gingival
sulcus.23,24
This result confirms that margins can
be placed within the sulcus and the
BOPT efficacy is based on this. The oth-
er fundamental concept is that the finish
line of horizontal preparations is located
on the prepared tooth, while the finish
line is the prosthetic cro\A/n's margin itself
in the BOPT technique. This margin can
be shortened or extended both in the
temporary or final restoration at differ-
ent intrasulcular levels, without harming
Fig 1 8 The patient's smile.
the quality of fit and without invading the
epithelial attachment because the finish

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Fig 1 9 Another case before treatment. Fig 2 0 The restoration completed in close up.

Fig 2 1 The pre-treatment situation of a case where Fig 2 2 Master model with the finished crown be-
new crowns on natural abutments are planned to- fore delivery to the patient.
gether with implant-supported restorations.

Fig 2 3 Ocolusal view before crowns' cementa- Fig 2 4 Clinical aspect of the finished case.
tion. The same prosthetic concepts are applied to
both natural and implant abutments and generate the
same thickening effect on buccal gingival tissues.

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area is always located above it (con- dentistry in the implant BOPT (IBOPT)
trolled invasion of the gingival sulcus). through the implementation of a shoul-
With the BOPT technique it is possible derless abutment design.26 The IBOPT
to transfer the emergent anatomy to the abutment has no finish line and it is the
prosthetic crown. This allows a free in- buccal gingival margin of the crown to
teraction with the gingiva that will adapt, create the soft tissue form. The reduced
shape and settle around new forms and buccal width of the abutment gives more
profiles (adaptation forms and profiles space to the gingival thickness and pro-
concept). Apparently, the cro\A/n's con- motes stability (Figs 20-24).
tours obtained with the BOPT technique
may appear excessively pronounced,
based on the traditional definition of Conclusions
"overcontour". It is the authors' opinion
that this concept should be reinterpret- In 15 years of clinical experience, the
ed. In fact, there is no consensus on \A/hat BOPT technique has proven success-
a "normal" contour should be. Sorensen ful in maintaining stability of pericoronal
suggested that a vertical contour up to soft tissues in both anterior and poster-
45 degrees can be still considered as ior areas, in both natural teeth and im-
normal.25 Based on the authors' experi- plants. With the BOPT technique, the
ence, there is no absolute overcontour, clinician and the laboratory technician
but instead different new contours and can interact 'with the surrounding tissues
new PCEJs. modifying their shape and scalloped
In contrast to what other authors sug- architecture regardless of any preexist-
gest,"i "'•''2 in most BOPT cases it is very ing dental or gingival limitation. The ad-
uncommon to observe inflamed gingiva vantages are relevant considering that
and recession related to the crown's most of the clinical results are obtained
contours. only through the restoration itself, both
The BOPT technique, with the in- provisional and final (margin position,
teraction between preparation—res- emerging profile, tooth form).
toration—gingiva (gingitage, clot, new In order to give scientific value to this
contour), enables the gingiva to thicken technique, more clinical and biological
and to adapt to new forms, resulting in studies are needed. A prospective mul-
increased stability both in the short and ticenter investigation will be designed
in the long term. As previously men- to verify if the BOPT procedure can be
tioned, it is commonly observed that used by clinicians with predictable re-
the apical recession of the marginal sults.
gingiva (Fig 19) can be corrected just
by the elimination of pre-existing finish
lines and by the ne\A/ emergence profile Acknowledgment
of the crown (Fig 20).
The authors want to express their gratitude to Dr
The same concepts and procedures Roberto Cocchetto for his Invaluable help in writing
have been applied also in implant and editing this article.

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