The “Prosthetic Orthodontic Approach”: An Application of the
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The biologically oriented preparation technique (BOPT) is a prosthetic protocol that consists of a feather-edge subgingival preparation whereby the gingival profile adapts itself to the new prosthetic coronal emergence profile. This is made possible by the elimination of an emergence profile of the tooth or any preexisting finish line. A new prosthetic emergence profile is created by placing the prosthesis in such a way that leaves the gingival margin at the desired position.

A 71-year-old man, American Society of Anesthesiologists (ASA) type I, presented to a hospital dental department hoping to correct aesthetic and functional problems of the maxillary arch where the teeth were severely worn and with the lateral incisor agenesis. The full-arch interim crown restoration was fabricated with the correct tooth proportion and position, in such a way that the lateral incisors replaced the misaligned canine. The correct tooth proportions were achieved by preparing the distal side of the canines more than the mesial side with the BOPT and POA so that the abutment teeth were adapted to the interim restoration and not the opposite. The full-arch interim restoration was positioned in the maxillary arch with the crown margin 0.5?mm subgingivally, and after one month of soft-tissue maturation, the soft tissue appeared healthy without signs of inflammation.

A panoramic radiograph was made with the interim restoration showing that the dental pulp was not involved after the prosthetic procedure. The definitive impression was taken using a double retraction cord soaked in a hemostatic solution and a one-step light body and putty polysiloxane impression. The impression was sent to the dental technician with a request that the final restorations be shaped in a manner that allowed the emergence profile to sustain the mature soft tissues. In the dental laboratory, the final restoration was fabricated with a zirconia framework veneered with feldspathic porcelain. The final restorations were clinically checked and sent for the final glaze and at the final appointment were cemented (placed 0.5?mm into the gingival sulcus) with self-adhesive resin cement. At the one-year follow-up visit, no biological or technical complications were noted, and the gingiva appeared thick, pink, healthy, and completely adapted to the definitive restoration.