PMC7787835_01
(a) Preoperative intraoral view. (b) The interim full-arch restoration after shortening of the left lateral incisor and the collagen matrix placement.
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The patient was unsatisfied with the appearance of her smile due to a previous interim full-arch rehabilitation (right first to left first maxillary molars) and multiple areas of gingival recession (Figure 1(a)). A collagen matrix graft (equine collagen-BioPad) was placed with a minimal partial thickness flap in the edentulous buccal area of the pontic zones (Figure 1(b)).
Adaptation of the gingiva to the new prosthetic emergence profile (a) interim restoration on the shortened left lateral incisor, (b) reduction of the gingival recession after 1 month, and (c) gingiva completely adapted to the left lateral incisor after 2 months.
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After 1 month of soft tissue maturation, the maxillary left lateral incisor was shortened to leave the gingival recession uncovered (Figure 2); this was because gingival adaptation to the new prosthetic emergence profile was expected, as described by previous studies utilizing the BOPT. One month later, the gingival recession of the left lateral incisor was reduced, and a month after that, the gingiva was completely adapted to the new crown shape (Figure 2).
(a) Abutment teeth and gingival architecture before the biologically oriented preparation technique (BOPT) protocol. (b) Abutment teeth and gingival architecture after the BOPT protocol. (c) Widening of the abutment tooth and gingival sulcus.
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The gingival margin of the left lateral incisor, which was apical to that of the adjacent teeth before the BOPT (Figure 3(a)), was now in a more coronal position (Figure 3(b)); the gingiva appeared thicker than before, thus achieving a correct gingival architecture with a healthy gingival sulcus (Figure 3(c)).
(a) Final rehabilitation at the 24-month follow-up: facial view. (b) Final rehabilitation at the 24-month follow-up: right lateral view. (c) Final rehabilitation at the 24-month follow-up: left lateral view.
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At the 24-month follow-up, the supporting tissues around the fixed prosthesis were healthy, with no signs of periodontal disease (Figure 4(a)). The gingiva appeared pink and stippled, and complete papillae fill was obtained at the interdental spaces (Figures 4(b) and 4(c)).
PMC7787835_02
(a) Preoperative intraoral view. (b) Interim restoration after 1 month of healing after the biologically oriented preparation technique.
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Clinical examination revealed short clinical crowns on the maxillary incisors, which the patient reported to be the cause of her negative self-image (Figure 5(a)). One month later, the gingival tissue had healed (Figure 5(b)), and the gingival sulcus of the central incisors was remeasured.
(a) The displacement of the buccal gingiva after vertical augmentation of the emergence profile of the central incisors. (b) Definitive restoration at 12-month follow-up.
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One month after soft tissue maturation, the gingiva appeared healthy at both teeth, and the gingival margins of the central incisors were at the same level as those of the canines (Figure 6(a)). At the 12-month follow-up, the keratinized gingiva appeared pink and stippled, and the interdental spaces were fully filled by interdental papillae (Figure 6(b)).