Clinical outcomes of the biologically oriented preparation technique (BOPT) in fixed dental prostheses: A systematic review.

STATEMENT OF PROBLEM: The biologically oriented preparation technique is a concept with a vertical tooth preparation, gingitage, an immediate interim restoration preserving the clot, and a specific laboratory technique aiming to adapt the marginal periodontal tissue to a remodeled emergence profile of the crown. However, the published scientific evidence on this subject is limited. PURPOSE: The purpose of this systematic review was to analyze whether using the biologically oriented preparation technique leads to improved clinical outcomes in terms of probing depth, gingival inflammation index, gingival marginal stability, and fewer mechanical and biological complications. MATERIAL AND METHODS: Recommendations from the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were used in this systematic review. An electronic search of the MEDLINE/PubMed, EMBASE, Science Direct, Wiley Online Library, Cochrane, and ProQuest databases was made for articles published between March 2010 and July 2021 using keywords. Three reviewers selected and analyzed all articles that mentioned the biologically oriented preparation technique and met the inclusion criteria. RESULTS: A total of 6 articles met the inclusion criteria: 1 prospective randomized clinical study, 1 randomized clinical study, 1 prospective clinical study, and 3 case series. According to these studies, of all the teeth treated with the biologically oriented preparation technique, probing depth (greater than 3 mm) increased in only 2.3%, gingival inflammation was present in 22.8%, gingival recession occurred in 1.7% (decreased gingival stability), and mechanical and biological failures occurred in 4.4% of the teeth. CONCLUSIONS: Fixed dental prosthesis treatments performed following the concept of the biologically oriented preparation technique did not increase probing depth and showed a moderate rate of gingival inflammation, lower recession rates, and lower mechanical and biological failures at the 5-year follow-up. The biologically oriented preparation technique appears to be a viable alternative technique for obtaining satisfactory and stable clinical results up to 5 years. Long-term randomized clinical trials are recommended to reach more conclusions about this protocol.

The importance of esthetic integration through laboratory adaptation profiles in the biologically oriented preparation technique.

The biologically oriented preparation technique (BOPT) has revolutionized the execution of fixed prosthetic treatments, ensuring tissue stability and the integration of the gingival tissue with the prosthetic restorations. BOPT follows both a clinical and laboratory sequence; the two must be perfectly integrated and synchronized, with the phase of preparation and temporary restorations in the clinic correlating with a well-founded and protocolized execution of the laboratory steps. In turn, prosthetic work returned to the clinic must show perfect integration between the prosthesis, the preparation, and the periodontal tissue, with a balance between pink and white esthetics. The clinical case in the present article illustrates the close relationship between the clinical and laboratory steps, including the technical laboratory procedures, that make it possible to achieve these objectives. The aim of the article is to introduce the concept of the prosthetic adaptation profile of new restorations, establishing the definition, importance, and direct relationship of this profile with the success of the rehabilitation treatment.

Clinical behavior of posterior fixed partial dentures with a biologically oriented preparation technique: A 5-year randomized controlled clinical trial.

STATEMENT OF PROBLEM: Evidence of the behavior of the periodontal tissues around anterior teeth restored with the biologically oriented preparation technique (BOPT) is available. However, outcomes of this technique in posterior teeth restored with fixed partial dentures (FPDs) are lacking. PURPOSE: The purpose of this randomized controlled clinical trial was to evaluate the clinical, mechanical, and biological behavior of posterior 3-unit FPDs placed on teeth prepared with BOPT. MATERIAL AND METHODS: Forty participants received a 3-unit zirconia FPD in the posterior region of the mandible or maxilla. Twenty FPDs were placed on teeth prepared with BOPT (study group) and 20 on teeth with a horizontal chamfer finishing line (control group). Follow-up examinations were performed 1, 3, and 5 years after treatment to evaluate periodontal responses around the prepared teeth by means of the following parameters: plaque index, gingival index, probing depth, and marginal stability (MS). Mechanical behavior was also assessed, as were any complications. RESULTS: After the 5-year follow-up, 57.9% of the control group and 35% of the BOPT group presented a plaque index of 1. The gingival index was 1 in 68.4% of the control group and 30% of the BOPT group after the follow-up period. In the analysis of probing depth, 26.3% of teeth in the control group had pockets of more than 3 mm in depth, whereas the BOPT group had only 10%. Marginal stability appeared in 100% of the BOPT group, whereas only 10.5% of the control group exhibited gingival stability. Complications during the follow-up period were similar, 20% in the control group and 15% in the BOPT group. CONCLUSIONS: Posterior FPDs prepared by using BOPT had a good clinical response over a 5-year follow-up, with a low gingival index, a small increase in pocket depth, and a 100% marginal stability of the surrounding tissues. High survival rates after 5 years indicated that the technique produced predictable outcomes.

Digital protocol for creating a virtual gingiva adjacent to teeth with subgingival dental preparations.

PURPOSE: This article describes a digital technique used to record gingival emergence profiles modeled for the prosthetic restoration of teeth prepared using biologically oriented preparation technique (BOPT). MATERIALS AND METHODS: The description of the technique of intraoral recording, manipulation of digital files, and chairside protocol of prosthetic restorations is developed in the present manuscript on two anterior teeth treated with vertical and subgingival dental preparations for restoration with ceramic crowns. The manipulation of the digital files registered with an intraoral scanner with software that allows its alignment (best-fit) and the performance boolean of operation manages to create a virtual gingival emergency like the one it presents when it is adapted on the cervical part of the interim prosthesis. CONCLUSIONS: The technique allows the dentist and laboratory technician to obtain a digital reproduction of the subgingival soft tissues around the prosthetic crown, unaffected by the collapse of the gingival sulcus when the provisional crown is removed, as well as an exact copy of the provisional restoration, making it possible to fabricate a definitive prosthesis that ensures precise anatomy, and so good compatibility with periodontal tissues.

Periodontal and prosthetic outcomes on teeth prepared with biologically oriented preparation technique: a 4-year follow-up prospective clinical study.

PURPOSE: To evaluate the clinicaland biological behavior of full coverage restorations on teeth prepared without finish line during a 4-year follow-up. METHODS: This prospective study included 149 teeth treated using biologically oriented preparation technique (BOPT). The sample (149 teeth) was divided into two groups: Seventy four teeth restored with crowns, and 75 teeth supporting fixed partial dentures (FPD). Restorations were fabricated with zirconium oxide cores and ceramic coverings. Patients attended regular annual check-ups when probe depth, presence of inflammation with bleeding on probing, presence of plaque, gingival thickness, marginal stability, biological or mechanical complications, and the patient's level of satisfaction were registered over a 4-year follow-up. RESULTS: After the 4-year follow-up, 2.1% of teeth underwent increases in probing depth; 12% of the sample presented inflammation and bleeding on probing; 20% of the restored teeth presented plaque; gingival thickening increased a 32.5%; 98.6% of teeth presented marginal stability; the restoration survival rate was 96.6%, with 2% of biological complications and 1.4% of mechanical complications. General satisfaction score was 80.73. CONCLUSIONS: Restorations placed on teeth prepared using BOPT present good periodontal behavior, increase of gingival thickening, and marginal stability over a 4-year follow-up. High survival rates after 4 years show that the technique produces predictable outcomes. CLINICAL SIGNIFICANCE: The BOPT technique is a good treatment option in cases where replacement of an old restoration is required; presenting good periodontal behavior, gingival thickening, and marginal stability.

A novel approach to treat gingival recession and non-caries cervical lesion combined defects: Restoration guided creeping attachment (RGCA) technique. A case report.

Gingival recessions have multifactorial etiology and are often associated with non-caries cervical lesions. Different surgical techniques have been proposed over the years for their treatment, according to the severity of the recession. A novel technique, called restoration guided creeping attachment (RGCA), for the treatment of combined gingival recession and non-caries cervical lesion is presented. RGCA aims at treating Miller class I and II recessions using a specifically designed composite restoration and a minimally invasive approach. A clinical case describing the technique and forming the basis for further studies is presented. Although the results obtained are encouraging, a wider number of patients and longer follow-ups are needed to assess the reliability of this technique.

Two or three machined vs roughened surface dental implants loaded immediately supporting total fixed prostheses: 1-year results from a randomised controlled trial.

PURPOSE: To compare implants with machined vs roughened surfaces placed flapless in totally edentulous jaws and immediately restored with metal-resin screw-retained cross-arch prostheses. Mandibles were rehabilitated with two implants (Fixed-on-2 or Fo2) and maxillae with three implants (Fixed-on-3 or Fo3). MATERIALS AND METHODS: Forty edentulous or to be rendered edentulous patients (20 in the mandible and 20 in the maxilla) were randomised to the machined group (20 patients: 10 mandibles and 10 maxillae) and to the roughened group (20 patients: 10 mandibles and 10 maxillae) according to a parallel group design. To be immediately loaded implants had to be inserted with a minimum torque of 60 Ncm. Outcome measures were prosthesis and implant failures, complications and peri-implant marginal bone level changes evaluated up to 1 year post-loading. RESULTS: Flaps were raised in four patients from the machined group. Four prostheses on machined implants and three on roughened implants were delayed for loading because a sufficient insertion torque was not obtained. There were no dropouts 1 year after loading. Two maxillary machined implants were lost in two patients (difference in proportions = 0.10; 95% CI = -0.03 to 0.23; P (Fisher's exact test) = 0.487); one maxillary Fo3 prosthesis on machined implants and one mandibular Fo2 prosthesis on roughened implants had to be remade (difference in proportions = 0; 95% CI = -0.14 to 0.14; P (Fisher's exact test) = 1.000). Five patients with machined implants had six complications vs seven patients who had eight complications at roughened implants (difference in proportions = -0.10; 95% CI = -0.38 to 0.18; P (Fisher's exact test) = 0.731). There were no statistically significant differences for implant failures, prosthetic failures or complications between groups. There were no statistically significant differences for marginal peri-implant bone levels between the two groups (estimate of the difference = -0.06 mm; 95% CI = -0.23 to 0.10; P (ANCOVA) = 0.445), with both groups losing marginal bone in a statistically significant way (0.35 ± 0.23 mm for machined and 0.42 ± 0.27 mm for roughened surface). CONCLUSIONS: These preliminary results suggest that immediately loaded cross-arch prostheses can be supported by only two mandibular or three maxillary dental implants at least up to 1 year post-loading, independently of the type of implant surface used. Longer follow-ups are needed to understand whether one of the two-implant surfaces is preferable.

Soft and hard tissue response to an implant with a convergent collar in the esthetic area: preliminary report at 18 months.

AIM: The purpose of this prospective cohort study was to investigate, over an 18-month period, soft and hard tissue response to a transmucosal implant with a convergent collar inserted in the anterior maxillary esthetic area. MATERIALS AND METHODS: From June 2013 to January 2014, 14 consecutive patients were enrolled (7 men and 7 women; mean age 63.7 ±â€¯14 years) with 20 implants, needing at least one implant-supported restoration between the canines in the maxillary anterior esthetic area. Six months after hopeless tooth extraction and an alveolar socket graft, a transmucosal-type implant with convergent collar walls was inserted in a midcrestal position with mini-flap surgery. An impression was taken 2 months later, and a definitive abutment with a provisional restoration was positioned. The final restoration was seated 2 weeks later. Clinical parameters, photographs, radiographs, and impressions were taken at this timepoint, and after 6 and 18 months. Using dedicated software, radiographic analysis (to detect marginal bone-level changes) and cast analysis (to detect soft tissue vertical and horizontal changes) were performed. RESULTS: At the 18-month follow-up, all implants were clinically osseointegrated, stable, and showed no sign of infection. At baseline, interproximal radiographs revealed no bone defect around the implant. After an initial minimal bone loss (0.09 ±â€¯0.144 mm), radiographic analysis showed a stable condition of bone remodeling (mean value 0.09 ±â€¯0.08; range 0.0 to 0.5 mm) at the 18-month follow-up. No statistically significant horizontal dimensional changes of the alveolar ridge were observed between each timepoint. Mean soft tissue levels significantly improved between baseline and 18 months. The mean heights of the mesial papilla (MP) and distal papilla (DP) changes were 0.38 ±â€¯0.22 and 0.47 ±â€¯0.31, respectively. The level of the labial gingival margin (LGM) was 1.01 ±â€¯0.63. Periodontal parameters never exceeded the physiological levels. CONCLUSIONS: Within the limitations of this preliminary study, the analyzed implants produced positive results in these esthetically demanding cases. This outcome should encourage long-term studies in order to assess, through controlled clinical trials, whether this convergent collar design offers advantages over other designs. Furthermore, due to the peculiar crestal module, together with the use of delayed implant insertion and a postextraction ridge preservation technique with biomimetic hydroxyapatite, the analyzed implants seem to help prevent the negative bone remodeling typically associated with two-piece implant systems, but without the well-known drawbacks of traditionally designed transmucosal implants. Therefore, wherever crestal bone preservation is a critical issue for clinical success in the anterior maxillary area can be considered of particular interest.

Immediate loading of two (fixed-on-2) versus three (fixed-on-3) implants placed flapless supporting cross-arch fixed prostheses: One-year results from a randomised controlled trial.

PURPOSE: To evaluate the outcome of two (fixed-on-2 = FO2) versus three (fixed-on-3 = FO3) implants placed flapless in fully edentulous jaws and immediately restored with metal-resin screw-retained crossarch prostheses. MATERIALS AND METHODS: Forty edentulous or to be rendered edentulous patients (20 in the maxilla and 20 in the mandible) were randomised to the FO2 group (20 patients: 10 in the maxilla and 10 in the mandible) and to the FO3 group (20 patients: 10 in the maxilla and 10 in the mandible) according to a parallel group design. To be immediately loaded, implants had to be inserted with a minimum torque of 60 Ncm. Outcome measures were prosthesis and implant failures, complications and periimplant marginal bone level changes evaluated up to 1-year post-loading. RESULTS: Flaps were raised in four patients and two prostheses were loaded early at 8 weeks in the FO2 group. One year after loading no dropout or implant failure occurred, however one FO2 maxillary prosthesis had to be remade because of repeated screw-loosening (risk difference = 0.05; 95% CI: -0.05 to 0.15; Fisher's exact test P = 1.000). Three FO2 patients were affected by complications versus five FO3 patients (risk difference = -0.1; 95% CI: -0.35 to 0.15; Fisher's exact test; P = 0.695). There were no statistically significant differences for prosthetic failures and complications between groups. There were no statistically significant differences for marginal peri-implant bone levels between the two groups (estimate of the difference = 0.031 mm; 95% Cl: -0.22 to 0.28; P (ancova) = 0.803), with both groups losing marginal bone in a statistically significant way (0.27 mm for FO2 patients and 0.24 mm for FO3 patients). CONCLUSIONS: These preliminary results suggest that immediately loaded cross-arch prostheses can be supported by only two or three dental implants at least up to 1-year post-loading. Longer follow-ups are needed to properly evaluate both these therapeutic options.

Machined versus roughened immediately loaded and finally restored single implants inserted flapless: Preliminary 6-month data from a split- mouth randomised controlled trial.

PURPOSE: To compare the outcome of immediately loaded single implants with a machined or a roughened surface. MATERIALS AND METHODS: Fifty patients had two implant sites randomly allocated to receive flaplessplaced single Syra implants (Sweden & Martina), one with a machined and one with a roughened surface (sand-blasted with zirconia powder and acid etched), according to a split-mouth design. To be loaded immediately, implants had to be inserted with a torque superior to 50 Ncm. Implants were restored with definitive crowns in direct occlusal contact within 48 h. Patients were followed for 6 months after loading. Outcome measures were prosthetic and implant failures and complications. RESULTS: Two machined implants and four roughened implants were not loaded immediately. Six months after loading no dropout occurred. One implant loaded late, which had a rough implant surface, failed 20 days after loading (P (McNemar test) = 0.625; difference in proportions = -0.04; 95% CI: -0.15 to 0.07). Three crowns had to be remade on machined implants and four on roughened implants (P (McNemar test) = 1.000; difference in proportions = -0.02; 95% CI: -0.12 to 0.08). Three machined and five roughened implants experienced complications (P (McNemar test) = 0.625; difference in proportions = -0.04; 95% CI: -0.15 to 0.07). There were no statistically significant differences between groups for crown and implant losses as well as complications. CONCLUSIONS: Up to 6 months after loading both machined and roughened flapless-placed and immediately loaded single implants provided good and similar results, however, longer follow-ups are needed to evaluate the long-term prognosis of implants with different surfaces.

Immediate loading of bimaxillary total fixed prostheses supported by five flapless-placed implants with machined surfaces: A 6-month follow-up prospective single cohort study.

PURPOSE: To evaluate the clinical outcome of fully edentulous patients rehabilitated with immediately loaded bimaxillary screw-retained metal-resin prostheses supported by five implants placed flapless: two in the mandible and three in the maxillae. MATERIALS AND METHODS: Twenty-five consecutively treated patients were recruited. To be immediately loaded, implants had to be inserted with a minimum torque of 80 Ncm. Outcome measures were prosthesis and implant failures, and complications. RESULTS: Six months after loading no patients dropped out and no prosthesis or implant failed. Two maxillary prostheses were loaded early at 8 weeks because implants were inserted with a torque inferior to 45 Ncm. Three complications occurred in two patients but they were all successfully treated. CONCLUSIONS: Six months after loading, immediately loaded bimaxillary cross-arch prostheses can be supported by only two mandibular and three maxillary flapless-placed dental implants. Longer follow-ups of approximately 10 years are needed to understand the prognosis of this treatment modality.

Clinical evaluation of an improved cementation technique for implant-supported restorations: a randomized controlled trial.

BACKGROUND: Cement remnants were frequently associated with peri-implantitis. Recently, a shoulderless abutment was proposed, raising some concern about cement excess removal. AIM: To compare different cementation techniques for implant-supported restorations assessing the amount of cement remnants in the peri-implant sulcus. Additional aim was to compare the effect of these cementation techniques using two different abutment designs. MATERIAL & METHODS: Forty-six patients requiring double implant-supported restoration in the posterior maxilla were randomly divided in two groups according to the cementation modality: intraoral and extraoral. According to the abutment finishing line, implants in each patient were randomly assigned to shoulderless or chamfer subgroup. In the intraoral group, crowns were directly seated onto the titanium abutment. In the extraoral group, crowns were firstly seated onto a resin abutment replica and immediately removed, then cleansed of the cement excess and finally seated on the titanium abutment. After cement setting, in both groups, cement excess was carefully tried to remove. Three months later, framework/abutment complexes were disconnected and prepared for microscopic analysis: surface occupied by exposed cement remnants and marginal gaps were measured. Additionally, crown/abutment complexes were grinded, and voids of cement were measured at abutment/crown interface. Related-samples Friedman's two-way analysis of variance by ranks was used to detect differences between groups and subgroups (P ≤ 0.5). RESULTS: At the end of the study, a mean value of 0.45 mm2 (±0.80), 0.38 mm2 (±0.84), and 0.065 mm2 (±0.13) and 0.07 mm2 (±0.15) described surface occupied by cement remnants in shoulderless and chamfer abutment with intraoral cementation and shoulderless and chamfer abutment with extraoral cementation, respectively. A mean value of 0.40 mm2 (±0.377), 0.41 mm2 (±0.39) and 0.485 mm2 (±0.47) and 0.477 mm2 (±0.43) described cement voids at the abutment/crown interface; a mean value of 0.062 mm (±0.03), 0.064 mm (±0.35), 0.055 mm (±0.016) and 0.054 mm (±0.024) described marginal gaps. Statistics showed tendency of intraoral cementation to have significantly higher cement remnants compared with abutments with extraoral cementation groups. At the same time, the presence of voids was significantly higher in case of extraoral cementation. No significant differences between groups for the variable "gap". CONCLUSIONS: Despite the presence of more voids, extraoral cementation reduces cement excess. However, using low adhesivity cement and careful cement removal, a very limited quantity of cement remnants was observed also in the intraoral cementation.

Biologically oriented preparation technique (BOPT): a new approach for prosthetic restoration of periodontically healthy teeth.

Tooth preparations for fixed prosthetic restorations can be done in different ways, basically of two kinds: preparation with a defined margin and the so-called vertical preparation or feather edge. The latter was originally used for prosthetics on teeth treated with resective surgery for periodontal disease. In this article, the author presents a prosthetic technique for periodontally healthy teeth using feather edge preparation in a flapless approach in both esthetic and posterior areas with ceramometal and zirconia restorations, achieving high quality clinical and esthetic results in terms of soft tissue stability at the prosthetic/tissue interface, both in the short and in the long term (clinical follow-up up to fifteen years). Moreover, the BOPT technique, if compared to other preparation techniques (chamfer, shoulder, etc), is simpler and faster when in preparation impression taking, temporary crowns' relining and creating the crowns' profiles up to the final prosthetic restoration.