BOPT VENEERsS PROSTHODONTICS IN DENTAL .

venners in prosthodontics

1. JOURNAL Journal of clinical and experimental dentistry,2017 AUTHOR’S Rubén Agustín-Panadero, Daniel Ausina- Escrihuela, Lucía Fernández-Estevan, Juan-Luis Román-Rodríguez, J oan Faus-López, María-Fernanda S ARTICLE Dental-gingival remodeling with BOPT no-prep veneers Presented by, Dr.Sreelakshmi E 2 nd year PG Student Dept of Prosthodontics 1

2. Agustín-Panadero R, Ausina- Escrihuela D, Fernández-Estevan L, Román-Rodríguez JL, Faus-López J, Solá-Ruíz MF. Dentalgingival remodeling with BOPT no-prep veneers . J Clin Exp Dent. 2017;9(12):e1496-500 . 2

3. INTRODUCTION AIM MATERIALS & METHODS DISCUSSION PROS & CONS CONCLUSION REFERENCES CONTENTS:- 3

4. INTRODUCTION:- The last 30 years [1] has seen the introduction of ceramic veneers aimed at improving the shape, alignment, and color of teeth as a response for patients increasing demands for improved dental esthetics. To begin with, these were designed for use without any kind of preparation, but later, in response to the deficiencies of materials and techniques, teeth underwent a milling procedure to reduce their thickness and so accommodate the ceramic veneers, ensuring esthetic outcomes and the treatment’s long-term durability [1]. 4

5. However, patients and clinicians’ concern to preserve a maximum quantity of healthy dental structures has led to further research into new materials and techniques aimed at maximizing dental conservation. New materials have appeared, especially in adhesive dentistry, that have made it possible to fabricate veneers that do not require any tooth preparation, while providing excellent long term function and esthetics. [2] 5

6. Generally, no-prep/minimally invasive veneers tend to have a thickness of 0.2 to 0.5 mm [3–6] , while conventional veneers range from 0.3 to 1.0 mm [7–13]. A recent trend in this field is the use of ultrathin, or contact lens veneers, which do not require invasive tooth preparation [14] The material of choice for the no-prep/minimally invasive veneers is feldspathic porcelain, which allows for the fabrication of very thin veneers from 0.2 to 0.3 mm; in comparison, thicker pressed ceramics have a thickness of 0.3 to 0.5 mm and require more aggressive reduction of dental structures [15, 16]. 6

7. AIM:- This article explains a clinical case report where they describes the placement of six hybrid ceramic veneers without preparation of the dental structure, applying BOPT (Biologically Oriented Preparation Technique) for purposes of gingival tissue modeling and closure of diastemata caused by microdontia. BOPT philosophy, which would make it possible to modify the height of the gingival margin without any need for surgery, simply by modifying the emergence profile to make it more concave or more convex, which would allow the gums to thicken and adapt to the new shapes. 7

8. In this way, it was possible to achieve greater gingival stability in the medium and long terms, improve the restorations’ emergence profiles, facilitate oral hygiene maintenance, and create a more natural appearance. 8

9. MATERIALS & METHODS:- A male patient aged 25 years sought treatment to improve his dental esthetics because he was concerned about small tooth sizes in the upper anterior region. A pre-treatment mock-up was fabricated on the basis of models and a diagnostic wax-up. 9

10. The treatment plan consisted of applying no-prep veneers without tooth preparation with BOPT-type morphology in the cervical area in order to regularize the position of the gingival margins and close diastemata. As no kind of dental or gingival preparation was performed, impressions were taken with addition silicon using double-mix impression technique (Wash Technique) with double-cord retraction, one cord of 0.89mm diameter at the base of the groove and the other of 1.6mm diameter to the crown. The latter was removed at the moment when the liquid impression material was injected. 10

11. The impression was cast in type IV plaster to obtain a physical master model. Intermaxillary registers and cranio-maxillary transfers were taken and mounted on semi-adjustable articulator set-up. The physical master model was then digitalized using an extraoral scanner and dedicated software and stored as an STL file. 11

12. This was used to design a virtual wax-up on the digital model for fabricating veneers for teeth 13, 12, 11, 21, 22 and 23. As the teeth and gingival tissue underwent no preparation, it was decided to make micro-veneers (mean thickness 0.2mm) using a hybrid ceramic, VITA Enamic HT with BOPT-type prosthetic cervical emergence. 12

13. In order to obtain the correct gingival scallop shape, veneers were given different cervical emergence morphologies; in this way, veneers for teeth 13, 11 and 21 presented a flattened cervical emergence with an angle of ≤45º between the dental axis and the prosthetic piece in order to avoid modifying the gingival position for these teeth. For teeth 12, 22 and 23, where the gingival margin position was more coronal, it was decided to create a prosthetic emergence profile >60°, in order to bring about controlled ischemia in the gingival area, and so displace the level of the gingival margin slightly towards apical. 13

14. All veneers were fitted to the cervical level at the cementoenamel junction, as the main objective of these restorations was not to invade the biological space in vertical direction but to manage the convexity of the tooth’s anatomical crown so that the gingiva would adapt to the crown shape in either apical or coronal direction. 14

15. At the second visit, the fit of the veneers in the mouth was checked using glycerin gel as well as the esthetic effect and gingival displacements (symmetrical scalloping). After checking that dental fit and gingival adaptation were correct, the color shade of the cement was selected using Try-in pastes 15

16. Firstly, the teeth were isolated with a rubber dam with a mean thickness of 0.18mm and the teeth were etched with 37% orthophosphoric acid etching gel for 30 seconds and the veneers with 5% hydrofluoric for 1 minute. 16

17. Both the teeth and the veneers were then washed and dried. Adhesive was applied to the dental enamel and polymerized for 10 seconds and a silane coupling agent was applied to the internal face of each veneer, followed by the adhesive without undergoing polymerization. 17

18. Then, the veneers were cemented with photpolymerizable resin cement one by one, starting with the central teeth, fitting each veneer in place and polymerizing for 2 seconds in order to remove excess cement. Afterwards full polymerization was performed for 60 seconds per tooth. Lastly, any remaining excess cement was removed with a scalpel blade.[17] 18

19. The patient was recalled to the clinic after 15 days, 3 and 6 months to assess the health of the soft tissues, checking that gingival scalloping adjacent to veneers was symmetrical and that prosthetic esthetics were optimal. 19

20. DISCUSSION:- BOPT repositions the cementoenamel junction in relation to the prosthetic restoration making it possible to manage dental contours by means of provisional restorations allowing blood coagulate derived from dental preparation to stabilize as gingival tissue mature. This is achieved by shortening or extending the edge of the restoration to reach different levels in the gingival sulcus and so establish the gingival margin, which helps to balance the soft tissues esthetically. 20

21. Compared with conventional preparation techniques, BOPT is accompanied by greater gingival thickening produced during dental preparation. To perform the technique correctly, it is essential to perform adequate periodontal diagnosis to verify the space available between the bone crest and the future margin of the restoration. 21

22. PROS:- Helps to preserve tooth vitality and reduce postoperative sensitivity. Biocompatible with dental substrates and are gentle to the periodontium, accumulate less bacterial plaque, and promote better oral hygiene by time. Less painful or completely painless, there is often no need for anesthesia. It is possible to correct the cementoenamel junction (CEJ) on non-prepared teeth.  With no tooth preparation, the shapes of the teeth remain unaltered. 22

23. Hybrid ceramics combine the versatility of resins – increased elasticity and less risk of fracture during cementation – with the durability and esthetics of ceramics. They are less fragile and enjoy an excellent milling capacity and their edges are stable. The material has abrasion behavior that is very similar to dental enamel so that it does not damage the antagonist teeth. Its high translucency allows good light conductivity and so perfect visual integration. 23

24. CONS:- Maintenance of the BOPT veneers is not explained. Not clearly explaining about the relation of teeth in laterotrusive movements. Gingival sulcus is invaded and ischemia noted on 12. A new CEJ is established despite the lack of dental reference points,which runs a risk. 24

25. A proper finish line is not given. No evidences given in long term prognosis. Appearance of increased gingival thickness regardless of its biotype. 25

26. Granell-Ruiz M, Rech-Ortega C, Oteiza-Galdón B, Bouazza-Juanes K. Case report: Vertical preparation protocol for veneers. J Clin Exp Dent. 2023;15(4):e346-50. A 25-year-old female patient who came for consultation due to wear of the incisal edges of the four upper incisors due to the presence of a parafunctional habit. To improve both aesthetics and function, four ceramic veneers using the vertical preparation technique (BOPT) are proposed . 26

27. Conclusi on:- The biologically oriented preparation technique (BOPT) consists of a vertical preparation of the tooth that involves a reduction to zero of the emergence anatomy, the creation of a new finish area, and immediate temporization, so that the gingiva is supported by a suitable prosthetic restoration. To this effect, it is not the restoration that adapts to the gingiva, but the gingiva that adapts to the restoration. This technique not only allows the gingiva around the tooth to stabilise, but over time it will also facilitate the achievement of a predictable coronal migration of the gingival margin. 27

28. Peris H, Godoy L, Cogolludo PG, Ferreiroa A. Ceramic veneers on central incisors without finish line using bopt in a case with gingival asymmetry . J Clin Exp Dent. 2019;11(6):e577-81. Conclusion: - It is possible to correct gingival asymmetry by performing dental preparation without finish line providing a correct periodontal analysis is first performed, which will contribute to successful soft tissue stabilization.Beyond of all the prosthodontic preparation techniques, knowledge of B.O.P.T. (Biological Oriented Preparation Technique) allows us to achieve predictable and consistent results in terms of periodontal health and gingiva architecture surrounding ceramic veneers. 28

29. Mohammad A, Abraham S, Nada A. The Effect of Biologically Oriented and Subgingival Horizontal Preparation Techniques on Periodontal Health: A Double-Blind Randomized Controlled Clinical Trial . The Saudi Dental Journal. 2023 Jun 17. Conclusion:- SHPT had significantly lower plaque and inflammation index at baseline, which increased significantly at 3 months and 2 years’ follow-up compared to BOPT. Patients’ satisfaction was significantly higher with SHPT at baseline, and it is reduced significantly at 6 months and two years follow- up. The probing depth was significantly higher in BOPT at baseline and 3 months and decreased significantly at 6 months, 1 year, and 2 years’ follow-up. 29

30. CONCLUSION:- The use of ultra-fine micro-veneers makes it possible to treat cases presenting diastema in the anterior region. Applying BOPT principles allows gingival modeling without the need for any type of pre-prosthetic surgery. Hybrid ceramics would appear to be an excellent alternative to feldspathic ceramics in this type of case, although longitudinal medium-long term studies are needed to confirm the correct behavior of this material in the oral medium over time. 30

31. REFERENCES:- Freydberg BK. No-prep veneers: the myths. Dent Today. 2011;30:70-1. Lowe RA. No-prep veneers: a realistic option. Dent Today. 2010;29:80-2. Gresnigt M, Özcan M (2011) Esthetic rehabilitation of anterior teeth with porcelain laminates and sectional veneers. J Can Dent Assoc 77:b143 Lin CC, Tsai YL, Li UM, Chang YC et al (2008) Horizontal/ oblique root fractures in the palatal root of maxillary molars with associated periodontal destruction: case reports. Int Endodont J 41:442–447 Radz GM (2011) Minimum thickness anterior porcelain restorations. Dent Clin N Am 55:353–370 Zarone F, Leone R, Di Mauro MI, Ferrari M et al (2018) Nopreparation ceramic veneers: a systematic review. J Osseointegr 10:17–22 31

32. 7. Calamia JR (1989) Clinical evaluation of etched porcelain veneers. Am J Dent 2:9–15 8. Rouse J, McGowan S (1999) Restoration of the anterior maxilla with ultraconservative veneers: clinical and laboratory considerations. Pract Periodontics Aesthet Dent 1:333–339 9. Nordbø H, Rygh-Thoresen N, Henaug T (1994) Clinical performance of porcelain laminate veneers without incisal overlapping: 3-year results. J Dent 22:342–345 10. Peumans M, De Munck J, Fieuws S, Lambrechts P et al (2004) A prospective ten-year clinical trial of porcelain veneers. J Adhes Dent 6:65–76 11. Peumans M, Van Meerbeek B, Lambrechts P, Vuylsteke-Wauters M et al (1998) Five-year clinical performance of porcelain veneers. Quintessence Int 29:211–221 12. Quinn F, McConnell RJ, Byrne D (1986) Porcelain laminates: a review. Br Dent J 161:61–65 13. Strassler HE, Nathanson D (1989) Clinical evaluation of etched porcelain veneers over a period of 18 to 42 months. J Esthet Dent 1:21–28 32

33. 14. Re D, Cerutti F, Augusti G, Cerutti A et al (2014) Comparison of marginal types of Lava CAD/CAM crown-copings with two fnish lines. Int J Esthet Dent 9:426–435 15. Cavanaugh RR, Croll TP (1994) Bonded porcelain veneer masking of dark tetracycline dentinal stains. Pract Periodont Aesthet Dent 6:71–9 (quiz 80) 16. Barghi N, McAlister E (1998) Porcelain for veneers. J Esthet Dent 10:191–197 17. Imburgia M, Canale A, Cortellini D, Maneschi M, Martucci C, Valenti M. Minimally invasive vertical preparation design for ceramic veneers. Int J Esthet Dent. 2016;11:460-71. 33

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35. The BOPT technique involves a series of steps that must be followed, referred by Dr. Ignazio Loi as “key points of the technique” ( 5 ): vertical preparation (elimination of the anatomical cementoenamel junction, CEJ); “gingitage” of the sulcus; relining and adjustment of the provisional restoration (clot preservation); adaptation profile (new prosthetic CEJ); timing of the impression; and laboratory procedure (new adaptation profile). The diagnostic wax-up and mock-up are essential tools for communication and evaluation of the final aspect of the restoration between the patient and the clinician A veneer bonded to a dentin substrate with higher elasticity may be exposed to higher stresses during loading, which could lead to an increased risk of fractures compared to veneers bonded to rigid enamel 35

36. Dentin has a much lower modulus of elasticity than porcelain, and hence, deeper preparation into it provides a less rigid base for restoration than enamel. Bonding to dentin results in much higher fracture rates than for enamel-supported restorations. Therefore, the reduction in dentin thickness observed after preparation may influence the life expectancy of the restoration [21, 39]. Enamel forms stronger mechanical bonds than dentin, which is less homogenous, contains humidity, and may possess sclerotic areas 36