06 December 2023

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Peripheral Build-Up technique: how to perform it

Lorenzo Breschi

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Introduction

Various strategies have been proposed over time to manage defective teeth in challenging situations like deep subgingival defects. Among the different techniques, cervical marginal relocation, doughnut, and preformed ring have been the most used methods. Peripheral Build-Up technique (PBUt) is the lately introduced method for the reconstruction of structurally compromised teeth (SCT). PBUt is an additive technique that share some similarities with already existing methods but offers a wider application range and possibilities. It focuses on managing the most apical and peripheral parts of the tooth structure, even up to >1.5 mm above the bone crest. The approach preserves significant sound tooth structure and enhances the resistance and retention features of the abutment tooth. Periodontal response needs to be monitored over time due to the technique's extended approach.

Materials and methods 

It is recommended, whenever the clinical condition allows, to perform a multiple teeth isolation. In this case, two clamps will be used: one on the target tooth (“master clamp”) and the second (“accessory clamp”) placed on the distal tooth. The clamp insertion would allow a detachment of the periodontal attachment and expose the sufficient tooth structure for an effective isolation. 

The customized proximal matrices are placed by means of periodontal microsurgical needle holder and engaged beyond the cervical sound structure. Once decided the inclination of the matrix, it is then stabilized with resin composite adequately bonded on the mesial and distal silicone stumps appropriately placed on the clamp's bows. A first thin layer of resin composite is placed on the proximal walls and light-cured. Then, the resin composite is placed up to the selected height of the abutment and light-cured.

The achievement of a perfectly smooth, polished restorative surface is necessary as not to irritate the periodontal tissue. After interproximal matrix removal, it is possible to detach the junctional epithelium and the more coronal portion of the connective attachment by means of a wide thin spatula to further enhance finishing of the restoration. 

Conclusions 

The authors concluded that the PBUt represents a viable alternative approach to SCT even in the worse periodontal clinical scenarios such as deep subgingival locations of the residual tooth structure. It encloses some of the concepts of cervical marginal relocation and donugth technique, overcomes their drawbacks, and widens the clinical versatility and the indication range. The rationale of the presented technique relies on biomechanical and biological concepts in order to provide long-lasting adhesive foundation restorations. 

Keywords: deep-margin elevation, built-up, subgingival margin, adhesion

Fichera G, Mazzitelli C, Picciariello V, Maravic T, Josic U, Mazzoni A, Breschi L. Structurally compromised teeth. Part II: A novel approach to peripheral build up procedures. J Esthet Restor Dent. 2023 Aug 10. doi: 10.1111/jerd.13118. Epub ahead of print. PMID: 37565412.