12 July 2024

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Esthetic Rehabilitation with No-Preparation Veneers Applying BOPT: A Case Report with a 12-Month Follow-Up

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A 45-year-old female patient was referred to the Department of Cosmetic Dentistry, Damascus University, seeking to improve dental aesthetics. The clinical examination showed a low smile line and microdontia in the maxillary arch. The treatment plan consisted of applying no-prep veneers with gingival modification, which is described in the biologically oriented preparation technique (BOPT) as a gingitage technique.

The gingitage of the sulcus was performed using a yellow ring diamond flame with an inclination of 45 degrees, which causes it to bleed and creates a space between the internal wall of the sulcus and the axial wall of the tooth. After a 12-month follow-up, the gingiva was free of inflammation, recession, and plaque, and there was no increase in probing depth, according to the modified gingival index (MGI), gingival recession index (GRI), Silness-Loe plaque index (PI), and the community periodontal index of treatment needs (CPITN), respectively. The porcelain veneers were intact, with no chippings, cracks, and marginal discoloration. The patient was satisfied with her new smile.

Introduction

A smile is the most powerful communication approach between humans, and an attractive smile is a smile that looks natural and healthy. Conservative cosmetic treatment options are more favorable, which contributed to the minimally invasive dentistry approach. Recently, the new biomimetic ceramic materials required reduced thickness, which led to a noticeable reduction of preparation invasiveness and optimal preservation of tooth structure. No-prep veneers are the best treatment option due to the maximum preservation of tooth structure. However, they have several limitations, including esthetic and periodontal complications because of overcontoured restoration that could alter the emergence profile. The apical migration of the gingival margins is the main shortcoming of fixed prosthodontics, which compromises the esthetic aspects.

The biologically oriented preparation technique (BOPT) was proposed as an alternative, which results in optimal symmetry and better management of periodontal tissue when applying ceramic veneers. In addition, it offers multiple biological advantages, such as repositioning the emergence profiles and increasing the thickness of the gingiva and the gingival margin stability.

The aim of induced bleeding BOPT is to facilitate the access of immature connective tissue cells and epithelial stem cells and stimulate cell differentiation, which leads to the formation of new periodontal tissue. This case report presents the case of a patient with multiple diastemas who was treated with no-prep veneers with the gingitage technique.

Authors: Dima Alawa, Mawia Karkoutly, Hussam Milly

Source: https://onlinelibrary.wiley.com/