CLINICAL RESEARCH

Biologically oriented preparation

technique (BOPT): a new approach
for prosthetic restoration of
periodontically healthy teeth
Ignazio Loi, MD, DDS
Private Practice, Cagliari, Italy

Antonello Di Felice, CDT

Private Practice, Rome, Italy

Correspondence to: Dr Ignazio Loi

Via Alghero 4, 09127, Cagliari, Italy;
Tel: +39 070 670365; E-mail: loi.ig@tiscali.it

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Abstract

terior areas with ceramometal and zirconia restorations, achieving high quality

Tooth preparations for xed prosthetic

clinical and esthetic results in terms of

restorations can be done in different

soft tissue stability at the prosthetic/tis-

ways, basically of two kinds: preparation

sue interface, both in the short and in

with a dened margin and the so-called

the long term (clinical follow-up up to

vertical preparation or feather edge. The

fteen years). Moreover, the BOPT tech-

latter was originally used for prosthetics

nique, if compared to other preparation

on teeth treated with resective surgery

techniques (chamfer, shoulder, etc), is

for periodontal disease. In this article,

simpler and faster when in preparation

the author presents a prosthetic tech-

impression taking, temporary crowns

nique for periodontally healthy teeth

relining and creating the crowns proles

using feather edge preparation in a ap-

up to the nal prosthetic restoration.

less approach in both esthetic and pos-

(Eur J Esthet Dent 2013;8:1023)

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Introduction

Horizontal preparations are preferred

when clinical and anatomical crown

One of the main clinical complications in

coincide and there is good periodontal

xed prosthodontics on natural teeth is

health. Prosthetic margins are located

the unsatisfactory esthetic result due to

near the cementoenamel junction (CEJ).

the apical migration of the gingival mar-

Preparations without nish lines are

gin.1,2

more conservative and are used when

The tendency of the gingival margin

the clinical crown does not coincide with

to migrate apically in time, is related to

the anatomic crown for the loss of sup-

different factors:

port due to periodontal disease. In these

Inadequate quality and quantity of

cases, the crowns margin is located on

keratinized gingiva (thin biotypes are

more likely to have recessions).
Reaction to a trauma during pros-

the root area.6-10

The difference between horizontal
and vertical preparations is that in the

thetic work (preparation, gingival

rst ones the margin is positioned by the

retraction).

dentist and leaves a well-dened line on

Chronic inammation due to pros-

the tooth, which is then replicated in the

thetic errors (technical problems like

impression and the working model. This

open margins, violation of the biolog-

is probably the reason that has made

ical width, horizontal overcontour).

prosthodontists prefer horizontal prep-

Trauma due to inadequate tooth

arations. For vertical preparations, the

margin is positioned by the laboratory

brushing.

technician based on the gingival tisAmong factors related to restorative

sue information. For the absence of a

procedures one is particularly relevant:

well-dened line, for the difculties in

preparation technique and the corre-

obtaining good esthetic results, for the

sponding geometry of the nish line.

possible risk of distortion of the metallic

Traditionally, there are two types of

preparations:3

margin during porcelain ring and func-

preparations with

tional load and for the resulting over

nishing lines, also called horizontal;

contour, some authors have considered

and preparations without nishing lines,

this preparation a possible cause of in-

described as feather edge.

ammation and gingival recession.11,12

dental

Even if there is no universally accepted classication, in time different types

BOPT

of preparations and margin denitions

have been proposed:4,5

Clinical advantages:

Shoulder.

Erasure of anatomical cementoe-

Shoulder with bevel.

namel junction (CEJ) in unprepared

Inclined shoulder (50 degrees and

teeth and deletion of the previously

135 degrees).
Chamfer.
Chamfer with bevel.

existing nish lines in already prepared teeth.

The possibility to position the nal
nish line at different levels, either

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Fig 1a

The prosthetic crown on the left central

incisor needs to be replaced. Note the asymmetry of

Fig 1b

A thorough periodontal probing is made to

map the intrasulcular space.

the crowns dimension and gingival margins architecture.

more coronally or more apically,

within the gingival sulcus (controlled

BOPT technique
description

invasion of sulcus), without affecting

the quality of marginal adaptation of

Preparation

the restoration.
The possibility to modulate the crown

Before starting the procedure, an accu-

emergence proles to create the

rate intrasulcular mapping is made with

ideal esthetic gingival architecture

a periodontal probe in order to assess

(adaptive forms and proles). In this

the level of the epithelial attachment

way, a new prosthetic cementoe-

(Figs 1a and 1b). If the tooth is intact,

namel junction (PCEJ) will be cre-

the initial phase is the preparation of the

ated.15,16

extragingival part of the tooth using a

Saving of dental structure.

diamond ame shaped bur (100/120 mi-

Easy and fast to execute.

cron granulometry). Then the intrasulcu-

Ease in relining and nishing tempor-

lar preparation is started by entering the

ary crowns.
Ease in impression taking.

sulcus with the bur tilted obliquely, so

that it cuts with its belly and not with the
tip, working at the same time on the tooth

Biological advantages:

and gingiva (gingitage technique) and

Increase in gingival thickness.

connecting this preparation plane with

Increased stability of the gingival

the axial one, into a single and even ver-

margin over time.

tical surface (nishing area) (Fig 2). In

Possibility to coronalize the gingival

this way, the existing CEJ is erased and,

margin by remodeling emergency

in prepared teeth, the same is done with

proles.

existing nishing lines. The bur interacts

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Fig 2

With a 120 microns grit ame shaped bur,

Fig 3

The tooth surface is then smoothed with a

the existing chamfer preparation is eliminated, leav-

30 microns grit bur. Note the intrasulcular bleeding

ing a margin-free surface.

due to the intentional gingitage procedure. The

blod clot formation will initiate the gingival tissue
biologic response, guided by the crowns prole.

Fig 4

The hollowed temporary crown is tried on

Fig 5

The temporary crown is relined with self-

the abutment.

curing methacrylate resin.

at the same time with the sulcular inter-

the dental anatomy or any pre-existing

nal wall and with the epithelial compo-

preparation margin. This will allow the

nent of the gingival attachment. While

creation of a nish area within which the

the gingitage technique proposed by In-

crown margin can be moved coronally.

bur,13,14

leaves

The nal step of the preparation is ren-

a neat nish line and is intended only

ing the entire surface with a 20-micron

to open the sulcus and help in impres-

diamond bur to smooth out the surface

sion taking, with BOPT the purpose is

(Fig 3).

graham using a chamfer

to eliminate the emerging component of

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Temporary crown relining

Based on a diagnostic wax-up, the
technician has previously prepared a
hollowed acrylic crown with a contour
that follows the gingival margin. After
verifying the t (Fig 4), the crown is relined with cold cure metacrylate resin
after isolating the abutment with glycerin (Fig 5). Once it has set, the crown
clearly shows two distinct margins: a
thin internal one, which reads the intrasulcular part of the prepared tooth,

Fig 6

Slightly before the nal setting of the resin,

the crown is removed from the abutment.

while the thicker external one follows

the external portion of the gingival margin. The space between the two margins is the negative image of the gingiva (Figs 6 and 7).
The space between the two portions
will be lled with uid acrylic resin or
with a light cured owable composite
resin to thicken the coronal margin and
allow the creation of the crown contour
(Figs 8a8c). The excess material is removed, connecting the crown margin
with the coronal prole at the gingival
margin (Fig 9). In this way, a new angular component will be formed together
with a new CEJ that will be positioned in

Fig 7

the sulcus, no deeper than 0.5 to 1 mm,

thin internal intrasulcular wall and the thicker exter-

fully respecting the biologic width (con-

nal one delimit the negative image of the gingival

trolled invasion of the gingival sulcus)

Details of the relined crowns margin: the

prole.

(Fig 10).
After an accurate polishing, the crown
is cemented and the excess cement material is easily removed.
As previously stated, gingitage prep-

tially, allowing the clot stabilization into

aration, together with the reduction of

a fully structured gingival tissue (clot

the tooth, will create a space that will be

preservation). The healing process will

lled by a clot resulting from intrasulcu-

determine the reattachment and thick-

lar bleeding. The intrasulcular portion of

ening of the gingival tissue, which will

the temporary crowns margin will sup-

mold and adapt to the new emergence

port the gingival margin circumferen-

prole (Figs 11a11e).

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Fig 8

The space between the two walls is lled

either with a owable light-cure composite (a) or

a uid mix of acrylic resin (b) After the setting, the
c

Fig 9

internal margin is evidenced with a sharp pencil (c).

The excess resin is trimmed away with a

Fig 10

The nished and polished crown that in-

paper disc and the emergence prole is shaped in

corporates the new CEJ with a new angular compo-

order to support the gingival margin.

nent of the emergence prole.

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Fig 11

After 4 weeks the blood clot, protected by the crowns margin, has developed into new connective

tissue and appears thickened and healthy, but still in maturation (ac). Now the reshaping of the gingival
margin can start. The crowns margin is shortened, mirroring the contour of the adjacent tooth (d). Within
one more week the gingival margin moves in a coronal direction and the ideal scalloped architecture is
completed (e).

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Impression technique

area between the two lines, the black

and the blue ones, is called the nish-

After a minimum of 4 weeks, the gingival

ing area and the technician will mark

tissue will be stabilized and it will be

the nishing line with a red pencil, on

possible to take the impression to nal-

which will fall the coronal margin (Fig 13).

ize the restoration. The absence of any

Positioning this line more apically or

nish line will make the procedure faster

coronally will depend on the depth of

and simpler. The use of two retraction

the sulcus and on the esthetic needs,

cords is strongly suggested in order to

but the crown margin will never invade

have a good reading of the sulcus and

the epithelial attachment. The red line is

to help the technician during laboratory

now the reference margin for the ditch-

procedures.

ing procedure and for eliminating the

underlying unuseful segment.

Laboratory procedures

As opposed to what other authors

have proposed for restorations with
feather

allow the technician to identify the n-

BOPT technique introduces a new con-

ish area on the working model. Since

cept based on an observation that it is

an improved control over the gingival

the gingival prole that adapts itself in a

levels is needed before exposing the

specular way to the coronal emergence

nishing area, a black mark is traced

prole and not the opposite (adaptation

with a 0.5 mm pencil over the gingival

forms and proles concept).

contour projecting it on the abutments

wall (black line).

edge

preparations,15,16

The development of the impression will

the

Based on this concept, the creation

of the proles is done on the master cast

Afterwards, the gingival part around

without the gingival component, creat-

the abutment is removed, showing the

ing a morphofunctional and esthetic

subgingival area of the preparation re-

ideal contour (Fig 14). The prosthetic

produced on the model (Fig 12). The

restoration is then transferred on the

apical part of the model is now exposed

model with the gingiva (Figs 15a15e)

and it will be marked with a blue line. The

to evaluate the contours tridimensional-

Fig 12

Fig 13

The black line projects the gingival margin

on the abutment. Then the gingiva is removed to expose the nishing area as recorded in the impression.

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Markings of the thee lines in the nishing

area and ditching of the abutment.

LOI

Fig 14

d
Fig 15

First ceramic bake on the master model without the gingival anatomy.

e
The crown contours, esthetically shaped, cannot be seated on the anatomic model reproducing

the gingiva (a). With a scalpel the technician removes the interferences until the crowns are fully seated
(b). Filling with ceramic the new parabolic volume (c and d). The new contours nished and polished (e).

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ly. In order to t the crown on the model,

the technician removes any small interference with the marginal gingiva using
a sharp scalpel, simulating the interaction between the prosthetic contours
and the gingiva that exists in vivo with
the oral tissues17-19 (Figs 1618).

Discussion
Fig 16

The case before treatment.

The results achieved in the last 15 years

with the BOPT technique allow the authors to make some clinical and biological considerations.
The coronal seal is denitely better on
feather-edge preparations than on horizontal ones. This is due, as it has been
demonstrated by many authors,20-22 to
the decreased space between the teeth
and crown as a result of vertical geometry. It results in a better t, a lesser cement exposure and a diminished bacterial penetration.
Some authors have also demonstrated that a bad periodontal response de-

Fig 17

The case completed.

pends more on a poor crowns margin

adaptation rather than on the placement
of the nishing margin inside the gingival
sulcus.23,24
This result conrms that margins can
be placed within the sulcus and the
BOPT efcacy is based on this. The other fundamental concept is that the nish
line of horizontal preparations is located
on the prepared tooth, while the nish
line is the prosthetic crowns margin itself
in the BOPT technique. This margin can
be shortened or extended both in the
temporary or nal restoration at differ-

Fig 18

The patients smile.

ent intrasulcular levels, without harming

the quality of t and without invading the
epithelial attachment because the nish

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Fig 19

Another case before treatment.

Fig 20

The restoration completed in close up.

Fig 21

The pre-treatment situation of a case where

Fig 22

Master model with the nished crown be-

new crowns on natural abutments are planned to-

fore delivery to the patient.

gether with implant-supported restorations.

Fig 23

Occlusal view before crowns cementa-

Fig 24

Clinical aspect of the nished case.

tion. The same prosthetic concepts are applied to

both natural and implant abutments and generate the
same thickening effect on buccal gingival tissues.

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area is always located above it (con-

dentistry in the implant BOPT (IBOPT)

trolled invasion of the gingival sulcus).

through the implementation of a shoul-

With the BOPT technique it is possible

derless abutment design.26 The IBOPT

to transfer the emergent anatomy to the

abutment has no nish line and it is the

prosthetic crown. This allows a free in-

buccal gingival margin of the crown to

teraction with the gingiva that will adapt,

create the soft tissue form. The reduced

shape and settle around new forms and

buccal width of the abutment gives more

proles (adaptation forms and proles

space to the gingival thickness and pro-

concept). Apparently, the crowns con-

motes stability (Figs 2024).

tours obtained with the BOPT technique

may appear excessively pronounced,
based on the traditional denition of

Conclusions

overcontour. It is the authors opinion

that this concept should be reinterpret-

In 15 years of clinical experience, the

ed. In fact, there is no consensus on what

BOPT technique has proven success-

a normal contour should be. Sorensen

ful in maintaining stability of pericoronal

suggested that a vertical contour up to

soft tissues in both anterior and poster-

45 degrees can be still considered as

ior areas, in both natural teeth and im-

normal.25

Based on the authors experi-

plants. With the BOPT technique, the

ence, there is no absolute overcontour,

clinician and the laboratory technician

but instead different new contours and

can interact with the surrounding tissues

new PCEJs.

modifying their shape and scalloped

In contrast to what other authors sug-

architecture regardless of any preexist-

gest,11,12 in most BOPT cases it is very

ing dental or gingival limitation. The ad-

uncommon to observe inamed gingiva

vantages are relevant considering that

and recession related to the crowns

most of the clinical results are obtained

contours.

only through the restoration itself, both

The BOPT technique, with the interaction

between

preparationres-

provisional and nal (margin position,

emerging prole, tooth form).

torationgingiva (gingitage, clot, new

In order to give scientic value to this

contour), enables the gingiva to thicken

technique, more clinical and biological

and to adapt to new forms, resulting in

studies are needed. A prospective mul-

increased stability both in the short and

ticenter investigation will be designed

in the long term. As previously men-

to verify if the BOPT procedure can be

tioned, it is commonly observed that

used by clinicians with predictable re-

the apical recession of the marginal

sults.

gingiva (Fig 19) can be corrected just

by the elimination of pre-existing nish
lines and by the new emergence prole

Acknowledgment

of the crown (Fig 20).

The same concepts and procedures
have

been

applied

also

in

implant

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The authors want to express their gratitude to Dr

Roberto Cocchetto for his invaluable help in writing
and editing this article.

LOI

References
1.



4.



6.

7.





Valderhaug J. Periodontal
condition and carious lesion
following the insertion of
xed prosthesis: a 10-years
follow-up study. Int Dental
Journal 1980;30:296304.
Valderhaug J, Birkeland M.
Periodontal conditions in
patients 5 years following
insertion of xed prostheses.
J Oral Rehab 1976;3:237
243.

1BSEP
(*
"
GVMM
DBTU
SFTUPSation design offering superior
marginal characteristics
J.Prosthet Dent1982;48:539
543.
Shillinburg HT, Hobo S,
Whitsett LD. Fundamentals
of xed prosthodontics ed
2. Chicago: Quintessence
Publishing Co, 1981:9093,
118.

,VXBUB
.
(JOHJWBM
NBSHJO

design of abutments for
ceramometal restorations. 2.
Quintessence Dent Technol
1979;10:2738.
Amsterdam M, Abrams L.
Periodontal prosthesis. In
).
(PMENBO
BOE
%8

Cohen (eds). Periodontal
therapy, ed 4. St.Louis: CV
Mosby Co, 1968.
Amsterdam M, Rossman SR.
Technique and hemisection
of multirooted teeth. Alpha
Omegan 1960;53:415.

$BSOFWBMF
(
%J
'FCP

( 5SFCCJ
-
"
QBUJFOU
QSFTentation: planning a difcult
case. Int J of Perio Rest Dent
1981;6:5163.

$BSOFWBMF
(
'SFOJ
4UFSSBOUJOP
4
%J
'FCP
(
4PGU
BOE

hard tissue wound healing
following tooth preparation to
the alveolar cret. Int J Periodont Rest Dent 1983;6:37
53.



%J
'FCP
(
$BSOFWBMF
(

Freni Sterrantino S. Treatment of a case of advanced
periodontitis: Clinical procedures utilizing the combined preparation technique
Int J of Perio Rest Dent
1985;5:5262.
11. Lang NP, Kiel RA, Anderhalden K. Clinical and microbiological effects of sub-gingival
restorations with overhanging or clinically perfect
margins. J Clin Periodontol
1983;10:563578.
12. Martignoni M, Schonenbergher A. Precisione e
contorno nella ricostruzione
protesica.Berlin: Quintessenza Biblioteca, 1987
13. Ingraham R, Evens JK. Tissue management in cavity preparation Dent Dimen
1975;9:911.
14. Ingraham R, Sochat P,
Hansing FJ. Rotary gingival curettage: A technique
for tooth preparation and
management of the gingival
sulcus for impression taking.
Int J Periodont Rest Dent
1981;1:933.


"CSBNT
-
(SBEVBUF

periodontal and prosthetic
lectures. Boston University
4DIPPM
PG
(SBEVBUF
%FOUJTUSZ

1971. Boston: Boston University Press, 1971.
16. Kay HB. Criteria for restorative contours in the altered
periodontal environment.
Int J Periodont Rest Dent
1985;5:4263.
17. Loi I. Protesi su denti naturali nei settori di rilevanza
estetica con tecnica BOPT:
Case series report. Dental
Cadmos 2008;76:5159.


-PJ
*
4DVUFMM
'
(BMMJ
'

Tecnica di preparazione
orientata biologicamente
(BOPT).Un nuovo approccio
nella preparazione protesica in odontostomatologia,
Quintessenza Internazionale
2008;5:6975.



-PJ
*
(BMMJ
'
4DVUFMM
'
%J

Felice A. Il contorno coronale
protesico con tecnica di
preparazione BOPT (Biologically Oriented Preparation
Technique) :considerazioni
tecniche. Quintessenza
Internazionale 2009;25:419.
20. Rosner D. Function,
placement,and reproduction
of bevels for gold castings. J
Prosthet Dent 1963;13:1160
1166.
21. Belser UC, Mac Entee MI,
Richter W. Fit of porcelainfused-to-metal marginal
designsin vivo: a scanning
microscope study. J. Prosthet Dent 1985;53:2429.
22. Cagidiaco MC, Ferrari M,
Bertelli. Cement thickness
and microleakage under
metal-ceramic restorations
with a facial butted margin:
an in vivo investigation.
Int J Periodont Rest Dent
1992;4:324331.
23. Richter WA, Ueno H. Relationship of crown margin
placement to gingival
inammation. J Prosthet Dent
1973;30:156161.
24. Waerhaung J. Histhologic
consideration which govern
where the margins of restorations should be located in
relation to the gingival. Dent
Clin North Am 1960;4:201
207.
25. Sorensen JA. Standardized
method for determination
of crown delity. J Prosthet
Dent 1990;64:1824.
26. Canullo L Cocchetto R Loi
I. Periimplant tissue remodeling: scientic background
and clinical implications.
Chapter 8: Abutment Morphology and Peri-Implant Soft
Tissues. Milan, Italy: Quintessence Editions, 2012.

23
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