EIJMRMS ISSN: 2750-8587
VOLUME04 ISSUE06
152
METHOD OF VORT IN PRACTICE OF DENTISTRY
Narziyeva Nigora
Samarkand State Medical University, Uzbekistan
Burxonova Zarafruz Kobilovna
Samarkand State Medical University, Uzbekistan
AB O U T ART I CL E
Key words:
VORT, vertical dissection, temporary
crowns.
Received:
20.06.2024
Accepted
: 25.06.2024
Published
: 30.06.2024
Abstract:
The challenge facing reconstructive
dentistry today is how to achieve excellent
aesthetic results while preserving the biological
structures involved as much as possible. Today,
clinicians and dental technicians have materials
and procedures at their disposal that make it
possible to recreate aesthetics and function in a
simpler and more predictable way.
INTRODUCTION
One of the main clinical complications of non
—
removable prosthetics on natural teeth is an
unsatisfactory aesthetic result due to the apical migration of the gingival margin. Thanks to the concept
of BOPT (Biologically oriented preparation technique), the clinician and dental technician can influence
the tissues surrounding the tooth, changing their shape and tooth architecture, regardless of any pre-
existing dental or gingival limitations.
We know that the apical migration of the gum is associated with various factors:
1. Inadequate quality and quantity of keratinized gums (thin biotypes are more likely to have
recessions)
2. Reaction to injury during prosthetics (preparation, gum retraction). Chronic inflammation due to
prosthetics errors (open edges, violation of biological width, horizontal hyperconture)
3. Poor oral hygiene and toothbrush injury.
VOLUME04 ISSUE06
https://doi.org/10.55640/eijmrms-04-06-23
Pages: 152-162
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ISSN: 2750-8587
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With the BOPT concept, it is possible to transfer the anatomy of teething from the gum to an artificial
crown. This will ensure free interaction with the gum, which will adapt, take shape and settle around
new shapes and profiles. The contours of the crown obtained using the BOPT technique may seem
overly pronounced, based on the traditional definition of "hyperconture". Clinically, there is no
redundant contour, but there is a "different new contour" and a new PCEJ (orthopedic cement-enamel
compound) (Fig. 1).
Fig.1.
MATERIAL AND METHOD
Among the factors related to the BOPT concept, one is particularly important: the preparation technique
and the corresponding geometry of the final preparation line.
Traditionally, there are two types of crown preparation:
1. Preparation with end lines (also called horizontal)
Ledge
Shoulder ledge with bevel
Ledge inclined shoulder (50 degrees and 135 degrees)
Rounded ledge
Rounded ledge with a bevel
2. Dissection without an end line (also called vertical), described as an edge from a light touch of the
edge of a bird's feather.
Horizontal dissections are preferable when the clinical and anatomical crown coincide, and when the
periodontal condition is good. The edges of the crown are located next to the cement-enamel joint (CEJ).
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ISSN: 2750-8587
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Dissection without end lines is more conservative and is used when the clinical crown does not match
the anatomical crown due to loss of stability due to periodontal disease.
Although preparation in the form of a bird's feather edge is usually indicated for use in periodontal
affected teeth used as support for fixed prostheses, this approach may also represent a less invasive
alternative to a horizontal edge in various other clinical settings.
They include the replacement of old crowns (fig. 2), which have:
• inadequate quality and quantity of keratinized gums
• violation of biological width
• changing the color of the gums
• impaired gum architecture
Fig.2.
As well as under conditions such as endodontically treated teeth or live teeth in young people who
require a change in color or shape, or are susceptible to erosive and abrasive pathologies.
Fig.3 illustrates the BOPT technique with veneers without preparation.
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Рис.3.
The main clinical difference between horizontal and vertical dissection is that in the first case, the edge
is set by the dentist and leaves a clearly defined line on the tooth, which is then reproduced in the
impression and working model. In vertical preparation, the boundary is determined by a dental
technician based on information about the gum tissues.
RESULTS
Before starting treatment with a periodontal probe, a careful intracerebral probing is performed to
assess the level of epithelial attachment (Fig. 4).
Fig.4.
Preparation of the tooth in the form of a bird's feather edge is performed using a flame-shaped boron,
separating the points of inter-proximal contacts and following the contour of the gum in order to
remove the undercurrents of the natural tooth and ensure an adequate fit of the crown (Fig. 5).
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At the end of tooth preparation, a minimum space of 0.3 mm along the edge, 0.5 mm along the axial
walls and from 1 to 1.5 mm on the occlusal surface is provided to ensure sufficient mechanical
resistance of the crown. The final shape of the preparation has a slightly conical shape (from 2 to 6
degrees), which allows you to get a full 360-degree view of the cervical perimeter of the natural
supporting tooth (Fig.5).
Fig.5.
Boron simultaneously interacts with the inner wall of the tooth inside the groove and with the epithelial
component of gum attachment (the technique of gingival curettage using boron). This removes the
existing CEJ or the existing horizontal end line. This allows you to create a finishing zone within which
the edge of the crown can move coronally or apically.
Rebasing the temporary crown is the key to understanding how to create a new CEJ. The new edge of
the temporary crown with a new shape and a new contour is located in the groove no deeper than 0.5
–
1 mm, fully respecting the biological width (controlled insertion into the gingival furrow) (Fig. 6).
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Fig.6.
Curettage preparation, together with tooth reduction, will create a space that will be filled with a clot
from intracellular bleeding. Inside, the groove part of the edge of the temporary crown will support the
edge of the gum circumference, ensuring the stabilization of the blood clot into a fully structured gum
tissue (clot preservation). The healing process will determine the reattachment and thickening of the
gingival tissue, which will form and adapt to the new eruption profile (Fig. 7).
Fig.7.
After at least four weeks, the gum tissue will stabilize, and it will be possible to remove the impression
for final restoration.
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Cementing of a permanent crown is performed using a cofferdam when the end line is located near the
edge of the gum. In this case, the usual adhesive procedure is performed, including etching, priming and
bonding of the tooth surface, and light-curing composite cement is used. When the edge of the crown is
located inside the gingival groove, alternative systems are used to isolate the environment from
moisture (for example, lip retractors, cotton pads or retraction threads to control the gingival groove
fluid) (Fig. 8).
Figure 8.
If coronary or apical soft tissue migration is required, in accordance with aesthetic expectations, we can
change both the temporary crown and the final edge of the crown by creating a new orthopedic CEJ,
more coronary or more apical. After a few weeks, the edge of the gum adapts to this new eruption profile
(Fig. 9).
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Fig.9.
CONCLUSION
The scientific literature contains extensive criticism of the edge of dissection in the form of a bird's
feather edge, mainly due to the presence of a hyperconture of the crown and, as a result, the fragility of
the crown associated with the limited thickness of the crown in the cervical region. It should be
emphasized that in everyday dental practice, however, these problems have no real clinical significance
and, apparently, do not represent a specific risk factor either for periodontal health or for the strength
of restoration if the correct clinical and dental requirements are met. The reaction of soft tissues
observed for a long time is optimal, with a stable position of the gums and absolutely no signs of
inflammation. This can be explained by the anatomical condition that is achieved using this approach,
which consists in creating an artificial CEJ, similar to the cement-enamel compound found in nature.
The edge of the artificial crown creates an excessive contour, just as it happens in a natural CEJ, where
there is always a change in the slope of the profile between the root and the crown. This small marginal
bulge provides support for periodontal tissues, providing excellent stability of the gum contour. The
edge of the artificial crown remains located in the surface part of the space inside the gingival groove,
without damaging the periodontal attachment. Moreover, the vertical edge is compatible with a high
level of precision of the edge fit of the crown, which also affects the health of marginal tissue and ensures
lower penetration of carious bacterial flora.
The strength of a permanent artificial crown (whether it is lithium disilicate, zirconium dioxide or
cermet) is guaranteed both by an adequate occlusal thickness and by strengthening the edge area due
to a slight increase in the penetration profile of a thin layer of ceramics, zirconium dioxide or metal (for
cermets). This moderate increase in the edge thickness creates a neck garland, which strengthens the
artificial crown.
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Using the VORT method, a dentist and a dental technician can easily and predictably interact with the
tissues surrounding the tooth. Clinical results are achieved through the crown itself, both temporary
and permanent (the location of the edge, the profile of the eruption, the shape of the tooth). Such an
orthopedic approach using a flap-free preparation method in the form of a bird's feather edge is easier
and faster compared to other preparation methods (rounded ledge, shoulder ledge, etc.).
We can achieve high-quality clinical and aesthetic results in terms of soft tissue stability at the border
of the crown and gum tissue using a minimally invasive approach, preserving as many biological
structures involved in treatment as possible.
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