Periodontal dominance in prosthetic preparation
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VEP, our acronym for Vertical Edgeless Preparation, is a full-crown prosthetic preparation method indicated for teeth that have lost attachment tissue – even where probing depths are minimal (≤ 3 mm) – and consequently have incomplete periodontal support. This technique involves extending the preparation subgingivally to ideally treat the entire exposed root surface as far as the epithelial attachment.
As the name suggests VEP does not produce a post-preparation edge. Instead of a marked finish line and associated transition angle, the technique creates a vertical tooth wall extending from the bottom of the sulcus on which the prosthetic crown margin may be positioned at a flexible height while still ensuring a reliable seal.
The periodontal dominance of VEP is due to the marginal periodontal tissue response to the subgingival preparation work: the healed tissues go on to submerge the inevitable transition angle remaining at the apical end of the prepared surface. This leaves a prosthetically exploitable axial wall area with no angles or margins, therefore edgeless.
This publication presents and describes the methodology along with a review of the underlying concepts including the Cartesian coordinate system and significant orders of magnitude. A new simplified classification is proposed dividing the various prosthetic preparation techniques into two straightforward groups.
Attention is also paid to the anatomical, histological and physiological aspects regarding the marginal periodontium which account for the periodontal dominance of this procedure. A detailed innovative analysis follows of the rationale behind extending prosthetic preparation apical to the gingival margin based on periodontal assessment of the tooth requiring treatment.
VEP is then described in practical terms including the various clinical and laboratory stages, instruments and operative sequence while comparing classical applications with more recent approaches in the light of ongoing technological developments.
Contents
Chapter 1. Geometry, Terminology, and Classification of Prosthodontics Preparation techniques
Chapter 2. Periodontal Dominance in VEP
Chapter 3. Tooth preparation: clinical and laboratory aspects
Chapter 4. Indications and advantages of VEP
Author
Italy
Dr Edoardo Foce graduated with a degree in Medicine and Surgery from the University of Genoa, Italy, with postgraduate specialization in dentistry and prosthodontics. From 1988 to 2019, Dr Foce was as an active member of the Italian Society of Conservative Dentistry, the Italian Society of Endodontics, the European Society of Endodontics, the Italian Academy of Prosthetic Dentistry, the Italian Society of Oral Surgery and Implantology, and the Italian Society of Periodontology and Implantology. He is currently active as a member of the Italian Society of Periodontology and Implantology and the Italian Academy of Prosthodontics. Between 2009 and 2013, Dr Foce served as Visiting Professor of Periodontology at San Raffaele University in Milan, Italy. He has been a guest speaker at conferences and congresses related to various dental specialties. Currently, Dr Foce works in private practice in La Spezia, Italy, where he deals with multidisciplinary dentistry with a special interest in dental implantology and prosthetic-periodontal cases.