Vertical Teeth Preparation: A Comprehensive Systematic Review of Patient Outcomes and Clinical Complications

Objective This study aimed to evaluate the influence of vertical tooth preparation techniques on tooth-supported fixed restorations, with specific attention to survival and success rates, periodontal outcome, and clinical complications. Methods A comprehensive literature search of related randomized controlled trials, prospective/retrospective cohort studies, and clinical trials was accomplished across electronic databases (MEDLINE/PubMed, ScienceDirect, Scopus, and Cochrane Central Library) up to March 2025. Primary outcomes included survival and success rates of tooth-supported fixed prostheses, whereas secondary outcomes encompassed periodontal health indices (bleeding, plaque, and recession), patient satisfaction, and mechanical/biological complications. Studies with a minimum follow-up period of six months were considered. Two reviewers independently conducted studies collection, data extraction, and quality assessment. Results This systematic review (12 studies, 2012–2024) evaluated patient outcomes and clinical complications of vertical preparation. Survival rates ranged from 96.5% to 100% across preparation types [biologically oriented preparation technique (BOPT), feather-edge, and chamfer]. Success rates (78%–100%) and periodontal outcomes also varied: plaque indices (57.9%–82% score 0), pocket depths (≤3 mm in 80%–97.9% cases), and bleeding on probing (8.4%–55.5%) showed no clear preference for any preparation method. BOPT and feather-edge correlated with lower bleeding rates than chamfer. Mechanical complications (ceramic chipping: 1.4%–15%) were more frequent than biological issues (2%–2.7%). Survival rates and patient satisfaction (80%–100%) were high. Discussion The findings of this systematic review supported the use of vertical techniques as a reliable option for fixed prostheses, balancing structural preservation and long-term success, making them a viable, tissue-preserving choice when indicated. Conclusion Vertical preparation techniques demonstrated favorable periodontal outcomes, high survival rates, and high patient satisfaction. Manageable mechanical and biological complications supported their viability for tooth-supported prostheses.