Biologically Oriented Preparation Technique In Restoring A Surgical Extruded Tooth

The biologically oriented preparation technique (BOPT), characterized by vertical tooth preparation without finishing line, demonstrates unique potential in improving gingival architecture. This report describes its application combined with surgical extrusion to address complex tooth fractures with 6 months follow-up. A 26-year-old male presented with traumatic fractures of maxillary central incisors. The right incisor exhibited a complicated crown fracture with subluxation, while the left incisor showed a complicated crown-root fracture extending 2mm below the gingival margin. Following fragment removal and immediate root canal treatment, the left incisor underwent surgical extrusion to align the fracture margin with gingival contour. Both teeth were splinted for 8 weeks using a fiber-composite splint. Post-stabilization evaluation revealed compromised gingival symmetry, with the extruded left incisor displaying a narrower gingival margin width compared to the contralateral tooth. BOPT protocol was implemented through vertical preparation, followed by 2-month temporary restoration with resin crowns. Definitive zirconia crowns were delivered after gingival stabilization, achieving optimal profile and symmetry at 6-month follow-up. Surgical extrusion preserved the non-restorable fractured tooth but induced dimensional discrepancies in supracrestal tissue structure, leading to gingival recession and asymmetry. BOPT addressed these problems through dynamic gingival remodeling, leveraging provisional restorations as biological guides. The synergy between extrusion and BOPT achieved predictable periodontal recontouring, yet warranted further validation with long-term studies. The integration of surgical extrusion and BOPT presents a viable solution for teeth with subgingival fractures, demonstrating therapeutic benefits both in functional rehabilitation and aesthetic harmonization.