Technical Note

Vertical Edgeless Preparation: Periodontal Dominance in

Prosthetic Crown Preparation
Gaetano Noè 1 , Andrea Toffoli 1, * , Edoardo Foce 2 , Gianfranco Di Febo 3 , Gianfranco Carnevale 4 ,
Roberto Bonfiglioli 3 , Guido Maria Macaluso 1 and Edoardo Manfredi 1

1 Department of Medicine and Surgery, Dental School, University of Parma, Via Gramsci 14, 43126 Parma, Italy;
gaetanonoe@gmail.com (G.N.); guidomaria.macaluso@unipr.it (G.M.M.); edoardo.manfredi@unipr.it (E.M.)
2 Private Practice, Via Vittorio Veneto 99, 19121 La Spezia, Italy; focedado@gmail.com
3 Private Practice, Piazza di Porta Mascarella 7, 40126 Bologna, Italy; difebo@centromascarella.it (G.D.F.);
erre.bonfi@gmail.com (R.B.)
4 Private Practice, Via Ridolfino Venuti 38, 00162 Roma, Italy; gi.carnevale@libero.it
* Correspondence: andrea.toffoli@unipr.it

Abstract: This article aims to describe Vertical Edgeless Preparation (VEP), a full-crown vertical
preparation technique initially introduced by the Porta Mascarella Group in the 1980s. The method
is defined as “periodontally driven” because its main indication is teeth with a loss of periodontal
attachment, and it aims to obtain healthier periodontal tissues. This work describes the step-by-step
procedure for performing this prosthetic technique and its indications, contraindications, impression
phases, temporary crown management, and its biological concept of periodontal dominance.

Keywords: prosthodontics; vertical preparation; full crown

1. Introduction
This work describes the Vertical Edgeless Preparation technique, its advantages and
Citation: Noè, G.; Toffoli, A.; Foce, E.;
limits, and the biological concepts on which the technique relies.
Di Febo, G.; Carnevale, G.;
Vertical Edgeless Preparation (VEP) is a full-crown preparation technique that extends
Bonfiglioli, R.; Macaluso, G.M.;
to the subgingival part of the root and is indicated for teeth with a loss of periodontal
Manfredi, E. Vertical Edgeless attachment. As described in communications, presentations, and books [1], VEP has been
Preparation: Periodontal Dominance used since the 1980s, being devised by the Porta Mascarella Group, a team of dentists and
in Prosthetic Crown Preparation. dental technicians composed of Dr. Di Febo, Dr. Carnevale, Mr. Trebbi, and Mr. Bonfiglioli,
Prosthesis 2023, 5, 358–367. https:// who were also founding members of the Italian Academy of Prosthetic Dentistry. At
doi.org/10.3390/prosthesis5020026 that time, this prosthetic preparation was performed by prosthodontists on patients who
suffered from periodontal disease as part of a treatment plan which involved the prosthetic
Academic Editor: Marco Cicciu
rehabilitation of teeth with reduced periodontal support, regardless of the presence of
Received: 15 March 2023 augmented probing depth after the initial periodontal treatment. The Porta Mascarella
Revised: 29 March 2023 Group also published the procedure of open-flap preparation, but not the technique known
Accepted: 30 March 2023 at the time as “preliminary prosthetic preparation” or “vertical feather edge preparation”.
Published: 5 April 2023 Regarding the latter definition, it is necessary to specify that there were many different
interpretations of feather-edge preparations. The one from which VEP was developed was
known as “feather edge according to Porta Mascarella” [2–4].
In 2015, Bedendo, Di Febo, and Foce published, in an Italian journal, an article under
Copyright: © 2023 by the authors.
the name “Vertical preparation Technique”, which detailed the technical aspects, the tools
Licensee MDPI, Basel, Switzerland.
to use, and the operative phases relating to the general principles of vertical preparations,
This article is an open access article
distributed under the terms and
describing the various stages of this procedure step-by-step. This work described the
conditions of the Creative Commons
operative technique of this prosthetic preparation, its advantages, and its limits without
Attribution (CC BY) license (https://
addressing the biological principles and the relationship with the marginal periodontium,
creativecommons.org/licenses/by/ which represents one of the main features of this procedure. These aspects have been
4.0/). addressed from 2020 to 2021 in a series of four articles in Italian and a monograph [1].

Prosthesis 2023, 5, 358–367. https://doi.org/10.3390/prosthesis5020026 https://www.mdpi.com/journal/prosthesis

Prosthesis 2023, 5 359

Teeth prepared according to the VEP technique present an area prosthetically usable
for marginal closure, with no steps, transition angles, edges, and undercuts; hence the
name “edgeless”. This particular and unique feature allows the prosthetic margin to be
positioned at different heights on the abutment surface, maintaining a reliable marginal
closure. The convergence between the final part of the prepared surface and the unprepared
surface results in a transition angle which, however, will be fully covered by the regrowth
of the healed periodontal tissues (junctional epithelium) injured during the preparation
procedures and will hence be irrelevant from the clinical perspective. To avoid interference
during tissue-healing processes, the margin of the provisional crown will be placed extra-
gingivally. On the basis of evaluation based on tissue thickness, materials used, and esthetic
needs, the clinician will be able to decide where to position the final prosthetic margin.
The root surface whose periodontal attachment is lost consists of necrotic cement and
dentin; these tissues are exposed to pathogens and could be compromised by toxins and
bacteria. Preparing these parts of the tooth helps protect the dental tissues from the oral
environment and eliminates the external and more compromised part of the root [5]. This
procedure is possible only on teeth with a loss of periodontal attachment, as performing
it on a periodontally intact tooth would result in periodontal damage. It is essential to
underline that the loss of periodontal attachment is not a synonym of active periodontitis,
which is a contraindication for prosthetic treatments [6]. Still, it refers to all those teeth
which have lost support in the past without active disease in the present, a widespread
occurrence in the adult population [7]. Subgingival preparations with diamond burs clearly
create periodontal damage, which have been shown to increase periodontal inflammation
indexes temporarily [8]. However, it is well-known from the classic literature that the
periodontal tissues wounded during tooth preparation will ultimately recover if left to
heal undisturbed [9,10]. The VEP technique, therefore, requires the provisional crown
margins to be left coronally to the gingival margin so that they cannot interfere with the
periodontal healing.
While most prosthetic crown preparation techniques are bur-shaped because the tooth/root
surface is shaped as the counter-mold of half of the bur, the VEP technique implies that the bur
is used at different angles, resulting in an edgeless, not-bur-shaped abutment.
VEP differs from other vertical preparation techniques since, unlike VEP, traditional
feather-edge or knife-edge preparations present a defined finishing line (Figure 1), and they
often use the provisional crown to manage soft tissues.
This technique is indicated for patients with thick/medium periodontal phenotype,
and when the tooth presents a loss of periodontal attachment and a probing depth greater
than 2 mm. Moreover, VEP is particularly indicated when extending the prosthetically
usable area is necessary to obtain more excellent retention and stability and to hide the
crown margin below the gingival level. Additionally, it helps approach old preparation or
restoration margins and small carious lesions below the gingival margin. Finally, it is indi-
cated when the clinician needs to bypass morphologic or structural alteration in the gingival
margin area, or when preparing a tooth with a long clinical crown in which a horizontal
preparation technique would result in a more significant loss of dental tissue (Figure 2).
On the other hand, VEP is contraindicated when the tooth requiring a complete crown
preparation allows maintaining the finishing line on enamel or does not present periodontal
attachment loss unless the treatment plan includes a reduction of the clinical attachment.
Additionally, it is fundamental to underline that the patient should not suffer from active
periodontitis when considering definitive prosthetic therapies and that periodontitis must
be treated before prosthetic planning and delivery.
The presented technique consists of a simple, effective, and easy-to-manage vertical
preparation philosophy, which also represents an essential inheritance of the School of
Porta Mascarella, one of the most important Italian study centers in prosthetic dentistry.
Prosthesis 2023, 5 360

Figure 1. (a) Subgingival finishing line on traditional vertical preparation. (b) A periodontal probe
shows the absence of a finishing line on a tooth prepared with the VEP technique.

Figure 2. Amount of tooth reduction with VEP (left) and with a horizontal preparation (right).

2. Technique
1. Periodontal mapping: The first step is to map the periodontium of the tooth with a
periodontal probe. Hence, the evaluation is repeated with a steady Komet 862 bur
(Komet Dental, Germany). The tip of the steady bur tilted 30◦ leans on the root surface.
Moving it in the sulcus allows the periodontal site mapping as if it were a probe,
obtaining the necessary anatomical information.
2. Initial reduction: Subsequently, the occlusal part of the tooth is reduced to create
adequate prosthetic space. The amount of occlusal reduction is defined by the nec-
essary thickness of the material used for the crown and the distance between the
to-be abutment and the opposing tooth. Usually, and specifically, when the tooth
is close to other dental structures not included in the prosthetic rehabilitation, the
preparation phase is preceded by an interproximal separation phase which prevents
sound structures from being damaged by the burs during subsequent steps.
3. Primary progressive reduction: This procedure is performed by using the bur with
an inclination of 30◦ so that only the final part of the bur is in contact with the tooth
structure. The bur is kept more coronal than the previously measured depth of the
gingival sulcus of that site. In this way, the tissue of the root surface and a small
component of the internal part of the gingival sulcus is removed. This reduction will
result in a small step at the level corresponding to the tip of the bur. At this point, the
preparation is “bur-shaped” as with most of the complete crown techniques (Figure 3).
Prosthesis 2023, 5 361

4. Secondary progressive reduction: The previously performed reduction of tooth struc-

ture and the push of the bur on the gingival margin, together with the unavoidable
gingitage, will result in an augmented space between the tooth structures and the
gingival margin. This allows the clinician to obtain better vision and access to the
deepest parts of the sulcus and, therefore, to see and remove any calculus, steps,
grooves, or undercuts from the root surfaces. Using a “toe-heel” technique, the apical
part of the root surface is structured, creating the edgeless profile of this preparation.
Then, the coronal portion of the abutment is reduced by using a bur with reverse
angulation. In this phase, it is also necessary to connect the different reduction planes
created during the various stages (Figure 4).
5. Finishing: At the end of these steps, which are performed with coarse-grain burs, the
abutment preparation is finished with fine-grain burs.
6. Temporary crown relining and delivery: Next, the insertion and the housing of
the temporary crown are checked and then relined. It is essential not to move the
crown during the relining stage so that the margin will not open, guaranteeing an
adequate closure (Figure 5). After that, refining is necessary, keeping the margin as
thin as possible. After polishing, the temporary crown is cemented with eugenol-free
temporary cement. With the VEP technique, as with the intraoperative preparation
technique, the apical part of the abutment reached by the bur does not correspond
with the prosthetic margins, both for the provisional crown and the ceramic one. The
cervical margin of the temporary crown is placed coronally to the corresponding
gingival margin to allow undisturbed healing of the soft tissues surrounding the
abutment (Figure 6).

Figure 3. Primary progressive reduction.

The abutment now presents a “prosthetically usable surface” which is edgeless in

all its extensions rather than a defined preparation margin. VEP is a vertical prosthetic
preparation technique because due to the fact that as the drill penetrates apically inside the
sulcus or pocket, its removal of tissue from the root wall will tend to decrease until it is zero.
It will therefore result in the formation of a transi-tion angle between the prepared part of
the root and the unprepared part. This angle will not be exposed as it will be submerged
by sulcular epithelium adhering to the root wall after the healing phase. Therefore, it will
be irrelevant from a clinical-practical point of view. At the end of soft tissue maturation,
choosing the ideal position of the final prosthetic margins will also be possible (Figure 7).
Prosthesis 2023, 5 362

Figure 4. Secondary progressive reduction.

Figure 5. Relined provisional FPP: the absence of a beyond-preparation area makes the refining
procedure faster and more straightforward.
Prosthesis 2023, 5 363

Figure 6. Provisional crown delivery and tissue healing.

Figure 7. VEP-prepared tooth after soft-tissue healing.

3. Discussion
3.1. Tooth Reduction
The amount of tooth reduction is lower with VEP than other preparation techniques.
Dental tissues saving is essential to preserve structural strength, which is a fundamen-
tal aspect of tooth preparation [11], and it is far more critical when preparing a non-
endodontically treated tooth to maintain its pulp vitality [12,13].

3.2. Temporary Crown Management

The absence of undercuts in all the abutment “prosthetically usable” area and of a
beyond-preparation zone, which is usually positioned in an undercut, allows the clinician
to avoid an “on-off” movement during the temporary crown relining, avoiding the opening
of the margins and the consequent need to reperform the relining procedure. Additionally,
the absence of a preparation margin lets the clinician prevent lining the temporary crown
external wall to beyond the preparation surface; this procedure is necessary to obtain a
correct emergence profile when using techniques with a defined preparation margin.
As previously described, with the VEP technique, temporary crown margins should
be positioned extra-gingivally so that they do not interfere with the healing procedures
of the soft tissues injured with the bur during the preparation phases. However, other
aspects must be considered; if the esthetic area is involved, the probing depth of the tooth
Prosthesis 2023, 5 364

is low, and it does not need periodontal surgery, it is possible to place the temporary crown
margin under the gingival level, since this would improve the esthetic outcome of the
provisional restoration and there are no predictable factors which can cause movements of
the gingival level.

3.3. Impression Phase

Final impressions require great precision to correctly reproduce the details of the
abutment, adjacent teeth, and soft tissues so that the final crown can fulfill all of its esthetic,
functional, and biological requirements. From this perspective, standard impression tech-
niques are very effective and reliable for VEP-prepared abutments. The clinician should
simply consider that, being an “edgeless” abutment, there are no margins nor a beyond-
preparation zone, which are essential elements in different, not edgeless, preparations, but
that sometimes are difficult to read correctly, both with analog and digital impression sys-
tems. With VEP, the prosthetically usable (and readable) area defines the apical extension
of the preparation, making the impression phase easier to manage (Figure 8).

Figure 8. Impression taken on VEP-prepared abutments.

3.4. Crown Margins

With techniques that involve a defined preparation margin, the position of this margin
establishes the position of the crown margin, be it a shoulder, a chamfer, a knife edge,
or other edges created by the bur during the preparation phases. If these preparation
techniques are used, the technician should also be able to see the beyond-preparation
(beyond-edge) zone so that the profile of the crown is coherent and aligned with the
unprepared part of the tooth, avoiding undercontours and overcontours. With VEP, instead,
during lab procedures it is fundamental to point out on the model the position of the margin
itself. Once the position of the margin and the final form of the crown have been defined,
the part of the model representing the surrounding soft tissues is removed until the most
apical part of the abutment is displayed. Then, a groove is created under the displayed
apical area (ditching procedure). VEP does not require the integration of the crown on the
prepared abutment; consequently, it will always lead to a positive misalignment (controlled
overcontouring) of the crown. The thickness and the height of the prosthetic margin are
therefore defined by the soft tissues’ characteristics and not by the position of an edge.
Once again, VEP proves to be a periodontally driven tooth preparation technique.
The apical part of the prosthetic margin, whose section presents a triangular form,
must be as thin as possible so that it does not create overcontours. The presence of
overcontours leads to more plaque retention and potentially to periodontal diseases [14].
Horizontal preparation techniques allow the creation of a thicker and, therefore, more
resistant margin. With vertical preparations, attention to detail and respecting indications
are critical factors in determining a long-term successful therapy. In particular, attention
to occlusal contacts and dynamic schemes is of the utmost importance, since an occlusal
Prosthesis 2023, 5 365

overload could lead to a severe restoration failure. However, complete ceramic materials
such as zirconia and lithium disilicate proved to be a safe and reliable choice for complete
crowns on vertical preparations and showed excellent performance in the long term and a
failure rate comparable to those on horizontal preparations, even when monolithic lithium
disilicate was used in the posterior region [15,16].
The possibility of deciding the position of the prosthetic margin after soft tissue heal-
ing and maturation guarantees an excellent esthetic since the crown margin is always
placed in the sulcus. Typically, subgingival clinical precision checks are difficult to perform,
and the correctness of margin adaptation on the preparation finishing line is not always
evident. With VEP, thanks to the presence of a prosthetically usable area, the margin
closure on the abutment is far more predictable; as with all the vertical preparation tech-
niques, VEP guarantees a better marginal closure of the prosthetic crown, particularly after
cementation [17,18]. Furthermore, the creation of an undercontour is virtually impossible.
It is well known from the classic literature that the correct seating of prosthetic restoration
on their abutment is more predictable on vertical preparations than on horizontal preparations,
or at least comparable and in the range of clinical efficacy [18–21]. On the other hand, more
recent studies suggest that horizontal preparation could lead to a more precise marginal fit [22].
When using metal–ceramic restorations, more factors must be considered: to maintain
the crown margin thickness below certain limits, the apical part of the margin is made of
metal alone, starting with the esthetic part as soon as the thickness allows the presence
of metal, opaque, and ceramic. The metal margin can therefore create esthetic concerns,
especially in cases of gingival recession. Modern complete ceramic materials prevent these
issues, guaranteeing an excellent esthetic even if a gingival recession occurs in the future.

3.5. Soft Tissues Management

The preparation of a subgingival area and the light gingitage caused by the bur help
remove bacteria from contaminated hard and soft tissues and can therefore lead to a
healthier periodontium [5] (Figure 9).

Figure 9. Tissue behavior during different VEP phases.

As previously described, temporary crown margins are placed extra-gingivally so that

they can not interfere with the healing process following the gingitage. This procedure allows
the subsequent impression phase to be more predictable, avoiding the risk of inflammation
and consequent tissue bleeding because of the resin crown margin in the sulcus.

4. Conclusions
The presented biological and clinical concepts suggest that VEP allows a more effortless
relining procedure and overall management of the temporary crown, a more predictable
impression phase, and a more significant saving of dental tissue (Figure 10).
Prosthesis 2023, 5 366

The Vertical Edgeless Preparation technique represents, therefore, a viable and robust
option among vertical preparation techniques.

Figure 10. VEP abutments.

Author Contributions: Conceptualization, G.N., E.F., G.D.F., G.C. and R.B.; methodology, G.D.F. and
G.C.; validation, E.M. and G.M.M.; formal analysis, A.T.; resources, G.N.; writing—original draft
preparation, A.T.; writing—review and editing, G.N., E.F. and E.M.; visualization, R.B.; supervision,
G.M.M. All authors have read and agreed to the published version of the manuscript.
Funding: The authors declare that they did not receive external funding for the development of this
technical note.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: No new data were created or analyzed in this study. Data sharing is
not applicable to this article.
Conflicts of Interest: The authors declare no conflict of interest.

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