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Definition
Pontic is defined as an artificial tooth on a fixed dental prosthesis that replaces a missing natural tooth , restores its function and usually fills the space previously occupied by the clinical crown.
Ideal Requirements
1-A pontic should restore the function of the tooth it replaces 2-It should provide good esthetics 3-It should be biocompatible with continued oral health and comfort. 4-It should permit effective oral hygiene. 5-It should preserve underlying mucosa and bone.
Pontic design
Proper Pontic Design leads to Success of the FPD *The pontic must be carefully designed and fabricated not only to facilitate plaque control of the tissue surface and around the adjacent abutment teeth but also to the existing occlusal considerations . *The design of pontic depends on various factors: Pretreatment assessment ,Pontic classification ,Biological considerations ,Mechanical considerations and Pontic fabrication .
A) Pretreatment assessment
Certain procedures enhance the success of pontics they are: 1 Pontic space 2 Residual ridge contour 3 Gingival architecture preservation
B) Classification of pontics
Pontic designs are classified into two major groups: *Those that contact the oral mucosa *Those that do not **Based on type of materials for fabrication **Based on method of fabrication Pontic selection is based primarily on esthetics and oral hygiene.
A
MUCOSAL CONTACT : Ridge lap Modified ridge lap Ovate Conical NO MUCOSAL CONTACT : Sanitary/ hygienic Modified sanitary/ hygiene
B
Based on type of material used : Metal & Porcelain Veneered Metal & Resin Veneered All Metal All Ceramic
PONTIC DESIGN
MATERIALS
LOCATION
SANITARY/HYGIEN IC
SADDLE-RIDGELAP CONICAL
All metal
Not recommended All metal Metal ceramic All resin All metal Metal ceramic All resin All metal Metal ceramic All resin
Posterior mandible
Not recommended Molars without esthetic requirement High esthetic requirement Very high esthetic requirement
ADVANTAGES Good access for oral hygiene esthetic Good access for oral hygiene Good esthetics Superior esthetics Negligible food entrapment Ease of cleaning
Moderately easy to clean Requires surgical preparation Not for residual ridge defects
PONTIC DESIGN
INDICATIONS
CONTRAINDICATION S
SANITARY/HYGIENIC
SADDLE-RIDGE-LAP CONICAL
Where minimal esthetic consideration exists Unwillingness for surgery Residual ridge defects
Design considerations for anterior pontic : 1-All surfaces should be smooth , convex and properly finished . 2-Contact with labial slope of the ridge should be minimal and pressure free. 3-A large contact with the ridge is provided for a natural look. 4-Lingual contour should be in harmony with that of the other teeth.
C) Biological considerations
The pontic has to preserve the surrounding biological tissues 1-Ridge contact Pressure free contact Should be evaluated during try-in stage Contact should be on the keratinized attached tissue 2-Oral hygiene considerations
Toxins of microbial plaque Gingival surface of pontic , not accessible to bristles of tooth brush
3-Pontic material
Pontic should have following qualities *Biocompatible-glazed porcelain , gold or metallic and acrylic *Rigidity resist flexure during mastication *Strength metal ceramic junction - in case of decresed vertical space for pontic *Longevity *Provide good esthetic results
4-Occlusal forces
*Reducing the buccolingual width by 30% Problems with narrowing the occlusal table Buccolingually collapsed ridges
Causes of mechanical failure of an FPD 1-Poor tooth preparation 2-Improper choice of materials 3-Poor frame work design 4-Poor occlusion 5-Long span Fixed Partial Dentures 6-Greater flexing 7-Displacement effects increase with cube of span length 8-Extension of ceramic on occlusal surfaces
D) Mechanical considerations
E) Esthetic considerations
Gingival Interface
*Pontic simulation to natural tooth is most challenging at pontic tissue interface *If original tooth contour is followed , pontic looks unnaturally long incisogingivally . . . SO , make use of Modified ridge lap Ovate pontics
Incisogingival Length
*Height of tooth is more obvious *Recontouring the gingival half of the labial surface *In case of moderate to severe bone resorption ,pontic can be made to simulate a normal crown and portion of root
Fabrication of pontics
*Custom-made pontics 1-Anatomic contour waxing 2-Prepare the pontic approximatley and adapt it to ridge 3-Pour molten wax into the impression of diagnostic waxing or provisional restoration *Prefabricated pontics 1-Cut-back procedure 2-Metal prepartion 3-Porcelain application
ALL METAL
STRENGTH
STRAIGHTFORW ARD PROCEDURE
NONESTHETIC
Prefabricated pontics
Sanitary or hygienic
Conical pontic
Ovate pontic
Pontic selection
Retainers
*Incase of PFM retainers , PFM pontics are used *In case of partial veneer retainers , prefabricated facings are indicated *In case of full metal retainer , all metal pontic is used
References
1-Stephen f rosenstiel: contemporary fixed prosthodontics . Third edition 2-Herbert t. shillinburg: Fundamentals of fixed prosthodontics . Third edition 3-William f.p malone: tylmans theory and practice of fixed prosthodontics . Eighth edition 4-Johnston: modern practice in fixed prosthodontics.fourth edition 5-Sohnmit singh: pontic designs . Famdent practical dentistry handbook 2002.p.no41-46