Pontics /certified fixed orthodontic courses by Indian dental academy

PONTICS
INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com


Contents
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Introduction
History
Classification
Pontic-ridge relationship
Pontic fabrication
Review of literature
Conclusion
References

INTRODUCTION
•The restorations
of partially
edentulous areas with fixed partial
dentures present a particular challenge
for the clinician.
• Because of their ease of use and
favorable
long
term
results,
conventional FPDs represent the most
popular treatment measure today.

• The pontic must fulfill the complex
roles of replacing the function of the
lost tooth, achieving an esthetic
appearance, enabling adequate oral
hygiene,
and
preventing
tissue
irritation.
•

In addition the pontic must meet
certain structural requirements to
ensure the mechanical stability of the
restorations.

HISTORY
The Histories of fixed and
removable partial prosthesis go more
or less in hand and it is difficult at
times to tell just where to draw the
line between these two types from the
available data.

• Replaced tooth was sewed in place by
using ligatures made from gold or
silver.
•

Egyptians and Phoeniceans were the
pioneers in the field of pontics and
were the first to construct dental bridge
work.

• These were mostly made of calf
bone or ivory.
• Kerr and Roger (1877) It is
suggested that teeth of ivory and
bone secured by copper wire or
catgut string were used in China
for ages before they were
introduced in Europe.

• It was Mancy in 1928 who laid the
foundation to present day FPD design,
• However Pierre Fauchard (1923) has
often been referred to as the ‘Father of
Modern Dental Prosthesis’.

• In his work in the field of FPD he
used what he called ‘Tenons’ which
were in reality dowels or pivots
screwed into the roots to retain
some of the bridges and it is
possible that he may have been the
first to attach dental bridges to
tooth roots by this method.

•

Selberg (1936) pointed out that
basic materials had changed but
little in the past few years.

• These materials were gold or
porcelain or a combination of the
two.

He summed up by saying that
the restoration must meet the
following requirements
• Protection
• Comfort
• Esthetics
• Durability
• Utility

DEFINITION
The Glossary of prosthodontic terms
defines Pontics as
“An artificial teeth on a fixed partial
denture that replaces missing natural
teeth, restores its function and usually
fills the space previously filled by the
natural teeth.”


Tylman defines Pontics as “The
suspended member of a fixed
partial denture which replaces the
lost natural tooth, restores function
and occupies the space of the
missing tooth.”


• The pontic or artificial tooth is
derived from the Latin word
Pons,meaning Bridge
• It is not a simple
replacement,because placing an
exact anatomic replica of the tooth
in the space would be hygienically
unmanageable

•
•
•
•
•

Design of the Prosthetic tooth will
be dictated by
Esthetics
Function
Ease of cleaning
Maintenance of healthy tissue on
edentulous ridge
Patient comfort

Requirements
•
•
•
•
•

Adequate strength
Esthetics
Color stability
Hygiene
Should not overload the abutment
teeth

Function
• Restore mastication and speech
• To maintain tooth relationships
• Patients esthetics
• Psychological

Pretreatment Assessment
• Pontic space
• Residual ridge contour


Pontic space
• When orthodontic repositioning is
not possible, increasing the
proximal contours of adjacent
teeth may be better than making
an FPD with undersized Pontics


Residual Ridge Contour
• An ideally shaped ridge has a
smooth,regular surface of attached
gingiva,which facilitates maintenance
of a plaque-free environment.
• Its height and width should allow
placement of a pontic that resembles
the neighbouring teeth.

• Ideal ridge contours vary
depending on the type of pontic to
be used
• The ideal ridge form allows for
pontic forms to be at same level as
a gingival margin of the adjacent
teeth


• Bulky ridge contour

• Deficient ridge contour


• Loss of residual ridge contour may
lead to unesthetic open gingival
embrasures(‘black triangles’),food
impaction and percolation of saliva
during speech


• Seibert has classified residual ridge
deformities in to three categories
• Class I defects-faciolingual loss of
tissue width with normal ridge height


• Class II defects –loss of ridge
height with normal ridge width


• Class III defects –a combination of
loss in both dimensions


• Allen et al., modified this
classification and included
Quantification of the Severity of
the Defect
• Mild-less than 3mm
• Moderate –3-6mm
• Severe –greater than 6mm

Surgical procedures for
ridge augmentation


Roll Technique


Pouch Technique


Interpositional Graft


Onlay Graft


Alveolar architecture
preservation technique


CLASSIFICATION
According to Shillingburg et al
Pontics are classified :
1. Depending on the shape of the
pontic contacting the tissues
2. Depending on the materials.
3. Depending upon the
manufacturer’s design

On Shape
i. Saddle/Ridge Lap pontic
ii. Modified ridge Lap
iii.Hygienic
iv. Conical
v. Ovate pontic

Pontics may be also classified
depending on Material used
• Metal ceramic
• Cast metal
• Resin processed to metal


Pre-Fabricated Pontics
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•
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•

TRUPONTIC
INTERCHANGEABLE FACINGS
HARMONY FACING
PORCELAIN FUSED TO METAL
FACING
• REVERSE PIN FACING
• PIN FACING

TRUPONTIC


INTERCHANGEABLE FACINGS


HARMONY FACING


PORCELAIN FUSED TO METAL
FACING


REVERSE PIN FACING


PIN FACING


According to Rosenstiel et al
Pontic designs are classified into
two general groups:
1) THOSE THAT CONTACT THE
ORAL MUCOSA
2) THOSE THAT DO NOT THE
ORAL MUCOSA .

A.

Mucosal contact B. No mucosal
contact

1. Ridge lap

1.Sanitary

2. Modified ridge lap

2. Modified sanitary
(hygienic)

3. Ovate
4. Conical


(hygienic)

.

PONTIC SELECTION

The design of pontic for a specific
FPD is determined by
1.Retainers
2.Esthetics
3.Occluso-gingival Height and
Mesio-distal Width of Edentulous
Area
4.Ridge Resorption and Contour

SADDLE OR RIDGE LAP PONTIC


MODIFIED RIDGE LAP PONTIC


Stein RS: Pontic- residual ridge relationship: A
research report. J Prosthet Dent 1966; 16: 251

Shaldon Stein in 1966 did a study on the
pontic residual ridge relationship. The
purpose of his study was:
To determine the frequency and the nature of
tissue reaction of underlying residual ridge
mucosa to specific pontic designs.
To compare the frequency and the nature of
tissue reactions of the residual ridge mucosa
to various materials used in pontic
constructions.

This 1966 Stein classic article on pontic
design was largely responsible for a
change in philosophy from a “sanitary”
shape design to what is now commonly
called a “modified ridge lap” design. The
modified ridge lap design in the anterior
region & in the posterior region offer
minimal tissue contact, gives acceptable
cosmetic value, proper cheek support, and
accessibility for adequate oral hygiene.

He postulated certain specifications for
pontic design
Posterior pontic design – a correctly
designed pontic should have
1. All surfaces should be convex, smooth
and properly finished.
2. Contact with the buccal contiguous
slopes should be minimal (pin point) and
pressure free (modified ridge lap).

3. Occlusal table must be in functional
harmony with the occlusion of all of the
teeth.
4. Buccal and lingual shunting mechanism
should conform to those of the adjacent
teeth.
5. The overall length of buccal surface
should be equal to that of the adjacent
abutments or Pontics.

Anterior pontic design – a correctly placed
anterior pontic should have
1. All surfaces should be convex, smooth and
properly finished.
2. Contact with the labial mucosa should be
minimal (pin point) and pressure free (lap
facing).
3. The lingual contour should be in harmony
with adjacent teeth or Pontics.

SANITARY OR HYGIENIC PONTIC


Perel M L : A modified sanitary pontic. J Prosthet Dent
1972; 28: 587

Morton L Perel in 1972 described a
modified sanitary pontic which has a free
archway design and is concave
mesiodistally. Proximally the solder joints
of the pontic are elongated. This addition
increases the strength of what is considered
to be the weakest part of any posterior fixed
prosthesis.


Antony H L: A sanitary “ Arc- fixed partial denture” : Concept
and technique of pontic design. J Prosthet Dent 1983; 50: 338

Antony H L in 1983 described a technique of pontic
design for extreme resorption of alveolar ridge. In
this the undersurface of the pontic was shaped
slightly convex or flat bucco-lingually to aid in
complete disruption of dental plaque with dental
floss or interproximal toothbrushes. The flat
undersurface allowed easy cleaning from either the
lingual or buccal aspect.


Conical


OVATE PONTIC


Techniques available for this
Immediate Pontic Technique (or)
Socket Preservation Technique


Advantages


Jacques L B et al: Tissue sculpturing: An alternative
method for improving esthetics of anterior fixed
prosthodontics. J Prosthet Dent 1999; 81: 630

L.B. Jacques et al in his
article describes a technique
for the improvement of
esthetics with conditioning of
tissue beneath the pontics by
displacing tissue with a
treatment restoration. Lateral
displacement of tissues under
gradual, controlled pressure
enhances the interdental
papilla which improves
esthetics.

Daniel E , H Spiekermann: A review of esthetic
pontic design options. Quintessence Int
2002;33:736-746

In 2002 Daniel Edelhoff et al did a review of
the different clinical and technical options that
are available for designing esthetic and
functional pontics for anterior region. He
mentions the use of Gingiva coloured
ceramics, all-ceramic gingival masks and
gingival prosthesis to achieve maximum
esthetics in the anterior region.

GINGIVA-COLORED CERAMICS

If augmentative measures are
contraindicated or undesirable, small
alveolar deficiencies and missing papillae
can be reconstructed by restorative
measures.
First, the exact shade of the gingiva has
to be established.
This can be accomplished with special
gingival shade guides that are supplied
with the different commercially
available pink veneering materials.

The basal surface must demonstrate a
convex shape similar to the ovate pontic


ALL-CERAMIC GINGIVAL MASKS

Separately fabricated ceramic gingival
masks can be used to make subsequent
adjustments in permanently placed
restorations.
This method is particularly suitable for
patients with a local alveolar ridge
defect that has not been corrected by
augmentation of the soft tissue.

For this purpose, an impression is taken of
the labial surface of the restoration using
a customized tray and a medium viscosity
polyether material.
The color of the gingiva is determined
with an individually fabricated shade
guide.


Donald A B : The design of multiple pontics. J
Prosthet Dent 1981; 46: 634

Donald in 1981 did a study for designing
multiple pontics.
He said that in multiple pontics, placement
of a V-shaped notch between the pontics on
their tissue aspect (an inter-pontic
embrasure) serves no useful purpose.
It acts as a niche to collect plaque and
interrupts the smooth passage of dental floss
along the tissue surface of the pontics.

The principle of “fusing” multiple Pontics
on their tissue aspect to give a smooth,
unbroken surface can be applied to fixed
partial dentures in maxillary posterior,and
mandibular anterior and posterior region.


His design principle should also be used routinely
for the maxillary anterior segment, using pink
porcelain to fill inter-pontic embrasures which also
enhances esthetics.


BIOLOGIC CONSIDERATIONS
The biologic principles of pontic
design pertain to the maintenance and
preservation of the residual ridge,
abutment and opposing teeth, and
supporting tissue.


RIDGE CONTACT
Pressure free contact between the pontic
and the underlying tissue is indicated to
prevent ulceration and inflammation of
the soft tissues.
If any blanching of the soft tissues is
observed in try-in, the pressure area
should be identified with a disclosing
medium (i.e pressure indicating paste)
and the pontic recontoured until tissue
contact is entirely passive.

This passive contact should occur
exclusively on keratinized attached tissue.
When a pontic rests on mucosa, some
ulcerations may appear as a result of the
normal movement of the mucosa in contact
with the pontic.


Positive ridge pressure may be due to
excessive scraping the ridge area on the
working cast.
This was once promoted as a way to
improve the appearance of the pontic
ridge relationship.
However, because of the ulceration that
inevitably results when flossing is not
meticulously performed, the concept is
not recommended, unless done as
previously described as an ovate pontic.

Cavozos E : Tissue response to fixed partial
denture pontics. J Prosthet Dent 1968; 20:
143

Cavazos in 1968 did a study to demonstrate
that the adaptations of pontic to the ridge or
the amount of “relief” (scraping of the cast
provided) on the cast is highly significant and
directly proportional to the amount of
unfavourable tissue change.
1)Absolute minimal (0.0 to 0.25mm of cast
scraping) produced no tissue changes.

2)When the cast scraping was increased to
1mm, tissue changes were produced
varying from mild inflammation to acute
ulceration


PONTIC MATERIAL

1)
2)
3)
4)
5)

Any material chosen to fabricate the
pontic should provide:
Good Esthetic Results Where Needed
Biocompatibility
Rigidity
Strength to Withstand Occlusal Forces
Longevity.

Occlusal contacts should not fall on
the junction between metal and
porcelain during centric or eccentric
tooth contacts, nor should a metal
ceramic junction occur in contact
with the residual ridge on the
gingival surface of the pontic.


Investigations into the
BIOCOMPATIBILITY of materials
used to fabricate pontics have
centered on two factors :
1. The effect of the materials and
2. The effects of surface adherence.


Glazed porcelain is generally
considered the most biocompatible of
the available pontic materials
Although the critical factor seems to
be the material’s ability to resist
plaque accumulation (rather than the
material itself).

Also its remarkable tissue tolerance,
when contacting the gingival has
played an important part in advanced
fixed bridge work.
High fusing porcelain when
correctly glazed will display surface
traits remarkably close to those of a
natural tooth.

Well polished gold is smoother, less
prone to corrosion, and less retentive
of plaque than an unpolished or porous
casting.
However, even highly polished surfaces
will accumulate plaque if oral hygiene
measures are ignored.

Although glazed porcelain looks very
smooth, when viewed under a
microscope, its surface shows many
voids and is rougher than either
polished gold or acrylic resin.


OCCLUSAL FORCES
Can be reduced by :
Reducing the buccolingual width of the pontic
by as much as 30%
Analysis reveals that forces are lessened only
when chewing food of uniform consistency
and that a mere 12% increase in chewing
efficiency can be expected from a one-third
reduction of pontic width.

The accidental biting on a hard object or
by parafunctional activities like bruxism
create potentially harmful forces on the
FPD
These forces are not reduced by
narrowing the occlusal table.


Narrowing the Occlusal Table may
• Impede or even preclude
development of a harmonious and
stable occlusal relationship.
• It may cause difficulties in plaque
control
• May not provide proper cheek
support.

• One exception is if the residual
alveolar ridge has collapsed
buccolingually.
• Reducing pontic width may then be
desired, thereby lessening the lingual
contour and facilitating plaque
control measures.

MECHANICAL CONSIDERATIONS

Mechanical problems may be caused
by
• Improper Choice of Materials
• Poor Frame Work Design
• Poor Tooth Preparation
• Poor Occlusion.

• When metal ceramic pontic are
chosen, extending porcelain onto the
occlusal surfaces to achieve better
esthetics should also be carefully
evaluated.
• In addition to its potential for
fracture, porcelain may abrade the
opposing dentition if the occlusal
contacts are on enamel.

OCCLUSAL SURFACE
The occlusal surface of the pontic
should roughly correspond with that of
the tooth it replaces.
In posterior region it is important that
it be confined within the margins of
the abutment teeth.


•
•
•
•
•

However width of the pontic required
will be governed by factors
Esthetics
Length of Span
The Strength of the Abutment Teeth
The Ridge Form
Occlusion.

It has also been advised that the
occlusal surface should not be
narrowed Arbitarily since this
may create
• Food impaction
• Plaque retention situation (similar
to that of malposed teeth)

The cusp tip-to-cusp tip width of a
posterior pontic should be the same
width as the original missing tooth.


AVAILABLE PONTIC MATERIALS

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•
•
•

Some fixed partial dentures are
fabricated entirely
Metal
Porcelain
Acrylic Resin
A Combination of Metal and Porcelain.

Acrylic resin veneered Pontics have had
limited acceptance because of their
reduced durability (wear and
discoloration).
The newer indirect composites, based on
high inorganic filled resins and the fiber
reinforced materials have revived interest
in composite resin and resin-veneered
Pontics.

METAL CERAMIC PONTICS
• The framework must provide a
uniform veneer of porcelain
• Excessive thickness of porcelain
contributes to inadequate support and
predispose to eventual fracture

This is often true in the cervical
portion of an anterior pontic.
A reliable technique for ensuring
uniform thickness of porcelain is to
wax the fixed prosthesis to complete
anatomic contour and then accurately
cut back the wax to a predetermined
depth.

The metal surfaces to be veneered must
be smooth and free of pits.
Surface irregularities will cause
incomplete wetting by the porcelain
slurry, leading to voids at the porcelain
metal interface that reduce bond strength
and increase the possibility of
mechanical failure

Sharp angles on the veneering area should
be rounded.
Any deformation of the metal frame work
at the junction can lead to chipping of the
porcelain.
Therefore , occlusal centric contacts must
be placed at least 1.5mm away from the
junction.

RESIN-VENEERED PONTICS
• Historically, acrylic resin-veneered
restorations had deficiencies that made
them acceptable only as longer term
provisionals.

• Dimensional change from water
absorption and thermal fluctuations
(thermo cycling)occurs because of
the relatively high surface
area/volume ratio of the thin resin
veneer

• The resin was retained by
mechanical means
(e.g.undercuts).
• Continuous dimensional change
of the veneers often caused
leakage at the metal-resin
interface, with subsequent
discoloration of the restoration.

FIBER-REINFORCED COMPOSITE RESIN
PONTICS

• Composite resins can be used in
fixed partial dentures without a metal
substructure.
• A substructure matrix of impregnated
glass or polymer fiber provides
structural strength.

The physical properties of this
system, combined with its excellent
marginal adaptation and esthetics,
make it a possible metal free
alternative for FPD


Mahesh chauhan .,natural tooth pontic fixed partial denture using resin
composite-reinforced glass fibers (quintessence int 2004;35:549-553)

• Glass fibers reinforced with resin
composite can be used as a bonded
external framework to support a patient’s
own natural anterior tooth that is due for
extraction.The extracted tooth,after root
sectioning,serves as a “natural tooth
pontic”,while glass-fiber bonding
simultaneously splints periodontically
weak abutment teeth.

ESTHETIC CONSIDERATIONS
• The Gingival Interface
• Incisogingival Length
• Mesiodistal Width


THE GINGIVAL INTERFACE
Therefore merely duplicating the facial
contour of the missing tooth is not enough
If the original tooth contour were
followed, the pontic would look
unnaturally long incisogingivally.

• The modified ridge-lap pontic is
recommended for most anterior
situations
• A properly designed, modified ridge
lap provides the required convexity on
the tissue side, with smooth and open
embrasures on the lingual side for ease
of cleaning.

If a pontic is poorly adapted to the
residual ridge, there will be an
unnatural shadow in the cervical area
that looks odd and spoils the illusion
of a natural tooth.
In addition, recesses occurring at the
gingival interface will collect food
debris, further betraying the illusion
of a natural tooth.

INCISOGINGIVAL LENGTH
The height of a tooth is immediately
obvious when the patient smiles and
shows the gingival margins.
An abnormal labiolingual position or
cervical contour, however, is not
immediately obvious.

MESIODISTAL WIDTH
.

The features of the contra lateral tooth should be
duplicated as precisely as possible in the pontic,
and the space discrepancy can be compensated
by altering the shape of the proximal areas.
The retainers and the pontic can be proportioned
to minimize the discrepancy.

PONTIC
FABRICATION


Cone placement


Cuspal ridges superimposed


Cones ,Cuspal,Triangular ridges


Cones ,Cuspal,Triangular
ridges&marginal ridges


Occlusal morphology


CUT BACK


CONCLUSION


The pontic design is said to determine
the success or failure of a bridge.
Designs that allow easy plaque control
are especially important to a pontic’s
long term success.


Minimizing tissue contact by
maximizing the convexity of the
pontic’s gingival surface is
essential.
Consideration is needed to create a
design that combines easy
maintenance with natural
appearance and adequate
mechanical strength.

REFERENCES
1. Rosenstiel S F et al : Contemporary Fixed
Prosthodontics, ed 3, Missouri, Mosby Inc, pg 513
2. Shillingburg H T et al : Fundamentals of fixed
prosthodontics,
ed 3, Chicago , Quintessence
Publishing, pg 485
3. Shillingburg H T et al : Fundamentals of fixed
prosthodontics,
ed 2, Chicago , Quintessence
Publishing, pg 387
4. The Glossary of Prosthodontic terms : J Prosthet
Dent 1999; 81
5. Antony H L: A sanitary “ Arc- fixed partial
denture” : Concept and technique of pontic design.
J Prosthet Dent 1983; 50: 338

6. Cavozos E : Tissue response to fixed partial denture
pontics. J Prosthet Dent 1968; 20: 143
7.Curtis M B: Current theories of crown contour,
margin placement and pontic design. J Prosthet
Dent 1981; 45: 268
8.Daniel Edelhoff, H Spiekermann: A review of
esthetic pontic design options. Quintessence Int
2002;33:736-746
9.Donald A B : The design of multiple pontics. J
Prosthet Dent 1981; 46: 634
10. Jacques L B et al: Tissue sculpturing: An alternative
method for improving esthetics of anterior fixed
prosthodontics. J Prosthet Dent 1999; 81: 630


11.Parkinson C.F: Pontic design of posterior fixed
partial prosthesis; is it a microbial misadventure? J
Prosthet Dent 1984; 51; 51-54.
12. Perel M L : A modified sanitary pontic. J Prosthet
Dent 1972; 28: 587
13. Porter CB: Anterior pontic design; a logical
progression. J Prosthet Dent 1984; 51; 774-776.
14. Stein RS: Pontic- residual ridge relationship: A
research report. J Prosthet Dent 1966; 16: 251


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