CS2-6. Pontic Design and Interrelationship Between Pontic and Mucosa PDF

2022-2023 PONTIC DESIGN AND INTERRELATIONSHIP BETWEEN PONTIC AND MUCOSA Assist.Prof.Delâl Bozyel LEARNING OUTCOMES After the completion of this subject, student will be able to: ØDecides on the pontic types according to the treatment. ØDiscuss the pontic type during the fixed bridge prosthesis...

2022-2023 PONTIC DESIGN AND INTERRELATIONSHIP BETWEEN PONTIC AND MUCOSA Assist.Prof.Delâl Bozyel LEARNING OUTCOMES After the completion of this subject, student will be able to: ØDecides on the pontic types according to the treatment. ØDiscuss the pontic type during the fixed bridge prosthesis design phase with the dental technician INTRODUCTION • According to the Glossary of Prosthodontic Terms, a pontic is an artificial tooth on a fixed partial denture that replaces the missing natural tooth, restores its function and usually fills the space previously occupied by the natural crown. OPTIMAL PONTIC DESIGN Biologic Mechanic Esthetic Cleansable tissue surface Metal-ceramic framework to resist porcelain fracture Shape to look like tooth it replaces Access to abutment teeth Strong connectors (to prevent fractue) Appears to grow out of edentulous ridge No pressure on ridge Rigidity (to resist deformation) Enough space for porceain ASSESSMENTS FOR PONTIC DESIGN 1) PONTIC SPACE • One function of fixed prosthodontic tratment is to prevent tilting or drifting of the adjacent teeth into the edentulous space. • Tilting Reduced pontic space Difficulty in fabricating pontic ASSESSMENTS FOR PONTIC DESIGN 2) RESIDUAL RIDGE CONTOUR Ideal Ridge Contour should be: • Smooth and regular surface of attached gingiva • Sufficient height and wide • Facially, free of frenal attachment ASSESSMENTS FOR PONTIC DESIGN 2) RESIDUAL RIDGE CONTOUR Loss of Residual Ridge Contour: • Unesthetic open gingival embrasures «Black Triangle» • Food impaction • Percolation of salivia during speech ASSESSMENTS FOR PONTIC DESIGN 2) RESIDUAL RIDGE CONTOUR Loss of Residual Ridge Contour: RIDGE AUGMENTATION ASSESSMENTS FOR PONTIC DESIGN 2) RESIDUAL RIDGE CONTOUR Loss of Residual Ridge Contour: RIDGE AUGMENTATION CLASSIFICATION Depending on shape of surface contacting alveolar ridge (Tylmann): - Sanitary/Hygienic - Modified sanitary - Conical/Spheroidal - Saddle - Ridge lap - Modified ridge-lap - Ovate CLASSIFICATION Depending on mucosal contact (Rosenstiel): - Mucosalcontact -No mucosal contact 1. Ridge lap 1. Hygienic/sanitary 2. Modified ridge-lap 2. Modified sanitary 3. Ovate 4.Conical CLASSIFICATION According to the form (Jonston): - Hygienic/sanitary - Anatomic type Based on material used: - Metal - Metal-porcelain - Metal-resin CLASSIFICATION Method of Fabrication: Prefabricated Pontics Custom Made Pontics CLASSIFICATION Prefabricated Pontics PONTIC SELECTION • Pontic selection depends primarily on esthetics and oral hygiene. Anterior Region Posterior Region ANTERIOR PONTIC DESIGN • All surfaces should be convex, smooth and properly finished. • Contact with the labial mucosa should be minimal and pressure free. • The lingual contour should be in harmony with adjacent teeth or pontics. POSTERIOR PONTIC DESIGN • All surfaces should be convex, smooth and properly finished. • Contact with the buccal contigous slopes should be minimal and pressure free. • Occlusal table must be in functional harmony. • The overall length of buccal surface should be equal to that of the adjacent abutments or pontics. PONTIC TYPES Sanitary-hygienic • At non-esthetic/non visible zone ,especially in restoration mandibular 1st molar • Convex entirely from faciolingual and mesiodistal views • The design of the sanitary pontic allows easy cleaning, because its tissue surface remains clear of the residual ridge. • They have good access for oral hygiene. • They have minimal tissue inflammation as they are clear of the residual ridge. • Its disadvantages include entrapment of food particles, which may lead to tongue habits that may annoy the patient. • They have very poor esthetics. PONTIC TYPES Modified Sanitary-Hygienic • They are an alternative design in which there is a mesiodistal concavity and a convexity faciolingually in the undersurface. • This design gives more strength to the connectors with space for easier cleansing. • They are indicated in nonesthetic zone and in areas where there is chance of food lodgment. • They have good access for oral hygiene. • They have minimal tissue inflammation as they are clear of the residual ridge. • They have very poor esthetics. PONTIC TYPES Saddle pontic/ Ridge lap • These pontics overlap the buccal and lingual surfaces of the ridge. They form a large concave contact with the ridge. • The saddle pontic has a concave fitting surface that overlaps the residual ridge buccolingually, simulating the contours and emergence profile od the missing tooth on both sides of residual ridge. • The concave gingival surface of the pontic is not accessible to cleaning with dental floss --- plaque accumulation--- tissue inflammation. • the pontic covering the gingival surface makes it difficult for the patient to clean and maintain. PONTIC TYPES Modified Saddle pontic/ Ridge lap • The modified ridge lap pontic combines the best features of the hygienic and saddle pontic designs, combining esthetics with easy cleaning. • The modified ridge lap design is the most common pontic form used in areas of the mouth that are visible during function. • Contact only at one point with buccal surface of ridge • Easier to clean • Esthetic • Maxillary and mandibular anterior teeth maxillary premolars and first molars PONTIC TYPES Conical Pontic • It is rounded and accessible for cleaning • It is used for resorbed mandibular/ a knife-edged residual ridge • Convex with only one point of contact at the center of the • Food impaction at wide residual ridge embrassure areas Smallest dimension of pontic • Recommended for the replacement of mandibular posterior teeth where esthetics is a lesser concern. PONTIC TYPES Ovate Pontic • The ovate pontic is the most esthetically appealing pontic design. Its convex tissue surface resides in a soft tissue depression or hollow in the residual ridge. • Its convex tissue surface resides in a soft tissue depression or hollow in the residual ridge, which makes it appear that a tooth is emerging from the gingiva. • Advantages include its pleasing appearance and its strength. its emergence from the ridge appears identical to that of a natural tooth. In addition, its recessed form is not susceptible to food impaction. • Disadvantages: Meticulous oral hygiene is necessary to prevent tissue inflammation resulting from the large area of tissue contact. Other disadvantages include the need for surgical tissue management and the associated cost. ORAL HYGIENE Contact between residual ridge- pontic should be passive and it should allow superfloss passage through the space between them. REFFERENCESS • Rosenstiel RF, Land MF, Fujimoto J. Contemporary fixed prosyhodontics. 4th Edition, Mosby Pub. 2007, 616-648. • • Shillinburg HT, Hobo S, Whisett LD, Jacobi R, Brackett SE. Fundemantals of fixed prosthodontics, 3rd Edition, Quintessence Pub, 2007. India, 486- 506. THANK YOU