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Pontics

Preeti kaliaIInd year PG student

Dept of ProsthodonticsA.E.C.S Maaruti College of Dental

Sciences

Pontics

Definition

Requirements

Design

Pretreatments assessment

Types

Fabrication

Definition

Pontic GPT : 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

Definition

Acc to Tylman –pontic is the suspended member of a fixed partial denture. it replaces the lost natural tooth, restores function ,and occupies the space of the missing tooth.

Ideal requirements of pontics

Smooth surfaced and convex in all directions

Easily cleansable

Pinpoint pressure free contact on the ridge

No irritation to the gingival tissues

Ideal requirement of pontics

Facilitate plaque control

Emergence profile

Strength and longevity

Be esthetic

Ideal requirements of pontics

Restore function

No abutment overloading

Color stable

Functions of pontics

Mastication

Speech

Esthetics

Considerations for a successful pontic design

Biologic considerations

Ridge contact Area of contact

with ridge should be small and convex.

Oral hygiene considerations

Pontic materials

Differences in the plaque-retaining capacities of.samples of a Type III gold, gold for veneering with porcelain, a vacuum-fired

bonded porcelain Veneer, and an acrylic resin.

After 48 hours in vivo, the Ceramco metal and Type III gold specimens accumulated significantly more dark stains than acrylic ones

Wise. M et al and Dykema .R, The plaque-retaining capacity of four dental materials,J Proshtet 1975;33:178

Occlusal forces

Reduce buccolingual width – 30% to lessen occlusal forces

12% increase in chewing efficiency Pontics with normal occlusal widths

– in the occlusal third area

Mechanical considerations

Improper choice of materials Poor framework design Poor tooth preparation Poor occlusion

It can be seen that the maximum tensile stress at the solder joint, mesial to the second molar and above the gingiva, was reduced from2,400 p.s.i, in the conventional pontic to 1,200 p.s.i, in the sanitary pontic and finally to 720 p.s.i, in the modified sanitary pontic.

For the solder joint distal to the second

premolar, also above till gingiva, the reductions were in the order of 1,920 (C.P.)to 960 (S.P.) to 720 p.s.i. (M.S.P.).

Hood, J. A. Stress and deflection of three different pontic designs. J Prosthet Dent 33:54-59, 1975

Esthetic considerations

Incisogingival length

Root can be stained to simulate exposed dentine.

Pink porcelain to simulate the gingival tissues

Mesiodistal width

Space discrepancy – less problem in posteriors

Mesiodistal width

Orthodontic treatment Pontic of abnormal size- illusion of natural tooth

Pretreatment assessment

Diagnostic cast Wax up

Pontic space

Individual crowns of increased proximal contours were preferredto an FPD with undersized pontics

Residual ridge contour

Loss of residual ridge contour leading tounesthetic open gingival embrasures

Food entrapment

Residual ridge contour

Class II defect.Class I defect.

Class III defect.

Sieberts classification

Residual ridge contour

Abrams et al showed Class I defects to constitute 32.4%Class II- 2.9% Class III- 55.9% 8.8% having no defects

Surgical management of class I defect

Pouch technique

Surgical management of class I defect

Pouch technique

Surgical management of class II and III defect

Interpostional graft

Surgical management of class II and III defect

onlay graft

Gingival architecture preservation

Classification

1. Depending on shape of surface contacting the ridge(Tylmann)

Sanitary Modified sanitary Spheroidal Saddle Ridge lap Modified ridgelap Ovate

2.According to Rosenstiel depending on mucosal contact A. mucosal contact ridge lap modified ridge lap ovate conical B. No mucosal contact sanitary(hygenic) modified sanitary

3.According to the form(Johnston)

Sanitary or Hygenic

Anatomic type

4.Based on materials used Metal Metal and porcelain Metal and resin

5.Prefabricated pontics

Flat back Trupontic

Longpinfacing

Pontips

Reverse pin facings

Sanitary or hygienic

Modified sanitary pontic

Ridge lap pontic

Modified ridge lap pontic

Conical pontic

Ovate pontic

Modified ovate pontic

Contact more labially than ovate pontic Easier to clean No need of surgical augmentation Push the labial gingival margin away

to floss

Liu.S,J Esthet Restor Dent 16:273-283, 2004

Residual ridge contour To determine the frequency and the

nature of tissue reactions of underlying residual ridge mucosa to specific pontic designs, and

To compare the frequency and the nature of tissue reactions of residual ridge mucosa to various materials used in pontic construction.

Stein.R.S , Pontic residual ridge relationship, J Proshtet Dent 1966;16: 251-285

Metal Ceramic pontics Uniform veneer of porcelain- 1.2 mm Metal surface – smooth and free of pits Round angles Occlusal centric contacts – 1.5 mm away from junction

Metal ceramic pontics

wax the prosthesis

All ceramic pontics

Resin veneered pontics

Fiber reinforced composite resin pontics

Pontic fabrication

All metal hygienic pontic Metal ceramic pontic

Armamentarium

Sable brush Plaster bowl Spatula Quick setting plaster Bunsen burner PKT waxing instruments- No

1,2,3,4,5 Beavertail burnisher No 7 wax spatula Inlay casting wax Die lubricant Cotton pliers Hollow plastic sprue

All metal hygienic pontic fabrication

All metal hygienic pontic fabrication

All metal hygienic pontic fabrication

All metal hygienic pontic fabrication

All metal hygienic pontic fabrication

Metal ceramic pontics

Requirements Adequate bulk of

metal Uniform

thickness of porcelain

Continuous strip of metal on lingual surface

Scalloped or trestle design

Connector is diminished in faciolingual dimension – Indication

Bulk or rigidity in connector areas Tissue contact – modified ridge lap

Metal ceramic pontics

To produce continuous contour and uniform thickness of porcelain – fabricate wax pattern to full contour and cut back

Fabricate the copings – No 7 wax spatula

Blue inlay wax stick – edentulous area

Metal ceramic pontics

Check the alignment in a mesiodistal and the facial profile

Metal ceramic pontics

Metal ceramic pontics

Available pontic systemsAdvantages Disadvantag

esIndications Contraindicatio

ns

Metal ceramic

EstheticsBiocompatible

Difficult if abutment not metal ceramic

Most situations

Long span with high stress

All metal StrengthStraightforward procedure

Non esthetic Mandibular molars, under high bite force

Esthetics

Fibre reinforced all resin

Conservative with inlaysEsthetics

Limited to short spans

Esthetics Long span

Facings Rarely used Rarely used Rarely used

Rarely used

Review of literature

Kumbulolu.O et al, A Different Pontic Design for Fiber-Reinforced Composite Bridgeworks: A Clinical Report, Eur J Dent. 2007 January; 1(1): 50–53.

Review of literature

Kim.T.H.Yet al, Simulated tissue using unique pontic design, J Prosthet Dent 2009;102:205-210

References

Malone W.F.P., Koth D.L., Cavazos E. : Tylman’s theory of practice of fixed prosthodontics. 8 Ed., lshiyaku publications, 1993,357-370

Rosenstiel R.F., Land M.F., Fujimot J.: Contemporary fixed prosthodontics. 4th Ed., Mosby Publications, 2007, 616-648

References

Shillingburg H.T., Hobo S., Whisett L.D., Jacobi R., Brackett S.E. Fundamentals of fixed prosthodontics, 3 Ed., Quintessence Publication,2007,India ,485-506

Stein.R.S , Pontic residual ridge relationship, J Proshtet Dent 1966;16: 251-285

References

Wise. M et al and Dykema .R, The plaque-retaining capacity of four dental materials,J Proshtet 1975;33:178

Liu.S ,Use of a modified ovate pontic in areas of ridge defects: A report of 2 cases, J Esthet Restor Dent 16:273-283, 2004

References

Kumbulolu.O et al, A Different Pontic Design for Fiber-Reinforced Composite

Bridgeworks: A Clinical Report, Eur J Dent. 2007 January; 1(1): 50–53.

Kim.T.H.Yet al, Simulated tissue using unique pontic design, J Prosthet Dent 2009;102:205-210

References

R.Duane Douglas ,Pontic design

FPDpontic wax up .ppt

FPD.ppt