Lecture: 7

Pontic
It is the suspended portion of the fixed partial denture (bridge)
replacing the missing natural tooth or teeth and restoring its function.
The abutment tooth is the tooth that supports the bridge by retainer
which connects to the pontic by connector, the retainer is either:
1- Major retainer (fixed by solder joint).
2-Minor retainer when the connection is not rigid (flexible) ex.
Stress breaker.
Each part of the bridge whether the retainer or pontic is called a
unit, example: 2 retainers and 1 pontic are called 3-unit bridge.

Components of the pontic:

In longitudinal section the pontic is divided into:
1- Metal backing.
2- Solder joint.
3- Facing.
Materials used in pontic fabrication
The pontic may be fabricated from casting metal or combination
of metal and porcelain or acrylic facing. Usually full metal pontic is
used for the posterior region while the combination of metal and
facing (porcelain or acrylic) is used in anterior region for esthetic
reason.
The glazed porcelain is more preferable than acrylic in pontic
fabrication because acrylic is porous in nature and difficult in
obtaining highly polished surface which leads to plaque accumulation
and cause gingival inflammation.
Requirements of the pontic
1- The pontic must be hygienic so the patient can easily
maintain good oral hygiene. The pontic must not cause
any irritation to the underlying soft tissue by pressure or
by food accumulation. Therefore, the contact of the
pontic tissue surface with the underlying soft tissue
should be convex to prevent entrapment of food under
the pontic.

2- The contact area or solder joint should guard the interproximal area
and the embrasure should be opened well to allow massage of the
gingival tissue.
 If the solder joint is too small there will be an increase interproximal
space and possible food accumulation. The connector region would be
weak and prone to fracture. If we have too wide contact area there
will be impingement of the pontic on the interproximal gingival
tissue.
3- The contour of the labial and lingual surfaces of the pontic must be
proper and lie with the same line of contour of the adjacent teeth so it
will allow protection of the underlying tissue
4- The pontic must restore the masticatory function of the tooth it
replaces efficiently.
It is advisable to narrow the occlusal surface of pontic to reduce the
stress that is going to be transmitted to the abutment tooth by occlusal
forces.
5- The pontic must be strong enough to withstand the force to which it is
subjected so mostly we use full metal in posterior region to withstand
the heavy occlusal stress.
6- Pontic must provide good esthetic to improve the appearance of the
patient.

Pontic design
1) Saddle pontic:
The tissue surface of the pontic has the shape of the ridge. This design
gives the illusion of a non-extracted tooth, which is accepted by the
 patient. This design is the most difficult to clean because there will be
food accumulation between the tissue surface of the pontic and the
alveolar ridge surface which will lead to tissue inflammation and
failure of restoration. This design shouldn’t be used at all.

2) Ridge lap pontic:

This design gives the illusion of a non-extracted tooth. The tissue
surface of the pontic is convex so there will be slight contact with the
underlying soft tissue. This is the best design for all upper and lower
teeth (the deciding factor of appearance zone depends on smile line).

3) Hygienic pontic (sanitary pontic):

In this type there isn’t any contact between the ridge and the pontic.
This is used when the missing tooth is located in the non-appearance
zone (mostly the posterior teeth)
 The pontic is completely made of metal and there is at least 3 mm
space between the ridge and the pontic to facilitate proper cleaning of
the region.
The pontic thickness should be at least 3mm to be strong enough to
withstand the occlusal force.

4) Conical pontic: (spheroid or bullet)

It is used when the occlusal two thirds of the pontic lie in the
appearance zone and this is mostly seen when we restore the lower
incisors, premolars and sometimes molars because the gingival third
is not seen (is not in the appearance zone) In this design there is no
extension toward the labial surface.
Lecture 9

Restoration of Endodontically Treated Teeth

Special techniques are needed to restore endodontically treated
teeth. Usually a considerable amount of tooth structure has been lost
because of caries, endodontic treatment, and the placement of previous
restoration. The loss of tooth structure makes retention of subsequent
restoration more problematic and increase likelihood of fracture during
functional load.

Factors influence the choice of technique:-

1- The type of tooth (whether it is an incisor, canine, premolar
or molar).
2- The amount of remaining coronal tooth structure. Which is
the most important indicator when determine the prognosis.
Before restoration, existing endodontically treated teeth need to be
assessed carefully for the following:-

 Good apical seal.

 No sensitivity to pressure.
 No exudates.
 No fistula.
 No active inflammation.

Indications:
 1. Restoration of endodontically treated teeth when excessive amount
of the tooth structure is removed or lost by caries, trauma , filling,
and making the retention of other types impossible.
2. Realignment of malposed teeth.
3. As bridge retainer (short span bridge).
4. Tooth with short clinical crown.

Factors to be considered in selection of a tooth for post

crown
1. The root of the tooth should be sufficiently shaped, with adequate
length and width.
2. The root should be without internal or external resorption.
3. Alignment of the root, any abnormality in the alignment of the root
in relation to the adjacent teeth will affect the steps of post crown
construction.
4. Quality of the root filling, in order to construct a post crown the
tooth should be filled endodontically with gutta percha.

Parts of post crown:

1. The post (dowel): it is the part of the crown, which
extended into the root canal; it should be 2/3 of the root
length.
2. The core: it is the coronal part of the post crown.
3. The crown: the crown should be a full metal, full veneer
or jacket crown (acrylic or porcelain).

There are two types of post- crowns

1. Two-unit post crown (post and core +crown).
2. One unit post crown (post + core + crown).

Advantages and indications of two unit system post-crown

1. Young patients under 18 years old, because the gingival-tooth
relationship will change with time.
2. The two-unit system can be repaired if crown is damaged.
3. When the endodontically treated tooth is to be used as a bridge
abutment, it is necessary to do a two unit system post crown.
POST-CROWN

Procedures:-
A three – stage operation:-

1- Removal of the root canal filling material to the appropriate depth.

2- Enlargement of the canal.

3- Preparation of the coronal tooth structure.

 A post cannot be placed if the canal is filled with a full – length

silver point, so these must be removed and the tooth retreated with
gutta-percha.
Before removing G.P. calculate the appropriate length of the post. It
should be adequate for retention and resistance but not long enough to
weaken the apical seal. As a guide, make the post length equal to:-

1- The height of the anatomic crown

2- Two – thirds the length of the root).
But leave 5mm of apical gutta -percha. On short teeth, it will not be
possible to meet both these restrictions, and a compromise must be made.
An absolute minimum of 3mm of apical fill is needed.

The operator should have acknowledged about the average values for
crown and root length.

Methods for removing G.P.:-

A – Using a warmed endodontic plugger.

 Select large enough plugger to hold heat well but not so large
that is binds against the canal walls.
  Mark it at the appropriate length (normally endodontic
working length minus 5mm) heats it, and places it in the
canal to soften the G.P.
B- Using a rotary instrument.

These are special post preparation instruments, these considered (safe-tip)

instruments because they are not end-cutting burs.


The friction generated between the fill and the tip of these
burs softens the G.P. Peeso-Reamers and Gates Glidden
drills are often used for this purpose.
 End-cutting instruments should never be used to gain
length because root perforation will result.
 The rotary instrument should be slightly narrower than the
canal.
 Make sure the instrument follows the center of the G.P. and
does not cut dentin.
 Knowledge of average root dimensions is important,
because the post should be no more than one third the
diameter of the root. With 1mm root wall thickness.
Post can be classified into two main types:-

1- Prefabricated post.

2- Custom-made post: casted in metal, indicated for teeth with root

canals whose cross section is not circular or is extremely tapered.

Many classifications of prefabricated posts are available

A-tapered, smooth-sided posts, B-tapered, serrated posts

C-tapered threaded posts, D-parallel, smooth-sided posts

E-parallel, serrated posts, F-parallel, threaded posts.

Prefabricated posts fabricated from different materials:-

  Posts made from precious, semiprecious, and non
precious alloys.
 Carbon –fiber posts gave increased
popularity in recent years consist of
bundles of stretched, aligned carbon
fibers embedded in an epoxy matrix; it is
strong with lower stiffness.
One advantage of carbon fiber post is the ease
of its removal for retreatment.

The chief disadvantage of a carbon fiber post is its black appearance,

which presents an esthetic problem.

 High strength ceramic posts

(Zirconium) have excellent esthetic
properties.
In case of prefabricated post system is chosen
Technique simplicity is one advantage of using prefabricated posts.

Enlargement of the canal

1- Enlarge the canal one or two sizes with a drill, endodontic file or
reamer that matches the configurations of the post

2- Use a prefabricated post that matches standard endodontic instrument.

 A tapered post will conform better to the canal than a

parallel-sided post and require less removal of dentin to
achieve an adequate fit. However, it will be slightly less
retentive and will cause greater stress concentration.
Modified post are available with tapered ends, conform better to the
shape of the canal, although they have slightly less retention than parallel-
sided do. In the absence of a vertical stop on sound tooth structure, such
posts can also create an undesirable wedging effect.

In case of custom made post system is chosen.

 Enlargement of the canal:-

 Often very little preparation will be needed. However, undercuts within

the canal must be removed, and some additional shaping usually is
necessary.
 Be most careful on molars to avoid root perforation.
In mandible molars the distal wall of the mesial root is particularly
susceptible. In maxillary molars the curvature of the mesiobuccal root
makes mesial or distal perforation more likely.

PREPARATION OF THE CORONAL TOOTH

STRUCTURE:-
After the post space has been prepared, the coronal tooth structure is
reduced for the extra coronal restoration.

1- Ignore any missing tooth structure (from previous

restorative procedures, caries, fracture, or
endodontic access) and prepare the remaining
tooth as though it were undamaged.
2- Be sure that the facial structure of the tooth is adequately, reduced for
good esthetics.
3- Remove all internal and external undercuts that will prevent withdrawal of
the pattern.
4- Remove any unsupported tooth structure, but preserve as much of the
crown as possible. Because tooth structure has been removed internally
and externally. The remaining walls, ideally, should be at least 1mm wide.
5- Be sure that part of the remaining coronal tissue is prepared perpendicular
to the post, because this will create a positive stop to prevent over seating
and splitting of the tooth.
 Rotation of the post must be prevented by preparing a flat surface parallel
to the post. If insufficient tooth structure for this feature remains, an
antirotation groove should be place in the canal.
 If there is supragingival tooth structure, use a flame diamond to place a
contrabevel around the external periphery of the preparation. This feature
provides a metal collar around the occlusal circumference of the
 preparation to aid in bracing the tooth against fracture of the remaining
tooth structure (ferrule effect).
6- Complete the preparation by eliminating sharp angles and establishing
smooth finish line.
 Crown & bridge
Lecture: 10
Effects of tooth loss:
If any tooth is lost, future problem will arise in the neighboring teeth,
and skeletal and muscular components of the face.
1. Drift of the neighboring teeth:
If any tooth is extracted, the adjacent teeth will drift to the extracted
tooth's space. This will lead to loss of contact between the existing teeth,
and future caries. Excessive drifting will cause the gingival proximal area
difficult to clean, therefore gingival inflammation and recession might
occur.
2. Over eruption of the opposing teeth:
Due to loss of a tooth, the occluding tooth in the opposing jaw will
over erupt until it occludes again, either with the other opposing teeth or
the alveolar ridge. This eruption will cause root exposure in the cervical
part of the roots.
3. Occlusal malalignement:
Disturbance in the intercuspation of the teeth due to loss of a tooth
will cause muscle spasm and pain in the TMJ.
 Reasons for treating tooth loss:
1- Esthetics restoration.
2- Restoring function.
3- Resolve pain in the muscles and TMJ.
4- Maintenance of dental health.
5- Restoring speech.
Types of bridges:
1. Fixed-fixed bridge:
All the components of this bridge are
fixed at the connector area.

2. Fixed-movable bridge:

The bridge is divided into 2 segments

and they are joined in a movable connector
which is a slot or a dove tail. This type of
bridge is used when there is no alignment in
the path of insertion of the abutments.

3. Spring bridge:
 This bridge consist of a retainer usually a premolar, along
palatal bar and a pontic far away from the abutment tooth, it's
used when there are spaced anterior teeth.

4. Cantilever bridge:
This bridge consist of a pontic fixed to one retainer, the
pontic size must be small in relation to abutment tooth so that
the bridge can withstand the masticatory forces.