Seminar on Pontics

 Introduction
 Requirements of pontics
 Functions of pontics
 Pretreatment assessment
 Classification of deficient ridge contour
 Classification of pontics
 Pontic selection
 Optimal pontic design
 Basic principles of pontic design
 pontics fabrication
 Post insertion hygiene
 Conclusion
 references
 introduction
 Meaning of the word pontics- “PONS”
 Mere replacement of tooth does not serve the purpose of
pontics
 Placing an exact anatomic replica is hygienically
unmanageable
 The design is dictated by the factors
1. Esthetics
2. Function
3. Ease of cleansing
4. Maintenance of healthy tissue
5. Patient comfort
 Definition of pontics
 Acc to GPT1999-an artificial tooth on a
fixed partial denture that replaces a missing
natural tooth, restores its function, and
usually space previously occupied by the
clinical crown
 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
1. Smooth surfaced and convex in all directions
2. Easily cleansable
3. Pinpoint pressure free contact on the ridge
4. No irritation to the gingival tissues
5. Facilitate plaque control
6. Emergence profile
7. Strength and longevity
8. Be esthetic
9. Restore function
10. No abutment overloading
11. Color stable
 Functions of pontics
Mastication –
 provides resistance to opposing tooth when food is
chewed
 Helps in continuation of chewing

Speech-
 Space created by loss of tooth alters the airflow and
pontics restricts the airflow
Esthetics
 Improves the personnel appearance
Maintenance of tooth relationship

tooth loss

teeth movement

occlusal interferences

excessive tooth mobility or

TMJ disturbances
 Pretreatment assesment
 Tools of pretreatment assesment
1. Diagnostic casts
2. Diagnostic waxing
 Pontic space
 Mesiodistal and occluso cervical space
 Analysed for any drifting or tilting of teeth
 In case of reduced pontic space
1. Orthodontic repostioning
2. Small pontics(disadvantages)
3. Increase the proximal contours of adjacent teeth
4. No prosthodontic intervention
•residual ridge contour

Ideal ridge contour:

1. Should have smooth regular surface of attached
gingiva with adequate width and height for
pontic placement.
2. Free of frenal attachment and must sustain the
appearance of interdental papilla
3. Ideal ridge contour vary with the type of pontic
to be used
 For modified ridge lap
 For ovate pontic
Bulky ridge contour

 a ridge may be excessive due to excessive hard

or soft tissue
Surgical correction
 In case of soft tissue excess-GINGIVOPLASTY

 incase of hard tissue excess-OSSEOUS

REDUCTION
Deficient ridge contour

 Causes of deficient ridge

1.trauma during tooth extraction
2.Traumatic injury
3.Developmental defects
4.Advanced periodontal disease
 preventive measures
1.Proper exodontic procedures
2.Implantation of granular or root form synthetic grafts
3.Ridge augmentation
4.Early treatment of periodontal disease
 Classification of deficient ridge contour

 Acc to SEIBERT
I –buccolingual loss of tissue
with normal tissue height
II-apicocoronal loss of tissue
with normal tissue width
III-combined loss of tisssue
in both dimensions
A  ALLEN modified this
c classification and included
B
D
the severity of the defect
MILD –less than 3mm
MODERATE-3-6mm
SEVERE-greater than 6 mm
 Surgical modification
1. For class I defects
roll technique pouch technique
2.For class II defects
interpostional graft onlay graft
Gingival architechture preservation

 Purpose-to simulate the gingival contour of

the adjacent teeth
 Procedure-
 Abutment preparation before the extraction

 Indirectly fabricated provisional FPD

 classification
1. Depending on shape of surface contacting the
ridge(TYLMANN)
 sanitary
 Modified sanitary
 Spheroidal
 Saddle
 Ridge lap
 Modified ridgelap
 ovate
2.according to dr.sohnmith singh based on the
shape of the surface contacting the ridge
 Saddle
 Modified saddle
 Ridgelap
 Modified ridge lap
 Lap facing
 Spheroidal
 Modified spheroidal
 Egg ,bullet or heart shaped
 Sanitary
 modified sanitary
 Bar shaped
3.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
4.According to the form(johnston)

sanitary or hygenic

anatomic type

5.Based on materials used

metal
metal and porcelain
metal andresin
6.Prefabricated pontics
Flat back Trupontic

Longpinfacing

Pontips
Reverse pin facings
 Saddle or ridge lap pontics
 Design-
Replaces all contours of a
missing toth
Concave contacting surface
Ridge lap
Emerence profile
Snug contact
 Advantages
esthetics
 Disadvantages
difficult to clean
may cause tissue
inflammation
 Modified ridge lap
 Design
Combined features of saddle
and hygenic pontics
Ridge lap –modified
no concavity , FPD partially seated. , FPD seated

tissue contact resembles

letter “T”
 Advantages
Good esthetics
Possible to maintain
hygiene
 Disadvantages
hygiene is inferior to sanitary
 Recommended location
appearance zone
 Contraindications
where esthetics is least concerned
 Materials
metal cermic and all resin
 Sanitary or hygienic
Design
 No contact with residual ridge
 Occluso gingival thickness greater than 3mm
 Adequate space for cleansing
 Two configurations
1. Fish belly design
2. Perel pontic, arc shaped FPD, modified sanitary
pontic
Advantages
 Good access for oral hygiene
 Least tissue inflammation

Disadvantages
 Poor aesthetics

Recommended location
 Non appearance zone

Contraindications
 Appearance zone
 Less vertical dimension

Materials
 All metal
 Conical pontic
 Synomyms
 Design
Gingival surface –rounded and
small tip
Preferred with knife edged
ridge
 Advantages
Oral hygiene
 Disadvantages
Poor esthetics
Recommended location
 Molars with out esthetic requirement

Contraindications
 Esthetic zone

 Patients with poor oral hygiene

Materials
 Allmetal

 Metal-cermic

 All resin
 Ovate pontic
 Most esthetically appealing design
Design
 Convex tissue surface of pontic
resides with in the ridge
 Treatment planning
 Prepration of ridge during extraction
 Preparing the preexisting residual ridge
Advantages
 Emergence profile

 Esthetics

 Stronger than modified ridge lap

disadvantages
 surgical prepration
 meticulous oral hygiene

Recommended location
 Maxillary incisors,cuspids and premolars

Contraindication
Patients unwillingness for surgery

Materials
Metal-ceramic
All-resin
 Pontic selection
 Retainers

 Incase of PFM retainers,PFM pontics are used

 In case of partial veneer retainers,prefabricated
facings are indicated
 In case of complete metal retainer,all metal pontic
is used
 esthetics
 Maxillary anterior segment-modified ridge lap is
the design of choice
 Multiple missing teeth-minimize the interproximal
embrassure
 Posterior segment
 Maxillary
 Mandibular
Occlusogingival height and mesiodistal width of
pontic space
 Long span areas with reduced occlusaogingival
height-porcelain fracture

Ridge resorption and ridge contour

 Extensive ridge resorption
 Tissue clearence of 3mm
 Ridge augmentation and recontouring`
Optimal pontic design
 Biological considerations
The pontic has to preserve the sorrounding
biological tissues
 Ridge contact
1. Pressure free contact
2. Should be evaluated during try-in stage
3. Contact should be on the keratinised attached
tissue
 Oral hygiene considerations
1. Toxins of microbial plaque
2. Gingival surface of pontic-not accessible to
bristles of tooth brush
 Pontic material
Pontic should have following qualities
1. Biocompatible-glazed porcelain,gold or metallic and
acrylic
2. Rigidity – resist flexure during mastication
3. Strength – metal ceramic junction
- in case of decresed vertical space for pontic
4 Longevity
5 Provide Good esthetic results
 Occlusal forces
1 Reducing the buccolingual width by 30%
2 Problems with narrowing the occlusal table
3 Buccolingually collapsed ridges
 Mechanical considerations
 Causes of mechanical failure of an FPD
1. Poor tooth prepration
2. Improper choice of materials
3. Poor frame work design
4. Poor occlusion
 Long span FPD’s
1. Greater flexing
2. Displacement effects increase with cube of span
lenth
 Extension of ceramic on occlusal surfaces
 Available pontic materials
metal, ceramic and acrylic
1. Metal ceramic pontics
 Commonley used
 Easy to keep clean and looks natural
limitations
 Chances of mechanical failure incase of inadequate frame
work design
-decreased ceramic thickness
-increased ceramic thickness
-cut back technique should be used to avoid discrepencies
 Metal surfaces to be veneered should be smooth and free of
voids
 Sharp angles in the veneering area
 Metal ceramic junction

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2. Resin veneered pontics
Advantages
 Easy to manipulate and repair

 Donot require high melting range

 Newer composite resin system(new generation

indirect resins)
1. Contains high density of ceramic fillers
2. High flexural strength
3. Minimal polymerization shrinkage
4. Reduced wear rate
5. Improvements in bonding between metal and resin
disadvantages
Resistance to abrason
Susceptible to dimensional change
Discoloration due to leakage between metal-resin
 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
 Modified ridge lap
 Ovate pontics

 Shadows around natural

tooth should be studied
 Inciso gingivo 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
 Mesio-distal width
 Space for tooth may be less or
more than the adjacent tooth
-orthodontic treatment
-incorporation of visual
perception principles to the pontic
 Width of the tooth is
identified by
1. Relative position of
mesiofascial and
distofascial line angles
2. Overall shape

3. Light reflection between

the line angles
 Space discrepency can be
compensated by altering the
shape of the proximal areas
 Basic principles of pontic design
 Occlusal surface: with in the
bounderies of the lines
connecting buccal and lingual
surfaces of abutment teeth
 Buccal ,lingual or palatal
surfaces: should lie in same
plane as the surfaces of adjacent
teeth
 Angle of contact: junction of
pontic with gingivae should be
as wide as possible
 Area of contact: should be as
minimal as possible
 Mucosal contact: should be
either convex or flat
 Embrassures : should be as
wide as possible
 Fabrication of pontics
 Anatomic contour waxing
 Prepare the pontic approximatley and adapt it to
ridge
 Pour molten wax into the impression of diagnostic
waxing or provisional restoration
 Prefabricated pontics

 Cut-back procedure
 Metal prepartion
 Porcelain application
 Post insertion hygiene
 Embrasures-wide
 Space between pontic
and tissue
 Education and
motivation of the patient
 Aids for maintaining the
hygiene
 Dental floss
 Interproximal brushes
 Pipe cleansers
 Evaluation of home care
 References
 Stephen f rosenstiel: contemporary fixed prosthodontics.third edition
 Herbert t. shillinburg: Fundamentals of fixed prosthodontics.third
edition
 William f.p malone: tylman’s theory and practice of fixed
prosthodontics.eigth edition
 Johnston: modern practice in fixed prosthodontics.fourth edition
 Colin r. cowell: inlays crown and bridges.fourth edition
 Georgia k. johnson:ponic design and localised ridge augmentation in
fixed prosthodontics.DCNA1992,p.no591-605
 Sohnmit singh: pontic designs.famdent practical dentistry
handbook 2002.p.no41-46