Pontics

1. Pontics Preeti kalia IInd year PG student Dept of Prosthodontics A.E.C.S Maaruti College of Dental Sciences

2. Pontics Definition Requirements Design Pretreatments assessment Types Fabrication

3. 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

4. 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.

5. 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

6. Ideal requirement of pontics Facilitate plaque control Emergence profile Strength and longevity Be esthetic

7. Ideal requirements of pontics Restore function No abutment overloading Color stable

8. Functions of pontics Mastication Speech Esthetics

9. Considerations for a successful pontic design

10. Biologic considerations Ridge contact Area of contact with ridge should be small and convex.

11. Oral hygiene considerations

12. Pontic materials

13. 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

14. 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

15. Mechanical considerations Improper choice of materials Poor framework design Poor tooth preparation Poor occlusion

16. 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

17. Esthetic considerations

18. Incisogingival length Root can be stained to simulate exposed dentine. Pink porcelain to simulate the gingival tissues

19. Mesiodistal width Space discrepancy – less problem in posteriors

20. Mesiodistal width Orthodontic treatment Pontic of abnormal size- illusion of natural tooth

21. Pretreatment assessment Diagnostic cast Wax up

22. Pontic space Individual crowns of increased proximal contours were preferred to an FPD with undersized pontics

23. Residual ridge contour Loss of residual ridge contour leading to unesthetic open gingival embrasures Food entrapment

24. Residual ridge contour Class II defect. Class I defect. Class III defect. Sieberts classification

25. 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

26. Surgical management of class I defect Pouch technique

27. Surgical management of class I defect Pouch technique

28. Surgical management of class II and III defect Interpostional graft

29. Surgical management of class II and III defect onlay graft

30. Gingival architecture preservation

31. Classification Depending on shape of surface contacting the ridge( Tylmann ) Sanitary Modified sanitary Spheroidal Saddle Ridge lap Modified ridgelap Ovate

32. 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

33. 3.According to the form(Johnston ) Sanitary or Hygenic Anatomic type 4.Based on materials used Metal Metal and porcelain Metal and resin

34. 5.Prefabricated pontics Flat back Trupontic Longpinfacing Pontips Reverse pin facings

35. Sanitary or hygienic

36. Modified sanitary pontic

37. Ridge lap pontic

38. Modified ridge lap pontic

39. Conical pontic

40. Ovate pontic

41. 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

42. 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

43. 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

44. Metal ceramic pontics wax the prosthesis

45. All ceramic pontics

46. Resin veneered pontics

47. Fiber reinforced composite resin pontics

48. Pontic fabrication All metal hygienic pontic Metal ceramic pontic

49. 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

50. All metal hygienic pontic fabrication

51. All metal hygienic pontic fabrication

52. All metal hygienic pontic fabrication

53. All metal hygienic pontic fabrication

54. All metal hygienic pontic fabrication

55. Metal ceramic pontics Requirements Adequate bulk of metal Uniform thickness of porcelain Continuous strip of metal on lingual surface

56. Scalloped or trestle design Connector is diminished in faciolingual dimension – Indication Bulk or rigidity in connector areas Tissue contact – modified ridge lap

57. 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

58. Metal ceramic pontics Check the alignment in a mesiodistal and the facial profile

59. Metal ceramic pontics

60. Metal ceramic pontics

61. Available pontic systems Advantages Disadvantages Indications Contraindications Metal ceramic Esthetics Biocompatible Difficult if abutment not metal ceramic Most situations Long span with high stress All metal Strength Straightforward procedure Non esthetic Mandibular molars, under high bite force Esthetics Fibre reinforced all resin Conservative with inlays Esthetics Limited to short spans Esthetics Long span Facings Rarely used Rarely used Rarely used Rarely used

62. 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.

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

64. 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

65. 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

66. 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

67. 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

68. References R.Duane Douglas , Pontic design FPDpontic wax up . ppt FPD.ppt