PONTICS IN Fixed partial denture - Prodthodontics.pptx

FPD - Pontics

1. introduction The restorations of edentulous areas with fixed partial dentures (FPDs) present a particular challenge for the clinician. Because of their ease of use and favorable long term results, conventional FPDs represent the most popular treatment measure today. In these restorations, the pontic must fulfill the complex roles of replacing the function of the lost tooth, achieving an esthetic appearance, enabling adequate oral hygiene, and preventing tissue irritation .

2. PONTICS IN FPD Dr Varsha Gupta 2 nd MDS,Prosthodontics

3. content Introduction Definition Pretreatment assessment pontic space residual ridge contour surgical modification gingival architecture preservation Classification of pontics Biologic considerations Mechanical considerations Esthetic considerations Cross references References

4. history Egyptians and Phoeniceans were the pioneers in the field of pontics and were the first to construct dental bridge work. These were mostly made of calf bone or ivory. It was Mancy in 1928 who laid the foundation to present day FPD design, however Pierre Fauchard (1923) has often been referred to as the ‘Father of Modern Dental Prosthesis’ . In his work in the field of FPD he used what he called ‘tenons’ which were in reality dowels or pivots screwed into the roots to retain some of the bridges. Selberg (1936) pointed out -basic materials had changed but little in the past few yrs.

5. Definition GPT 9 - pontic \ pŏn΄tĭk \ n: an artificial tooth on a fixed partial denture that replaces a missing natural tooth, restores its function, and usually restores the space previously occupied by the clinical crown. TYLMAN the suspended member of a fixed partial denture which replaces the lost natural tooth , restores function and occupies the space of the missing tooth. ROSENSTIEL defines pontic as “the artificial teeth of a fixed partial dental prosthesis that replaces the missing natural teeth, restoring function and appearance.”

6. FUNCTIONS

7. PRETREATMENT ASSESSMENT

8. 2)Residual ridge contour Loss of ridge contour

9. SIEBERT’S CLASSIFICATION OF RESIDUAL RIDGE DEFORMITIES :

10. GINGIVAL ARCHITECTURE PRESERVATION

11. PONTIC SELECTION Anterior region Pontic- residual ridge relationship: A research report. Stein RS, J Prosthet Dent 1966; 16: 251

12. Pontic- residual ridge relationship: A research report. Stein RS, J Prosthet Dent 1966; 16: 251 Posterior region

13. 1. Depending on shape of surface contacting the ridge( Tylman ) Sanitary Modifiedsanitary Spheroidal Saddle / Ridge lap Modified ridgelap Ovate CLASSIFICATION Based on mtaerials used Metal and porcelain veneered Metal and resin veneered All metal pontic All ceramic pontic

14. Custom made pontic 4.METHOD OF FABRCIATION

15. According to Oswal : Ÿ Conventional – commonly used pontic designs are ridge lap pontic , modified ridge lap pontic , sanitary, conical and ovate pontic . Ÿ Unconventional – modified ovate, modified sanitary pontic , occlusal bar, Stein pontic , spheroidal, hollow, inzoma , split pontic , cross pin and wing

16. Zero tissue contact Occlusalgingival thickness should be atleast 3mm & Convex mesiodistally and faciolingually Space beneath the pontic – 2mm ( Rosenstiel) - 3 mm ( Tylman ) SANITARY OR HYGIENIC PONTIC OR FISH BELLY

17. gingival portion is shaped like a concave archway mesiodistally between the retainers and convex faciolingually . Allows increased connector size while decreasing the stress concentrated in the pontic MODIFIED SANITARY PONTIC/PEREL/ARC FIXED :-

18. A modified sanitary pontic

19. SADDLE OR RIDGE LAP PONTIC The concave gingival surface of the pontic is not accessible to cleaning with dental floss-plaque accumulation- tissue inflammation

20. MODIFIED RIDGE LAP The modified ridge lap pontic combines the best features of the hygienic and saddle pontic designs , combining esthetics with easy cleaning

21. Tissue contact should resemble a letter T whose vertical arm ends at the crest of the ridge. maxillary and mandibular anterior teeth & maxillary premolars and first molars

22. egg-shaped, bullet-shaped, or heart-shaped recommended for the replacement of mandibular posterior teeth where esthetics is a lesser concern . CONICAL PONTIC

23. A knife-edged residual ridge will necessitate flatter contours with a narrow tissue contact area. This type of design may be unsuitable for broad residual ridges , because the emergence profile associated with the small tissue contact point may create areas of food entrapment.

24. Its convex tissue surface resides in a soft tissue depression or hollow in the residual ridge, which makes it appear that a tooth is literally emerging from the gingiva OVATE PONTIC

25. Socket-preservation techniques should be performed at the time of extraction to create the tissue recess from which the ovate pontic form will emerge Contour of provisional is important

26. The modification of the ovate pontic involves moving he height of contour at the tissue surface from the center of the base to a more labial position . MODIFIED OVATE PONTIC Unconventional pontics in Fixed Partial Dentures Mansi Manish Oswal , Manish Sohan Oswal

27. PREFABRICATED PONTICS These are commercially available porcelain pontics which can be altered by the dentist and reglazed if necessary. These include: Trupontic – A horizontal tubular slot in the center of the lingual surface of the facing Indication: Reduced interarch distance

28. b) Interchangeable facings /flat back facing– Manufactured with vertical slot running down the flat lingual surface , this facing is retained with a lug which engages the retention slot

29. The major disadvantage: of this system is its complex design, which leads to accumulation of plaque and gingival inflammation.

30. c) Sanitary facing – flat occlusal surface and a slot on the proximal surface to fit into the metal projections made in the FDP Pin facing – A flat lingual facing with two horizontal pins for retention. Reduced occlusogingival height.

31. e) Modified Pin Facing Facing is modified by adding porcelain to lingual gingival area of a pin facing f)Reverse pin facing – Porcelain is added to the gingival end of the facing and multiple precision pin holes are drilled into the lingual surface indicated - deep overbite where short pins are required

32. g. Harmony facing – This facing is supplied with an uncontoured porcelain gingival surface and usually two retentive pins on the flat lingual side . h. Porcelain fused to metal facing Facing consists of a metal core over which porcelain is fused.

33. i . Pontips : These facings are used when the tissue contact of the ponic should of glazed porcelain Convex gingival surface having pinpoint tissue contact and Attached to the backing occlusally with retentive pins

34. BIOLOGICAL CONSIDERATIONS Factors of specific influence are:

35. Pressure free contact between the pontic and the underlying tissue is indicated to prevented ulceration and inflammation of the soft tissues. When a pontic rests on mucosa, some ulcerations may appear as a result of the normal movement of the mucosa in contact with the pontic . RIDGE CONTACT

36. Pontic- residual ridge relationship: A research report Stein RS, J Prosthet Dent 1966; 16: 251 . AIM: To determine the frequency and the nature of tissue reaction of underlying the residual ridge mucosa to specific pontic designs and various materials used in pontic constructions. Upon removal of pontics , inflammatory reactions of the underlying mucosa were found under 95 per cent of the pontics . The ideal design was shown to be a “modified ridge lap” in the posterior region and a “lap facing” in the anterior region , with a pinpoint contact on the facial contiguous slope of the residual ridge.

37. The ideal design should include surface smoothness and a fine finish A successful artificial tooth replacement was characterized by a healthy tissue response with the appearance of a lack of contact between the residual ridge and undersurface of the pontic .

38. Cavozos E : Tissue response to fixed partial denture pontics . J Prosthet Dent 1968; 20: 143 A study to demonstrate that the adaptations of pontic to the ridge or the amount of “relief” on the cast is highly significant and directly proportional to the amount of unfavourable tissue change. Absolute minimal (0.0 to 0.25mm of cast scraping ) produced no tissue changes. When the cast scraping was increased to 1mm , tissue changes were produced varying from mild inflammation to ac 8 u 1 te ulceration

39. NOTE:

40. Devices such as proxy brushes , pipe cleaners, Oral-B Super Floss , and dental floss with a threader are highly recommended Gingival embrasures around the pontic should be wide enough to permit oral hygiene aids.

41. S h ou l d p r o v id e g ood es th e ti c r es u lt s , b io c o m pa tib i lit y , ri g idi t y , a nd strength to withstand occlusal forces; and longevity. Occlusal contacts should not fall on the junction between metal and porcelain during centric or eccentric tooth contacts, Investigations into the biocompatibility of materials used to fabricate pontics have centered on two factors : The effect of the materials and The effects of surface adherence. PONTIC MATERIAL

42. Well-polished gold is smoother, less prone to corrosion, and less retentive of plaque than an unpolished or porous casting For easier plaque removal and biocompatibility, the tissue surface of the pontic should be made in glazed porcelain However, ceramic tissue contact may be contraindicated in edentulous areas where there is minimal distance between the residual ridge and the occlusal table . Scanning electron micrographs of glazed porcelain (A), polished gold (B), and polished acrylic resin (C).

43. Reducing the buccolingual width of the pontic by as much as 30% 12% increase in chewing efficiency can be expected from a one third reduction of pontic width . OCCLUSAL FORCES

44. Narrowing the occlusal table may actually impede the development of a harmonious and stable occlusal relationship Pontics with normal occlusal widths (at least on the occlusal third) are generally recommended . One exception is if the residual alveolar ridge has collapsed buccolingually. Reducing pontic width may then be desired, thereby lessening the lingual contour and facilitating plaque control

45. MECHANICAL CONSIDERATIONS Mechanical problems may be caused by  improper choice of materials  poor frame work design  poor tooth preparation  poor occlusion.

46. The framework must provide a uniform veneer of porcelain (approximately 1.2 mm). The metal surfaces to be veneered must be smooth and free of pits Sharp angles on the veneering area should be rounded. METAL CERAMIC PONTICS

47. Occlusal centric contacts must be placed at least 1.5 mm away from the metal-porcelain junction

48. A reliable technique for ensuring uniform thickness of porcelain is to wax the fixed prosthesis to complete anatomic contour and then accurately cut back the wax to a predetermined depth .

49. Continuous dimensional change of the veneers often caused leakage a t the metal-resin interface, with subsequent discoloration of the restoration. New-generation indirect resins - High flexural strength, minimal polymerization shrinkage, and wear rates comparable with those of tooth enamel RESIN VENEERED PONTICS

50. A substructure matrix of impregnated glass or polymer fiber provides structural strength. Excellent marginal adaptation and esthetics FIBER-REINFORCED COMPOSITE RESIN PONTICS

51. SUMMARRY

52. No matter how well biologic and mechanical principles have been followed during fabrication, the patient will evaluate the result by how it looks, especially when anterior teeth have been replaced ESTHETIC CONSIDERATIONS

53. An esthetically successful pontic will replicate the form, contours, incisal edge, gingival and incisal embrasures, and color of adjacent teeth. The pontic’s simulation of a natural tooth is most often betrayed at the tissue pontic interface. Special attentio n should be paid to the contour of the labial surface a s i t a p p r o a ch e s t he p on t i c - t i ss ue j u n c t io n t o ac h i e ve a “ n a t u r a l appearance.” GINGIVAL INTERFACE

54. Special care must be taken when studying where shadows fall around natural teeth, particularly around the gingival margin. If a pontic is poorly adapted to the residual ridge , there will be an unnatural shadow in the cervical area -spoils the illusion of a natural tooth. Recesses occurring at the gingival interface collect food debris, further betraying the illusion of a natural tooth.

55. The modified ridge-lap pontic is recommended for most anterior situations; it compensates for lost buccolingual width in the residual ridge by overlapping what remains However, When appearance is of utmost concern, the ovate pontic , used in conjunction with alveolar preservation or soft tissue ridge augmentation

56. Ridge resorption will make a pontic look too long in the cervical region. An abnormal labiolingual position or cervical contour, however, is not immediately obvious. This fact can be used to produce a pontic of good appearance by recontouring the gingival half of the labial surface. INCISOGINGIVAL LENGTH

57. In areas where tooth loss is accompanied by excessive loss of alveolar bone, the pontic is shaped to simulate a normal crown and root with emphasis on the cementoenamel junction.

58. Frequently, the space available for a pontic will be greater or smaller than the width of the contra lateral tooth. If possible, such a discrepancy should be corrected by orthodontic treatment. If this is not possible, an acceptable appearance may be obtained by incorporating visual perception principles into the pontic design MESIODISTAL WIDTH

59. The width of an anterior tooth is usually identified by the relative positions of the mesiofacial and distofacial line angles, and the overall shape by the detailed pattern of surface contour and light reflection between these line angles

60. The exact shade of the gingiva has to be established with special gingival shade guides. The basal surface must demonstrate a convex shape similar to the ovate pontic designs for the dental floss to establish tight contact with all the surface areas. H Spiekermann: A review of esthetic pontic design options. Quintessence Int 2002;33:736-746 GINGIVA COLOURED CERAMICS

61. This method is particularly suitable for patiens with a local alveolar ridge defect that has not been corrected by augmentation of the soft tissue. D 8 a 1 niel E , H Spiekermann: A review of esthetic pontic design options. Quintessence Int 2002;33:736-746 ALL CERAMIC GINGIVAL MASKS

62. The features of the contra lateral tooth should be duplicated as precisely as possible in the pontic , and the space discrepancy can be compensated by altering the shape of the proximal areas . The retainers and the pontic can be proportioned to minimize the discrepancy. (This is another situations in which a diagnostic waxing procedure will help solve a challenging restorative problem).

63. Discrepancy here can be managed by duplicating the visible mesial half of the tooth and adjusting the size of the distal half. Space discrepancy presents less of a problem when posterior teeth are being replaced because their distal halves are not normally visible from the front.

64. Connector in a fixed partial denture can be defined as,"The portion of a fixed partial denture that unites the retainer(s) and pontic (s)"—GPT. Classified as – RIGID NON RIGID

65. RIGID-These connectors are used when the entire load on the pontic is to be transferred directly to the abutments NON RIGID-These connectors are indicated in cases where a single path of insertion cannot be achieved due non-parallel abutments.

66. Tenon Mortise Connectors (TMC) with a male and female component or dovetail connectors

67. LOOP CONNECTIRS Loop connectors are used when an existing diastema is to be maintained in a planned fixed prosthesis.The connector consists of a loop on the lingual aspect of the prosthesis that connects adjacent retainers and/or pontics

68. SPLIT PONTIC CONNECTOR : They are used only in cases with a pier abutment. Here the connector is incorporated within the pontic . The pontic is split into mesial and distal segments.

69. CROSS PIN AND WING

70. PONTIC FABRICATION Most pontics are now made with the metal-ceramic technique, which provides the best solutionto the biologic, mechanical, and esthetic challenges encountered in pontic design. Their fabrication,however , differs slightly from the fabrication of in- dividual crowns. These differences will be empha - sized in the ensuing paragraphs.

71. For strength andesthetics , an accurately controlled thickness of porcelain is needed in the finished restoration. To ensure this, a wax pattern is made to the final anatomic contour.

72. 1.Wax the internal, proximal, and axial surfaces of the retainers 2. Soften the inlay wax, mold it to the approxi - mate desired pontic shape, and adapt it to the ridge. This is the starting point for subse-quent modification. 3.Lute the pontic to the retainers and, for addi-tional stability, connect its cervical aspect di- rectly to the master cast with sticky wax. Then wax the pontic to proper axial and oc - clusal (or incisal) contour (Fig. 20-44). 5. Complete the retainers and contour the prox-imal and tissue surfaces of the pontic for the desired tissue contact. 6. The pontic is now ready for evaluation before cut-back. STEPS

73. STEPS FOR CUT BACK 1 . Use a sharp explorer to outline the area that will be veneered with porcelain . The porcelain-metal junction must be placed suf-ficiently lingual to ensure good esthetics,section one connector 2.Finish the cut-back of this retainer, making sure there is a distinct 90-degree porcelain-metal junction. 3.Reflow and finalize the margins. The ponticis held in position by the other retainer dur- ing this procedure. 4. Refine the pontic cut-back where access is im-proved by removal of the first retainer. 5. Reseat the first retainer, reattach it to the pon -tic, section the other connector, and repeat the process.

74. 6. Sprue the units and do any final reshaping as needed and casting is carried out. Recover the castings Finish the gingival surface of the pontic . Do not overreduce this area.

75. PURPOSE: To evaluate the load-bearing capacities of fiber- reinforced composite (FRC ) fixed dental prostheses (FDP) with pontics of various materials and thicknesses . MATERIALS: 72 FDPs with frameworks made of continuous unidirectional glass fibers were fabricated. Fibre reinforced composite fixed dental prosthesis with various pontics Leila perera et al

76. Three different pontic materials were used: glass ceramics , polymer denture teeth, and composite resin . The FDPs were divided into 3 categories based on the occlusal thicknesses of the pontics (2.5 mm, 3.2 mm, and 4.0 mm).

77. CONCLUSION: By increasing the occlusal thickness of the pontic , the load- bearing capacity of the FRC FDPs may be increased. The highest load-bearing capacity was obtained with 4.0 mm thickness in the ceramic pontic . However, with thinner pontics , polymer denture teeth and composite pontics resulted in higher load-bearing values.

78. Enhancing Esthetics with a Fixed Prosthesis Utilizing an Innovative Pontic Design and Periodontal Plastic Surgery Journal of Esthetic and Restorative Dentistry, 2014 This article addresses how to reestablish or maintain papilla height and the facial gingival tissue between a single or multiple missing teeth adjacent to a natural tooth or an implant by using a pontic design termed the E- pontic Limitations: when there is an alveolar ridge defect with apico -coronal loss of tissue and/or a combination of buccolingual and apico -coronal loss of tissue At least 2 mm of soft tissue over the alveolar bone is necessary to create the site; 3–5 mm of soft tissue coverage is ideal

79. PREFABRICATED WAX PONTICS Advantages: Without collar Reduced occlusal depths Perfect scraping and modelling characteristics Primary use: Temporary Bridges Plastic to fabricate quick and economical temporary bridges. Wear-resistant, vacuum- processed synthetic resin Special lingual channel ensures pontic locks into the plastic

80. The pontic design is said to determine the success or failure of a bridge . Designs that allow easy plaque control are especially important to a pontic’s long term success. M i ni m i z in g ti s s ue c o n t ac t by m a x i m i z in g th e c o n v e x it y of t h e pontic’s gingival surface is essential. Special consideration is also needed to create a design that combines easy maintenance with natural appearance and adequate mechanical strength CONCLUSION

81. Rosenstiel S F et al : Contemporary Fixed Prosthodontics, 4 th edn Missouri, Mosby Inc, pg 513 Shillingburg H T et al : Fundamentals of fixed prosthodontics, ed 4, Chicago , Quintessence Publishing, pg 485 Tylman SMalone W. Tylman's Theory and practice of fixed prosthodontics. 8th ed. The Glossary of Prosthodontic Terms. The Journal of Prosthetic Dentistry. 2005;94(1):10-92. Cavozos E : Tissue response to fixed partial denture pontics . J Prosthet Dent 1968; 20: 143 Daniel Edelhoff , H Spiekermann : A review of esthetic pontic design options. Quintessence Int 2002;33:736-746 Henry P J et al: Tissue changes beneath fixed partial dentures. J Prosthet Dent 1966; 16: 937 REFERENCES

82. Perel M L : A modified sanitary pontic . J Prosthet Dent 1972; 28: 587 Stein RS: Pontic- residual ridge relationship: A research report. J Prosthet Dent 1966; 16: 251 Korman R. Enhancing Esthetics with a Fixed Prosthesis Utilizing an Innovative Pontic Design and Periodontal Plastic Surgery. Journal of Esthetic and Restorative Dentistry. 2014;27(1):13-28. Fiber -reinforced Composite Fixed Dental Prostheses with Various Pontics The Journal of Adhesive Dentistry2014Vol 16, No 2 Kim T, Cascione D, Knezevic A. Simulated tissue using a unique pontic design: A clinical report. The Journal of Prosthetic Dentistry. 2009;102(4):205-210. Purra AMushtaq M. Aesthetic replacement of an anterior tooth using the natural tooth as a pontic ; an innovative technique. The Saudi Dental Journal. 2013;25(3):125-128

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