Pontics in Fixed Partial Dentures

Pontics in Fixed Partial Dentures

1. PONTICS IN FIXED PARTIAL
DENTURE
1
PRESENTED BY
DR KELLY NORTON
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2. CONTENTS
2
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
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3. •Esthetic appearance
•Enabling adequate oral hygiene
•Preventing tissue irritation
3
INTRODUCTION
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4. ACCORDING TO :
GPT-8
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.
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.
4
DEFINITION
.
The Glossary of Prosthodontic Terms. The Journal of Prosthetic Dentistry. 2005;94(1):10-92.
Tylman SMalone W. Tylman's Theory and practice of fixed prosthodontics. 8th ed.
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5. OPTIMAL PONTIC DESIGN
5
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6. PRETREATMENT ASSESSMENT
6
I] PONTIC SPACE:
One function of FPD is to prevent tilting or drifting of the
adjacent teeth into the edentulous space.
Drifting / tilting
Reduced pontic space
Difficulty in fabricating pontic
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7. ESTHETIC ZONE
• Orthodontic alignment
• Abutment modification with
complete coverage retainers
NONESTHETIC ZONE
• Overly small pontics are
unacceptable
•Trap food
•Difficult to clean•Careful diagnostic waxing to
determine most appropriate
treatment
7
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8. 2) RESIDUAL RIDGE CONTOUR
8
Features of Ideal Ridge
Contour:
Smooth and regular surface of
attached gingiva -Facilitate
maintenance of plaque-free
environment
Sufficient height and width
-Mimic adjacent tooth contours-
Appear to emerge from the
ridge
Facially, free of frenal
attachment
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9. LOSS OF RESIDUAL RIDGE CONTOUR :
Unesthetic open gingival embrasures “BLACK
TRIANGLES”
Food impaction
Percolation of saliva during speech
9
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10. 10
SIEBERT’S CLASSIFICATION OF RESIDUAL RIDGE DEFORMITIES :
Class I defects 
Faciolingual loss of
tissue width with
normal ridge height.
Class II defects 
Loss of ridge height
with normal ridge
width.
Class III defects 
a combination of loss
in both dimensions.
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11. 91% residual ridge deformities
¯
Anterior tooth loss
¯
Majority of patients with class II & class III defects
¯
Unsatisfied with esthetics
¯
Pre-prosthetic surgery
Ridge augmentation
11
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12. SURGICAL MODIFICATION
12
Ridge augmentation with hard tissue grafts is not
indicated unless it is to receive an implant.
Class I Defects:
Infrequent
Not esthetically challenging
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13. THE ROLL TECHNIQUE FOR SOFT TISSUE RIDGE
AUGMENTATION:
13
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14. II] THE POUCH TECHNIQUE FOR SOFT TISSUE RIDGE
AUGMENTATION:
14
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15. CLASS II & CLASS III DEFECTS
15
I] INTERPOSITIONAL GRAFT:
Variation of pouch technique
Augmentation of ridge height & width
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16. II] ONLAY GRAFT

16
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17. 17
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18. GINGIVAL ARCHITECTURE
PRESERVATION
18
By conditioning the extraction site and providing a matrix for healing,
the pre-extraction gingival architecture, or “socket,” can be preserved.
If bone levels are compromised :
Allograft materials
Hydroxyapatite
Tricalcium phosphate
Freeze dried bone
Can be grafted into the sockets
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19. The tissue side of the pontic should be:
 an ovate form - 2.5 mm apical to the
facial free gingival margin
The pontic causes tissue blanching as it
supports the papillae and facial/palatal
gingiva.
The tissue side of the pontic must
conform to within 1 mm of the
interproximal and facial bone contour to
act as a template for healing.
After approximately 1 month of healing,
oral hygiene access is improved by
recontouring the pontic to provide 1 to 1.5
mm of relief from the tissue.
19
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20. Orthodontic Extrusions
Avoids ridge augmentation and gain vertical ridge height
However, Additional time and expense of orthodontic treatment,
as well as previous endodontic treatment is necessary
20
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21. CLASSIFICATION
1.Depending on shape of surface
contacting the ridge(Tylman)
 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. Based on materials used
•Metal and porcelain veneered
•Metal and resin veneered
•All metal pontic
•All ceramic pontic
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21

22. 4. METHOD OF FABRICATION:
•Custom made pontic
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22

23. Pontic selection depends primarily on esthetics and oral hygiene.
 ANTERIOR REGION
 POSTERIOR REGIONS
23
PONTIC SELECTION
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24. ANTERIOR PONTIC DESIGN – a
correctly placed anterior pontic should
have
1.All surfaces should be convex, smooth
and properly finished.
2.Contact with the labial mucosa should
be minimal (pin point) and pressure
free (lap facing).
3.The lingual contour should be in
harmony with adjacent teeth or pontics.
24
Pontic- residual ridge relationship: A research report.
Stein RS, J Prosthet Dent 1966; 16: 251
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25. POSTERIOR PONTIC DESIGN – a correctly designed pontic
should have
1.All surfaces should be convex, smooth and properly finished.
2.Contact with the buccal contiguous slopes should be minimal (pin
point) and pressure free (modified ridge lap).
3.Occlusal table must be in functional harmony with the occlusion
of all of the teeth
4.Buccal and lingual shunting mechanism should conform to those
of the adjacent teeth.
5.The overall length of buccal surface should be equal to that of the
adjacent abutments or pontics.
25
Pontic- residual ridge relationship: A research report. Stein RS, J Prosthet Dent 1966; 16: 251
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26. PRE-FABRICATED PONTIC FACINGS
These are commercially available porcelain pontics which can be
altered by the dentist and reglazed if necessary. These include:
a)Trupontic – A horizontal tubular slot in the
center of the lingual surface of the facing.
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. 81
26

27. c)Sanitary facing –flat occlusal
surface and a slot on the proximal
surface to fit into the metal
projections made in the FDP
d)Pin facing – A flat lingual facing
with two horizontal pins for
retention.
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27

28. e)Modified Pin Facing
Facing is modified by adding porcelain
to lingual gingival area of a pin facing
f)Reverse pin facing – Porcelain
denture teeth can be modified to be
used as the bridge facing. Porcelain is
added to the gingival end of the facing
and multiple precision pin holes are
drilled into the lingual surface
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28

29. 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.
i. Pontips:
Convex gingival surface having
pinpoint tissue contact and attached
to the backing occlusally with
retentive pins.
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29

30. SANITARY OR HYGIENIC PONTIC
Zero tissue contact
Occlusalgingival thickness should be atleast 3mm
Convex mesiodistally and faciolingually
Space beneath the pontic – 2mm ( Rosenstiel)
 - 3 mm ( Tylman)
Adequate space for cleaning
Modified sanitary pontic:- 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
and connectors.
Recommended for mandibular posteriors
FISH BELLY
ARC-FIXED OR PEREL
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30

31. A modified sanitary pontic
31
Perel M L : J Prosthet Dent 1972; 28: 587
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32. SADDLE PONTIC OR RIDGE LAP PONTIC
The saddle pontic has a concave fitting surface that overlaps the
residual ridge buccolingually, simulating the contours and emergence
profile of the missing tooth on both sides of the residual ridge.
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32

33.  Saddle or ridge lap designs should be avoided
 The concave gingival surface of the pontic is not accessible to cleaning
with dental floss>>>>plaque accumulation>>>>> tissue inflammation.
33
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34. The modified ridge lap pontic combines the best features of the hygienic
and saddle pontic designs, combining esthetics with easy cleaning.
34
MODIFIED RIDGE LAP PONTIC
•Overlaps the residual ridge on
the facial (to achieve the
appearance of a tooth emerging
from the gingiva)
•Remains clear of the ridge on the
lingual side.
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35. Tissue contact should resemble a letter T whose vertical arm ends at the
crest of the ridge.
The ridge contact should be upto the midline of the edentulous ridge.
Most common pontic form used in areas of high visibility---
maxillary and mandibular anterior teeth and maxillary premolars and
first molars
35
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36. CONICAL PONTIC
•egg-shaped, bullet-shaped, or
heart-shaped
•Convex with only one point of
contact at the center of the
residual ridge.
•recommended for the
replacement of mandibular
posterior teeth where esthetics is
a lesser concern.
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36

37. The facial and lingual contours are dependent on the width of the
residual ridge;
a knife-edged residual ridge necessitates 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
37
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38. most esthetically appealing
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
38
OVATE PONTIC
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39. Socket-preservation techniques
should be performed at the time
of extraction to create the tissue
recess from which the ovate
pontic form will emerge.
For a preexisting residual ridge,
soft tissue surgical
augmentation is typically
required. When an adequate
volume of ridge tissue is
established, a socket depression
is sculpted into the ridge with
surgical diamonds or
electrosurgery. 39
81

40. 40
81

41. 41
Rosenstiel S F et al : Contemporary Fixed Prosthodontics, 4
th
edn
81

42. 42
Aesthetic replacement of an anterior tooth using the natural tooth
as a pontic; an innovative technique
Purra A Mushtaq M.. The Saudi Dental Journal. 2013;25(3):125-128.
81

43. The biologic principles of pontic design pertain to the maintenance
and preservation of the residual ridge, abutment and opposing teeth,
and supporting tissue.
Factors of specific influence are,
43
BIOLOGIC CONSIDERATIONS
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44. 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.
Positive ridge pressure (hyperpressure) may be caused by excessive
scraping of the ridge area on the definitive cast
44
RIDGE CONTACT
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45. Pontic- residual ridge relationship: A research report.
Stein RS, J Prosthet Dent 1966; 16: 251
-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.
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. 45
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46. Cavozos E : Tissue response to fixed partial denture pontics.
J Prosthet Dent 1968; 20: 143
46
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
acute ulceration
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47. Ridge irritation microbial plaque between the gingival surface

of the pontic and the residual ridge
tissue inflammation and calculus formation.
47
ORAL HYGIENE CONSIDERATIONS
Normally, where tissue contact
occurs, the gingival surface of a
pontic is inaccessible to the bristles
of a tooth brush. Therefore, excellent
hygiene habits must be developed by
the patient.
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48. 48
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.
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49. Should provide good esthetic results, biocompatibility, rigidity, and
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, nor should a metal
ceramic junction occur in contact with the residual ridge on the gingival
surface of the pontic.
Investigations into the biocompatibility of materials used to
fabricate pontics have centered on two factors :
1.The effect of the materials and
2.The effects of surface adherence.
49
PONTIC MATERIAL
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50. 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.

50
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51. HENRY P J ET AL: TISSUE CHANGES BENEATH FIXED
PARTIAL DENTURES. J PROSTHET DENT 1966; 16: 937
 placed 14 pontics on human gingival tissue.

 gingival response to polished gold, Glazed porcelain or unglazed
porcelain
 there were general histologic changes in the tissue under all the
materials tested.
 noted that glazed porcelain was the most hygienic material used and it
is superior in terms of esthetics and ease of cleaning.
51
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52. 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.
Narrowing the occlusal table may actually impede the development
of a harmonious and stable occlusal relationship
Difficulties in plaque control and improper cheek support.
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
measures. 52
OCCLUSAL FORCES
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53. Mechanical problems may be caused by
improper choice of materials
poor frame work design
poor tooth preparation
poor occlusion.
Therefore, evaluating the likely
forces on a pontic and designing
accordingly are important. For
example, a strong all metal pontic
may be needed in high stress
situations rather than a metal ceramic
pontic which would be more
susceptible to fracture.
53
MECHANICAL CONSIDERATIONS
81

54. A well fabricated metal ceramic pontic
is strong, easy to keep clean, and
looks natural.
54
METAL CERAMIC PONTICS
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.
Occlusal centric contacts must be
placed at least 1.5 mm away from
the metal-porcelain junction
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55. Resistance to abrasion is lower than enamel or porcelain,
no chemical bond existed between the resin and the metal framework,
55
RESIN-VENEERED PONTICS
•Continuous dimensional change of the
veneers often caused leakage at 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
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56. Composite resins can be used in fixed partial dentures without a
metal substructure.
A substructure matrix of impregnated glass or polymer fiber
provides structural strength.
Excellent marginal adaptation and esthetics
56
FIBER-REINFORCED COMPOSITE RESIN
PONTICS
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57. SUMMARYSUMMARY
57
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58.  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.
58
ESTHETIC CONSIDERATIONS
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59. 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 attention should be paid to the contour of the labial surface
as it approaches the pontic-tissue junction to achieve a “natural”
appearance.
59
THE GINGIVAL INTERFACE
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60. This cannot be accomplished by
merely duplicating the facial
contour of the missing tooth.
If the original tooth contour were
followed, the pontic would look
unnaturally long incisogingivally.

60
81

61. 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.
61
81

62. 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
62
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63. 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.
63
INCISOGINGIVAL LENGTH
81

64.  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.
The root can be stained to
simulate exposed dentin
64
81

65. If augmentative measures are
contraindicated or undesirable,
small alveolar deficiencies and
missing papillae can be
reconstructed by restorative
measures.
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. 65
GINGIVA-COLORED CERAMICS
Daniel E , H Spiekermann: A review of esthetic pontic design options. Quintessence Int
2002;33:736-746
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66. Separately fabricated ceramic gingival masks can be used to make
subsequent adjustments in permanently placed restorations.
This method is particularly suitable for patients with a local alveolar
ridge defect that has not been corrected by augmentation of the soft
tissue.
66
ALL-CERAMIC GINGIVAL MASKS
Daniel E , H Spiekermann: A review of esthetic pontic design options. Quintessence Int
2002;33:736-746
81

67. 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.
67
MESIODISTAL WIDTH
81

68.  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).
68
81

69. Space discrepancy presents less of a
problem when posterior teeth are
being replaced because their distal
halves are not normally visible from
the front.
Discrepancy here can be managed
by duplicating the visible mesial
half of the tooth and adjusting the
size of the distal half.
69
81

70. CROSS REFERENCES
70
81

71. 71
J Prosthet Dent 2009;102:205-210
SIMULATED TISSUE USING UNIQUE PONTIC DESIGN
Kim.T.H.Yet al,
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72. 72
81

73. 73
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 (everStick C&B) were fabricated.
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).
Fiber-reinforced Composite Fixed Dental
Prostheses
with Various PonticsThe Journal of Adhesive Dentistry2014Vol 16, No 2
81

74. 74
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
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75. 75
Enhancing Esthetics with a Fixed Prosthesis Utilizing an
Innovative Pontic Design and Periodontal Plastic Surgery
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.
Journal of Esthetic and Restorative Dentistry, 2014
81

76. 76
81

77. 77
PREFABRICATED WAX PONTICS
Advantages:
* Without collar
* Reduced occlusal depths
* Reinforced approximal surfaces
* 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
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78. 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.
Minimizing tissue contact by maximizing the convexity of the
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.
78
CONCLUSION
The dentist should not attempt to duplicate nature
exactly, but should attempt to support it by supplying a
prosthesis based on sound biomechanical principles.
81

79. 1.Rosenstiel S F et al : Contemporary Fixed Prosthodontics, 4
th

edn Missouri, Mosby Inc, pg 513
2.Shillingburg H T et al : Fundamentals of fixed
prosthodontics, ed 4, Chicago , Quintessence
Publishing, pg 485
3.Tylman SMalone W. Tylman's Theory and practice of fixed
prosthodontics. 8th ed.
4.The Glossary of Prosthodontic Terms. The Journal of
Prosthetic Dentistry. 2005;94(1):10-92.
5.Cavozos E : Tissue response to fixed partial denture pontics.
J Prosthet Dent 1968; 20: 143
6.Daniel Edelhoff, H Spiekermann: A review of esthetic
pontic design options. Quintessence Int 2002;33:736-746
7.Henry P J et al: Tissue changes beneath fixed partial
dentures. J Prosthet Dent 1966; 16: 937
79
REFERENCES
81

80. 7.Perel M L : A modified sanitary pontic. J Prosthet Dent 1972; 28:
587
8.Stein RS: Pontic- residual ridge relationship: A research report. J
Prosthet Dent 1966; 16: 251
9.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.
10.Fiber-reinforced Composite Fixed Dental Prostheses with Various
Pontics The Journal of Adhesive Dentistry2014Vol 16, No 2
11.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.
12.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.
80
81

81. 81
THANK YOU
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