|Figure 1. Tooth extraction has been accomplished by the oral surgeon.|
|Figure 2. A Siltec putty mold (Ivoclar Vivadent) is created from study models.|
|Figure 3. The adjacent teeth are prepared for inlays.|
|Figure 4. Adding Luxaflow (Zenith DMG) to the putty mold creates the ideal pontic shape.|
|Figure 5. The Luxaflow approximates the shape of the extracted root and extends apically about 3 mm.|
|Figure 6. Normal tissue shrinkage during healing leaves a depth of 1.5 mm.|
|Figure 7. Final bridge, including ovate pointic.|
Replacing lost teeth has always been an aesthetic challenge, especially in fixed crown and bridge prosthetics. Over the years, there have been many designs that attempt to create pontics that are both (1) hygienic and (2) natural in appearance. The design of the ovate pontic gives us an opportunity to achieve both of these goals. This article will demonstrate the process to form a physiologic and aesthetic ovate pontic.
There are several methods that can be used to create an ovate pontic. If the tooth has already been extracted, we must create the pontic from the tissue after it has healed. This can be done with a laser or electrosurgery. In this article, we will demonstrate how to form the pontic immediately after the extraction. I have found it to be easier for the patient when the healing of the socket is directed to form the desired shape of the ovate pontic.
The patient presented to the office with an extraction that had just been accomplished by the oral surgeon (Figure 1). During tooth extraction, every effort should be made to preserve the facial cortical plate of bone. This will allow for the creation of a more naturally placed pontic. Also, note that the correct positioning of the sutures helps to maintain the original gingival architecture.
Prior to the extraction, impressions had been taken for study models. From the models, we created a Siltec (Ivoclar Vivadent) putty mold (Figure 2). After preparing the adjacent teeth for inlays (Figure 3), we filled the Siltec with Luxatemp A-1 (Zenith DMG) and placed it back in the mouth over the prepared area. After allowing 1.5 minutes for initial set, we removed the putty mold. By adding Luxaflow (Zenith DMG), we can now create the ideal pontic shape (Figure 4). This should approximate the original shape of the extracted root and extend apically about 3 mm (Figure 5). It is important to ensure that the tissue side of the temporary is polished and smooth, which will allow for better cleansing and healing. The normal shrinkage of the tissue from the healing process will usually leave a depth of 1.5 mm (Figure 6). The protrusion of the temporary pontic into the socket will not impede clot formation or healing. Anything much deeper than this would create a hygienic problem for the patient. Eight to 10 weeks was allowed for healing before proceeding with the final impression.
The final bridge was fabricated by Frontier Laboratory using Targis-Vectris (Ivoclar Vivadent). Cementation can be accomplished with any resin bonding cement such as Nexus (Kerr) or Variolink (Ivoclar Vivadent). The result is shown in Figure 7.
This article has presented a technique for creating an ovate pontic at the time of tooth extraction, ensuring that the resulting pontic is both aesthetic and physiologically compatible with good oral hygiene.
Dr. Berman practices in West Palm Beach, Florida. He is an instructor who teaches hands-on courses several times a year for both the Rosenthal Institute and the Atlantic Research Group of Palm Beach County. He can be reached at (561) 659-1144.