Ovate Pontic

Pontics -FPD components that replace missing teeth and restore function and apperance compatible with continued oral health and comport

Pontic design Tx plan 단계에서 미리 결정 Esthetic ⇔Hygiene Pontic space Residual ridge contour

Biologic considerations Pressure free ridge contact Cleansible ridge surface

Pontic design classifications Mucosal contact -saddle( ↔ridge lap) -Modified ridge lap No mucosal contact -sanitary(fish belly) -modified sanitary(arch) -bullet

Modified ridge lap pontics Convex ridge surface-cleansible Esthetic ploblems -black triangle -unnatural emergency profile Lingual food trap Possible Phonetic difficulties

Ovate Pontics More accurate duplicate of emergency profile Esthetic and cleansible ridge surface Positive pressure

Historical Background Porcelain root tip pontic-anecdotal resistance; Reichenbach Brill has made use of long porcelain roots for fixed bridgework (1 to 2 mm from the base of the extraction socket) apparently with good clinical results Tissue reaction about porcelain root- histological evaluations by Dewey and Zugsmith(1933); “…revealed tendency of epithelium to cover wound surfaces from the margin, not only in simple extraction wounds but also in empty sockets into which porcelain roots have been imbedded.”

smaller extraction wounds were completely covered with a delicate epithelial film in approximately 1 week; Loos and Gross, 1933 Clinical and histologic findings showed the hyperpressure from smooth, polished and glazed convex metal ceramic pontics with excellent plaque control does not introduce inflammation to the adjacent tissues. However, if flossing the areas of hyperpressure does not take place, inflammation is inevitable.”; Tripodakis and Constantinides, 1990

Biologic rationale After extraction, fibrin clot begins to form Epitherial cells migrate from wound margin to center area Thin layer of epitherial cells diffrentiates into stratified squamous epitherium Highly polished ovate pontics can act as matrix for stratified squamous epitherium

Indication Tooth Fx due to trauma, caries High esthetic demand Intact buccal plate Refusal for implant therapy

Pontic extention 3mm from most apical tissue in normal ridge High bone crest-less pontic depth Low bone crest- more extended pontic is needed(greater tissue support) Too much extended potic may result in poor tissue healing.

Tissue surface preparation Provisionalization immediate after tooth extraction Surgical correction of residual ridge -electrosurgery -high speed round bur

Clinical procedure -evaluation of pontic space, bone crest level, and esthetic demand -Dx wax up and provisional restoration -teeth extraction and adjust of provisional restoration -epitherialization and remodelling of socket surfaces

Case report Name; 김재준(M/45) C.C;이가 흔들린다 P.I ; root Fx on #21 congenital missing state of #12 diastema(≒2mm) Tx plan;3-unit FPD(Modified ridge lap) 3-unit FPD(ovate pontic) Implant on #21