Kreyer on Removables: Esthetic anterior ovate pontics

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Dental Lab Products | January 2009
Kreyer on Removables

Esthetic anterior ovate pontics

Preserving the gingival margin and interdental papillae while achieving esthetics.

Robert Kreyer, CDT

In the past, it has been all too common a technique that when designing an anterior acrylic partial or stayplate and performing stone cast surgery in the dental laboratory, the teeth and tissue are removed, destroying the integrity of the gingival margin and interdental papillae. This old technique in the anterior region creates the need to make a transitional acrylic partial with a labial flange to compensate for surgery and residual ridge resorption.

THE CASE IN PICTURES: SLIDESHOW
Refer to slideshow for figures

The problem

A 50-year-old female patient must have her anterior centrals extracted. Esthetics is a major concern, but because of economic conditions, she is reluctant to have implants placed. However, she would like to keep that option open for the future, when the economy turns around.

The solution

Esthetics should be a primary concern in this anterior smile zone. To achieve optimal esthetics, an ovate pontic design can be created for the acrylic partial that would preserve the gingival margin and interdental papillae.

The Glossary of Prosthodontic Terms defines an ovate pontic as “a pontic that is shaped on its tissue surface like an egg in two dimensions, typically partially submerged in a surgically-prepared soft-tissue depression to enhance the illusion that a natural tooth is emerging from the gingival tissues.”

Following is a technique that preserves a patient’s gingival margin and interdental papillae to achieve optimal anterior esthetics with an acrylic partial.

01 Mount and analyze stone casts for tooth selection and placement before starting model surgery (Fig. A).

02 Outline gingival margins and interdental papillae in red around teeth to be extracted (Fig. B).

03 Outline lingual gingival margins as well to serve as a facial and lingual guide when removing teeth from stone casts (Fig. C).

04 Remove teeth using a fissure bur and handpiece instead of a coping saw (Fig. D). Note: It is important to remove one tooth at a time to preserve the interdental papillae.

05 Remove both centrals to the gingival margin outline (Fig. E), and extraction sites are ready to prep for ovate pontic.

06 Use a small fissure and egg-shaped carbide bur to create the necessary facial to palatal contours (Fig. F). Note: The facial depth at the gingival margin should be at least 3 mm extending to 4 mm at the deepest point on the long axis of tooth. The interproximal depth as the ovate pontic tapers toward the abutment teeth is 2 mm.

07 Reduce the palatal aspect of the ovate pontic design at the gingival margin to allow for tooth placement and anterior contact of mandibular incisal edges (Fig. G). Note: This palatal gingival margin reduction is approximately 2 mm.

08 Contour the anterior denture teeth centrals to fit exactly in prepared ovate pontic extraction sites (Fig. H), and wax accordingly.

09 Contour the palatal aspect of the denture teeth around the incisive papillae and outline the acrylic partial to prepare for waxing and final processing of acrylic resin (Fig. I).

Conclusion

Whenever designing an acrylic partial, it’s very important as a collaborative member of the prosthetic dental team to discuss treatment options such as ovate pontics. Communicate with the restorative dentist, periodontist, or oral surgeon to determine if they would like ovate pontics in the transitional acrylic partial. Ask them if they plan an augmentation to the surgical site such as a bone graft, which will alter the design of your ovate pontic. If there will be a socket or ridge augmentation, then the depth of prepared ovate pontic site will be decreased. The reason for decreasing depth is to eliminate pressure on the augmented surgical site. Discuss these issues with restorative and surgical team members to provide the patient with a transitional acrylic partial that exceeds anterior esthetic expectations.

Through communication and collaboration with the entire prosthetic dental team, we understand each other’s needs and desires, and can provide optimal removable prosthetic treatment and care for the patient.

For courses and consulting by Robert Kreyer, CDT, go to www.PersonalizedDenture.com.

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