Modified soft tissue cast for fixed partial denture: a technique

Perio-prosthodontic pontic site management, part I: Pontic designs and their current applications

OBJECTIVE

Emulating natural dentition with dental implant restorations is challenging, increasing its complexity when a pontic area must be restored. Many different methods have been described to solve this problem. The pontic designs which have been proposed have specific indications and may require additional treatments, including soft tissue augmentation procedures, to increase the possibility of an esthetically pleasing and biologically tolerable outcome. Proper conditioning of the soft tissues during the interim restoration stage and adequate communication with the laboratory are also critical factors to a successful outcome. This article describes the different approaches to restoring pontic sites with different degrees of complexity, their clinical indications, and limitations viewed from a perio-prosthodontic approach.

CLINICAL CONSIDERATIONS

Different clinical scenarios for pontic sites require different approaches. Missing hard and soft tissues can be replaced by surgical or prosthetic means. Understanding the clinical indications and implications of the different pontic designs allows the clinician to make good decisions when planning and treating patients that require replacement of pontic spaces leading to more successful outcomes.

CONCLUSIONS

Different pontic designs have specific indications as well as biologic and esthetic prognoses. Selection of a good design, proper modifications during the provisionalization stage, and adequate communication with the dental laboratory will lead to higher chances of esthetic and biological success.

CLINICAL SIGNIFICANCE

The proper pontic design allows for esthetically pleasing pontic sites which emulate natural emergence from the soft tissues while promoting biological stability.

Precise Reproduction of Soft Tissue Structure around the Pontic Area Using Computer-Aided Design and Manufacturing

Reproducing soft tissue contours around a pontic area is important for the fabrication of an esthetic prosthesis, especially in the anterior area. A gingival model that precisely replicates the soft tissue structure around the pontic area can be easily obtained by taking a pick-up impression of an interim fixed dental prosthesis. After a working cast is fabricated using the customary technique, the pick-up model is superimposed onto the working model for the pontic area using computer-aided design and manufacturing (CAD/CAM). A definitive restoration using this technique would be well adapted to the pontic base, which is formed by the interim prosthesis.

Accuracy of Multiple Pour Cast from Various Elastomer Impression Methods

The accurate duplicate cast obtained from a single impression reduces the profession clinical time, patient inconvenience, and extra material cost. The stainless steel working cast model assembly consisting of two abutments and one pontic area was fabricated. Two sets of six each custom aluminum trays were fabricated, with five mm spacer and two mm spacer. The impression methods evaluated during the study were additional silicone putty reline (two steps), heavy-light body (one step), monophase (one step), and polyether (one step). Type IV gypsum casts were poured at the interval of one hour, 12 hours, 24 hours, and 48 hours. The resultant cast was measured with traveling microscope for the comparative dimensional accuracy. The data obtained were subjected to Analysis of Variance test at significance level <0.05. The die obtained from two-step putty reline impression techniques had the percentage of variation for the height −0.36 to −0.97%, while diameter was increased by 0.40–0.90%. The values for one-step heavy-light body impression dies, additional silicone monophase impressions, and polyether were −0.73 to −1.21%, −1.34%, and −1.46% for the height and 0.50–0.80%, 1.20%, and −1.30% for the width, respectively.