Presented by

MOHAMED ABD EL AZIZ MOHAMED

Assistant Lecturer of Fixed Prosthodontics
Must University
2007
ESTHETIC CONSIDERATIONS IN FIXED
REPLACEMENT OF MISSING TEETH
Introduction:
- Once the patient decides to have a lost tooth replaced with a
fixed partial denture, especially in the anterior region, the patient
will judge his result primarily on the basis of esthetics.
- Esthetic is the study of beauty. Knowledge of esthetics helps the
dentist achieve a pleasing appearance. Esthetic dentistry aims to
achieve an attractive smile.
- Todays patient is more aware of the interrelationship between
teeth and facial appearance and is entitled to the dentists best
artistic efforts.
- !rior to choosing a fixed partial denture as the restoration of
choice for a given edentulous situation, a logical se"uence of
diagnosis and treatment planning must be followed to achieve a
successful outcome. # thorough diagnostic wor$-up should be
performed, which will provide the restoring dentist with all of the
information needed to determine the best treatment plan for the
patient.
DIAGNOSIS
%- Medical and Dental History:
- &nformation gathered on the written history sheet can provide the
restoring dentist with data important for successful prosthodontic
treatment.
- 'ental history is important in developing information about the
patients dental experiences and attitude toward treatment.
- The patient should be given an opportunity to describe the nature
of his chief complaint that has brought him to the dental office for
treatment. &f it is esthetic in nature, specific esthetic desires and
needs should be assessed, as well as any esthetic shortcomings
with previous prostheses.
2- Intraoral Examination:
2
- # comprehensive intraoral examination should be performed. #ll
diagnoses should be documented, such as missing teeth,
periodontal status, pulpal pathosis, caries, fractures, wear,
unesthetic restorations, muscle and temporomandibular joint
pathosis.
- #ll data should be recorded, and the patient should be treatment
planned as a total entity, rather than only addressing the specific
edentulous area and adjacent tooth structure.
- The intraoral examination can be enhanced by using an intra oral
camera or surgical microscope. The surgical microscope, due to
the extremely bright field and high magnification, it provides the
ultimate in intraoral diagnosis.
- #ny defects such as( hidden micro-crac$s, defective restoration
margins, and other tooth and tissue defects should be recorded in
the chart and)or electronically in the computer.
An intra-oral a!"ra #it$ a o!%&t"r !onitor
A surgical microscoe
!- Extraoral Examination:
3
- The extra oral examination should include assessment of
symmetry, muscle hypertrophy, possible loss of vertical dimension
of occlusion, and a smile analysis that determines the amount of
each tooth that will be seen while smiling, spea$ing, etc.
*- "adiogra#s(
- # full-mouth series of radiographs or a panoramic radiograph with
selected periapical radiographs of the proposed abutment teeth is
necessary in the evaluation for treatment with a fixed partial
denture.
- The purpose of radiographs is to evaluate the root morphology,
pulpal outline, periodontal ligament space, and the extent of caries.
#lso, the radiographs can provide information about pulpal
pathosis, crown-to-root ratio, and "uality of remaining bone and aid
in determining the tilt of teeth.
+- Diagnostic $asts:
- !roperly mounted, accurate diagnostic casts on a suitable
articulator are a very important element of the diagnosis and
treatment planning of a fixed partial denture.
T$" 'ia(no)ti a)t) !o&nt"' in "ntri
ol&)ion on a )"!i-a'*&)ta+l" arti&lator
- 'iagnostic casts will enable the restoring dentist to evaluate the
condition of the patients mouth.
4
- ,linical crown length, tipped or rotated teeth, ridge form, and the
span of the edentulous area can all be evaluated.
- The inter arch space and the occlusal plane can be evaluated on
the diagnostic casts, which may lead to the diagnosis of lost
interocclusal space or super-eruption of a segment of the dentition.
The treatment, therefore, may involve crown lengthening, ridge
reduction, endodontic therapy, repositioning of teeth, segmental
osteotomy, or extraction.

- Diagnostic Waxing(
- # diagnostic waxing of the proposed fixed partial denture can be
invaluable in determining the esthetic criteria for a treatment plan(
a- &t allows for the observation of the abutment tooth-pontic
relationship and the pontic-ridge relationship.
b- &t allows the dentist to evaluate the edentulous area. The
edentulous area may be badly resorbed and re"uire surgical
correction with grafting of bone, soft tissue, or both.
c- &t may indicate orthodontic treatment for limited spaces and
rotated, tipped, or malposed teeth. This may be done in
place of or prior to fabrication of a fixed partial denture.
d- &t may indicate the need for endodontic treatment when
tooth preparation will involve the pulp of slightly malposed or
tipped teeth.

T$" 'ia(no)ti #a,-&% )$o#) t$" %lann"' r")toration
- Est#etic $onsiderations
5
- ,ommunication with the patient provides a general sense of what
the patient expects esthetically before treatment begins to avoid
esthetic disasters.
- !atients prefer their dental restorations to loo$ as natural as
possible. .owever, care must be ta$en that esthetic considerations
are not pursued at the expense of a patients long-term oral health
or functional efficiency.
The elements of an esthetic fixed partial denture include(
%- Retainer: its type, material, amount of coverage of the teeth,
margin location and ceramic-metal junction location on metal-
ceramic crowns.
/- Pontic design.
- 0hen designing these elements, the following should be
considered(
a- The arch in which the prosthesis is to be placed.
b- The restorations position in that arch.
c- The amount of display of the prosthesis.
d- The patients esthetic awareness.
- These esthetic considerations must be coupled with biologic and
functional considerations such as:
a- 1pan length.
b- The need for splinting.
c- !eriodontal support.
d- 1oft tissue management.
e- The use of provisionals.
f- The need for adjunctive care such as orthodontics,
endodontics, periodontics, and oral and maxillofacial surgery.
- The anterior fixed prosthesis often presents the most difficult
esthetic problem. The choice of tooth form, shade, and
arrangement used for complete dentures is not usually available
for the fabrication of a fixed prosthesis.
6
- !leasing esthetics can best be achieved when restorations blend
with the patients remaining natural dentition. #n exception to this
rule is when the entire dentition is changed.
- Computer-generated analyses and imaging can also be used as
an adjunct when considering esthetic re"uirements. One of the
greatest advantages of this techni"ue is the ability to evaluate
proposed tooth si2es and shapes before the final restoration is
constructed.
$omuter image maniulation %as used to determine t#e attracti&eness o' &arious
smiles( )ig#t colours and o&al-s#aed teet# in %omen and rectangular teet# in men
%ere considered t#e most attracti&e(
* +unctional $onsiderations
- 3unctional considerations should meet together with the esthetic
considerations.
- The type and number of abutments re"uired for functional
considerations can affect the esthetic result.
- The use of intracoronal or extra coronal retainers depends on the
length of the space to be restored and the functional stresses that
will be placed on the prosthesis.
- &f extra coronal retainers are chosen, the same considerations
apply to the choice of either complete- or partial-coverage crowns.
7
,reatment otions
- 4ultiple treatment modalities and all treatment options for the
patient should be investigated and presented during the treatment
planning phase.

Once the diagnostic process has been completed,
treatment options may be selected from the following choices(
I( "etainers
A. Partial coverage:
%. ,emented
/. 5esin bonded
6. !orcelain veneers
B. Complete coverage:
%. #ll metal
/. #ll ceramic
6. ,eramo-metal
a. 4argins
7 8ocation
7 4aterial
7 4etal collar margin
7 'isappearing metal margin
7 !orcelain margin
b. !orcelain-metal junction
C. Other considerations:
%. ,antilever fixed partial denture
/. &mplants
6. 1plinting
*. 9se of telescoping crowns as abutments
II( -ontics
#. 'esign
:. Edentulous ridge form
,. 4aterial
8
* Est#etic $onsiderations o' t#e treatment otions
I- "E,AINE"S
- 0hen selecting appropriate retainers for a fixed partial denture,
esthetics is only one of three important factors to be considered.
The other two are biologic considerations and functional or
mechanical considerations.
; 9nfortunately, some of the most esthetically advantageous
retainers can be the poorest from a mechanical standpoint, and
other very esthetic retainers can be the most biologically invasive.
- 3ixed partial denture retainers can be separated broadly into two
categories, partial- and complete-coverage retainers.
A- -artial-$o&erage "etainers:
- 9sually, the most esthetic material that matches the patients
existing dentition is natural tooth structure. This display of natural
tooth structure in the esthetic 2one is accomplished by using
partial-veneer restorations.
%- The cemented partial-coverage retainers are the metal inlay,
onlay, or three-"uarter crown. These are usually made of gold
alloy.

'ue to retention, and resistance form necessary to ma$e these
retainers functionally successful, it is impossible to avoid some
show of metal at the proximal and incisal or occlusal line angles.
- :ecause of this show of metal, this retainer is unacceptable in the
anterior region. &t can be used very acceptably, however, in less
esthetically critical areas of the mouth. &ts best application is for
use on large, relatively unrestored second premolars and first
molars in the maxillary arch.
9
a< b<
a. / retainers on uer 0
st
and 2
nd
remolars( 1. Gold inlay on uer 2
nd
remolar and
onlay on uer 0
st
molar( Alt#oug# t#e artial-co&erage retainers can 1e a 'unctionally
sound retainer2 it is est#etically di''icult to a&oid s#o%ing metal at t#e roximal or
occlusal line angles(
,#is conser&ati&e2 economical2 t#ree-unit #ygienic ontic 'ixed artial denture is
suorted %it# gold onlays and can 1e est#etically acceta1le 'or some atients(
Esthetic guidelines in tooth preparation:
- -roximal Margin:
- !lacement of the proximal margins =particularly the mesial,
generally more visible, margin< is critical to the esthetic result of a
partial-coverage restoration.
- The margin of the preparation is placed just buccal to the
proximal contact area, where metal will be hidden by the distal line
angle of the neighbouring tooth.
10
,#e margin o' t#e rearation is laced 3ust 1uccal to t#e roximal contact area
- Tooth preparation angulation should normally follow the long axes
of posterior teeth and the incisal two thirds of the labial surface of
anteriors.
,#e rearation s#ould 'ollo% t#e long axes o' osterior teet#
- &f a buccal or lingual tilt is given to the tooth preparation, metal
may be visible.
- The distal margin of posterior partial-coverage restorations is less
visible than the mesial margin. &n this area, it is often
advantageous to extend the preparation farther beyond the contact
point for easier preparation and finishing of the restoration and
better access for oral hygiene.
- +acial Margin:
- The facial margin of a maxillary partial-coverage restoration
should be extended just beyond the occluso-facial line angle. #
short 1e&el is needed to prevent enamel chipping.
11

A s#ort 1e&el is needed 3ust 1eyond t#e occluso-'acial line angle to re&ent enamel
c#iing(
- # chamfer can be placed where appearance is less important
=e.g., on molars< because this will provide greater bul$ of metal for
strength.
A c#am'er is recommended 'or t#e 1uccal margin in mandi1ular artial cast cro%ns
1ecause it ro&ides a greater 1ul4 o' metal around t#e #ig#ly stressed centric cus(
- 0hen mandibular partial cast crowns are made, metal display is
unavoidable because the occlusal surface of mandibular teeth can
be seen during speech. # chamfer, rather than a bevel, is
recommended for the buccal margin because it provides a greater
bul$ of metal around the highly stressed centric cusp.
- &f the appearance of metal is unacceptable to the patient, a
metal-ceramic restoration with porcelain coverage on the occlusal
surface can be made.
- #nterior partial-coverage restorations can be fabricated to show
no metal, but their preparation re"uires considerable care. The
facial margin is extended just beyond the highest contour of the
incisal edge but not "uite to the inciso-labial line angle. .ere the
metal will protect the tooth from chipping but will not be visible.
12
A
5
A2 ,eet# can 1e reared 'or artial-co&erage restorations t#at do not s#o% any metal(
5( ,#e restoration margin is located 1et%een t#e #ig#est oint o' t#e incisal contour
and t#e inciso-'acial angle(
/- 5esin-bonded retainer(
- 5esin-bonded partial-veneer fixed partial dentures would be the
restoration of choice, particularly in the anterior part of the mouth if
the following conditions are met(
a- The abutment teeth are esthetically acceptable in their si2e,
form, and color.
b- The teeth are free of restorations or have only minimal
restoration that does not involve the crown margins.
c- The abutment teeth are of ade"uate length to afford preparation
resistance and retention.
d- The abutment teeth are of ade"uate thic$ness to prevent metal
shadowing from the lingual surface.
e- The resin-bonded partial-veneer retained prosthesis should only
replace one tooth.
f- The teeth should have only normal mobility.
g- The pontic space must be of the ideal width.
13
a< b<
a. Missing maxillary lateral incisor( 1. ,issue surgery done %it# electro surgery to
ma4e a roer ontic site(
c< d<
c. ,#e con&entional resin-1onded 'ixed artial denture is made o' t#in metal linguals
on eac# o' t#e retainers( d. ,#e 'inal result s#o%s a natural-aearing toot#
relacement(
- The best design for long-term results with a resin-bonded fixed
partial denture is to include parallel groves to aid retention and
resistance form, in addition to the possible use of potholes, pins, or
ledges and a well-defined finish line.
,#e ossi1le use o' ot#oles2 ins2 or ledges and a %ell-de'ined 'inis#ing line in a
resin-1onded 'ixed artial denture
14
- One of the most fre"uently seen esthetic problems with this type
of retainer is the difficulty of perfect shade matching. &f the adjacent
retainers are metal, light translucency of the abutment teeth is
diminished, resulting in greyish shine.
- To overcome this esthetic problem, all ceramic resin-bonded fixed
partial dentures were introduced.
- 3or this type of restoration to succeed, two re"uirements are
necessary( minimal or no occlusion force and patient should avoid
biting hard foods or objects.
a b
a- Missing maxillary le't lateral incisor( 1- ,#e lingual sur'aces are reared 'or a resin-
1onded 1ridge(
c d
c- A t#ree-unit all-ceramic 6In ceram. 'ixed artial denture is laced( d- )a1ial &ie% o'
t#e 'inal restoration( ,#e main ad&antage 'or using t#e all-ceramic retainer is to a&oid
a1utment toot# discoloration(

6- !orcelain laminate veneer fits and bonded to the tooth correctly
as a single tooth restoration.
- 8aminate veneering is a conservative method of restoring the
appearance of discoloured, pitted, or fractured anterior teeth.
15
- &t consists of bonding thin ceramic laminates onto the labial
surfaces of affected teeth.
- Esthetic veneers should always be considered as a conservative
alternative to cemented crowns. &n many practices they have
largely replaced metal-ceramic crowns for the treatment of multiple
discoloured teeth.


)aminate &eneering is a conser&ati&e met#od o' restoring t#e aearance o'
discoloured anterior teet#(

- 8aminate veneers are contraindicated in cases of badly
destructed teeth and presence of !ara functional habits.
5- $omlete-$o&erage "etainers:
- 3ull-veneer retainers are the most popular retainers used for
fixed partial dentures. They generally fall into three categories( all-
metal, all-ceramic, and metal-ceramic retainers.
%- All metal crowns are not particularly esthetic and therefore
should be used in areas of the mouth that cannot be viewed by
observers or the patient. They are ideal for maxillary and
mandibular second and third molar abutments and for the
16
occasional maxillary first molar in patients with acceptable esthetic
smile lines that do not expose this tooth.
- The major advantages of all metal retainers in comparison with
the metal-ceramic or all-ceramic crown preparation are(
%- 4inimal tooth reduction.
/- Ease of fabrication.
6- 8ac$ of wear of the opposing dentition.
/- The use of all-ceramic restorations as retainers for fixed
partial dentures is experimental and is unsupported by any long-
term clinical studies.
- The all-ceramic fixed partial denture should be used with extreme
caution and limited to one-tooth anterior replacements in patients
with less than normal occlusal force.
- should be fully explained to the patient, as well as other more
traditional alternatives, before selecting this unproven choice.
4aximum esthetics rather than longevity must be the overriding
consideration in the use of all-ceramic fixed prostheses due to the
inferior mechanical properties related to the strength of all-ceramic
connectors.

Missing uer le't central incisor( -rearation o' 0I 7 I2 and a 'ull-s#oulder margin is
'inis#ed %it# a diamond 1ur(
17

,#e ontic site is en#anced using a $O2 laser to reare t#e tissue 'or an o&ate ontic(
,#e t#ree-unit all-ceramic core structure 6In ceram. ro&ides t#e strengt# 'or t#e all-
ceramic 'ixed artial denture(
,#e t#ree-unit all-ceramic 'ixed artial denture is cemented %it# a resin cement and t#e
excess cement is trimmed(
Maximum est#etics rat#er t#an longe&ity %as t#e o&erriding consideration in t#e
c#oice o' an all-ceramic 'ixed rost#esis(
18
6- he metal-ceramic crown is the most commonly used retainer
for fixed partial dentures. This restoration has proven to be a very
satisfactory compromise between functional success and
esthetics.
- 1ome of the variables that should be considered with metal-
ceramic retainers are the location of the margins in relation to the
gingiva, the materials used for margin fabrication, and the location
of the porcelain-metal junction in relation to the occlusal surface of
the retainer.
a. Margins o' metal ceramic retainer:
- Margin )ocation:
- 1tudies have shown that with respect to biologic acceptance of
an artificial crown by the gingival apparatus, the artificial material
should remains supragingival.
- 1upragingival margins are also easier to prepare, impress, and
evaluate for fit.
- &f the margins of ceramo-metallic restoration having an exposed
metal placed supragingivally, an esthetic problem is created except
if the lip line is favourable.
Suragingi&al margins %it# exosed metal %ill generally not 1e an est#etic ro1lem i'
t#e li line is 'a&oura1le(
19
- The margins should only be placed into the gingival sulcus
subgingivally in cases of(
- 5easons of esthetics.
- 'ecreased occluso-gingival height for resistance and
retention.
- The need for extension beyond existing caries or
restorations.
- &f sub gingival margins are chosen solely for esthetics, they
should be limited to areas in which the gingival margins are visible
to observers of the patient in normal and extreme facial movement.
- &t was shown that less than +>? of the population observed in
revealed the gingival area of any of their mandibular teeth during
movements of facial expression.
- The patient should understand that what is visible with mirrors,
chee$ retractors, and fingers in the mouth is not necessarily visible
in normal circumstances.
,#is atient %as extremely dissatis'ied %it# t#e exosed metal margins
- Margin Materials(
- ,ertain sub gingival margins are not completely natural and
esthetic in appearance. This is usually because the restorative
material shows through the thin gingival sulcular tissue or there is
too much artificial crown material subgingivally either in the form of
over contouring, overextension, or both.
20
,#in2 transarent gingi&a may not 1e t#ic4 enoug#
to 'ully mas4 a su1gingi&al metal margin(
- This unesthetic subgingival material has led to three different
approaches to metal-ceramic crown margins.
!a"ial margin designs #or metal ceramic restorations$
%< ,#e metal collar margin, in which a small band of metal
creates the terminus for the crown with no porcelain overlaying it.
A t#in metal 1and ro&ides excellent adatation 1ut is &ery unest#etic unless it can 1e
#idden su1gingi&ally(
-The metal collar margin was the techni"ue for all early metal-
ceramic crowns.

,#e metal collar margins o' metal-ceramic 'ixed artial denture laced su1gingi&ally
%it# good est#etic results
21
- 4any metal collars have been placed subgingivally with good
esthetic results. This re"uires a superior technical approach to
margin preparation, retraction, and impression techni"ues and
soft-tissue management in the interim phase. .owever, the results
are often less than predictable.
- 3or esthetic reasons, this design is rarely used for anterior teeth.
/< ,#e metal-orcelain margin or the disappearing metal margin.
This is a techni"ue in which the technician creates the metal collar
as thin as possible and then overlays this thin metal with porcelain.
8Disaearing8 margin is commonly used and is est#etically acceta1le in some
atients( Ho%e&er2 t#e metal o'ten causes unacceta1le greyness o' t#e gingi&al toot#
sur'ace(
- The drawbac$s of this design(
@ :ecause the metal is thin at the margin, it is often distorts during
the porcelain firing cycles.
@ :ecause of the extreme thinness of the porcelain overlying this
metal, it could not mas$ the metal colour which causes
unacceptable greyness of the gingival tooth surface.
22
6< ,#e all-ceramic marginA This is accomplished by removing all
metal bac$ to the internal line angle of the shoulder of the
preparation and replacing it with a special higher- fusing shoulder
porcelain of the same shade as the body or gingival porcelain.
A !9:-degree orcelain margin ro&ides excellent lig#t transmission in t#e gingi&al
area and otimal est#etics; #o%e&er2 t#e la1oratory 'a1rication is &ery demanding( ,#is
design re<uires a rearation design t#at is similar to an all-ceramic cro%n
,#is t#ree-unit metal-ceramic 'ixed artial denture 'eatures a !9:-degree all-orcelain
margin(
- ,eramic margins were not expected to be strong enough to
withstand clinical loads. .owever, research has indicated that once
cemented to the abutment teeth, all-ceramic margins have e"ual
or possibly greater strength than metal collar margins.
23
he recommendation #or margin selection:
- 9se metal collar margins in esthetically non-critical areas
supragingivally.
- #ll-ceramic margins should be used in the patients esthetic 2one
or for patients with higher esthetic demands.
-The combination metal-porcelain margin should be avoided
whenever possible.
1. -orcelain-Metal =unction:
- The most esthetic choice is to cover the entire metal coping with
porcelain in all areas of the mouth where the abutment retainer is
visible. #s long as the underlying metal coping is of sufficient
thic$ness and shape to protect and support the overlying porcelain
and the porcelain is of ade"uate and e"ual thic$ness.
- &f inade"uate occlusal reduction occurs in the preparations for
porcelain overlying metal, this may lead to fracture of the ceramic
under functional load.
- .owever, these all-porcelain occlusal surfaces can have
disastrous results on the opposing dentition, particularly if the
restorations will occlude with natural tooth structure.
- The most esthetically necessary area for complete-porcelain
coverage is the mandibular premolars and first molar. This is
because the occlusal and lingual surfaces of these teeth are
readily visible when the mouth is open.
,#e most est#etically necessary use o' comlete- co&erage orcelain is %it# t#e
mandi1ular remolar and e&en t#e mandi1ular molars %#en atients demand t#em(
24
- 5arely, the maxillary posterior occlusal surfaces visible, even in
wide open movements. Therefore, from a functional and esthetic
perspective, these retainers can usually have porcelain-metal
junctions that end on the lingual slope of the bucco-occlusal
surfaces.
,#e orcelain-metal 3unctions end on t#e lingual sloe o' t#e 1ucco-occlusal sur'aces
- The exception to this is when the maxillary fixed prostheses are
opposed by all-porcelain occlusal coverage in the mandibular arch.
&n this case, complete-porcelain coverage of the maxillary
restorations is advisable to prevent excessive wear by the
opposing porcelain.
- The decision of the location of the porcelain- metal junction for
maxillary anterior of little conse"uence esthetically since the
lingual surface of maxillary anterior teeth is never visible.
- 1ome clinicians feel that having the intercuspal contact in metal
on the maxillary anterior prosthesis will preclude wear. This is not
entirely true since all of these patients will still function to some
degree in excursive movements on porcelain of the lingual surface
of these crowns incisively to the porcelain-metal junction.
- :iologically, owing to the small si2e of mandibular anterior teeth,
over contouring of the lingual surface of the restorations is best
avoided by locating the junction as far incisively as esthetics
allows.
25
$- O,HE" $ONSIDE"A,IONSA
0- $antile&er +ixed -artial Denture:
The ideal choice for the single missing tooth is the single-tooth
implant. .owever, there are times when an implant may not be
possible. # conservative alternative would be the cantilever fixed
partial denture involving one or more abutment teeth. The
cantilevered restoration is highly desirable esthetically.
$ongenital missing maxillary lateral incisors and reared maxillary canine( Electro
surgery %as used to contour t#e tissue 'or t#e o&ate ontic(

$antile&er 'ixed artial denture on 1ot# sides( ,#e 'inal relacement #as a more
#armonious gingi&al relations#i 1et%een t#e ontic and t#e a1utment(
- 3or esthetic reasons, it may be necessary to cantilever a
posterior abutment. 3or example, if the patients smile line shows
the missing molar, then this tooth can be replaced as a posterior
cantilever.

,#e distal cantile&er mas4s t#e dar4 sace e&en %it# a %ide smile
26
2- Imlants:
- The selection of implant prosthesis rather than a tooth-borne
fixed partial denture is generally decided by the dentist and the
patient after a thorough analysis of the advantages and
disadvantages, both esthetically and functionally, of each
treatment.
- # diagnostic waxing may be necessary to reveal the difference,
especially if it involves soft-tissue issues.
II(-ON,I$S
A. -ontic Design(
- The overall esthetic objective in pontic design is to ma$e the
missing tooth replacement loo$ li$e a real tooth. # tooth substitute
should be in harmony with the abutment teeth and the remaining
dentition.
- The pontic is an artificial replacement is accomplished by the
outline form, si2e, alignment, contour, surface texture, and colour.
&n addition, it must function with the opposing occlusion and
provide comfort and support to the adjacent tissues and continuity
to food flow patternsA it must have contours that are easy to $eep
clean.
- he pontic designs availa"le #or #ixed partial dentures:
%- 5idge lap.
/- 4odified ridge lap.
6- ,onical.
*- .ygienic.
+- 4odified hygienic.
B- Ovate.
27
-ontic design( %A& ,otal ridge la( %B& Modi'ied ridge la( %C& O&ate(

- The selection of pontic design depends on( the esthetics, the
edentulous ridge anatomy, and the patients ability to maintain
ade"uate hygiene.
- 'ue to the inability of the patient to maintain ade"uate hygiene
under the ridge lap pontic, it is not recommend using this type of
pontic design.
- To optimi2e esthetics, the modified ridge lap and the ovate pontic
are considered the pontics of choice.
,#e o&ate ontic #as 1ecome one o' t#e most desired 'orms 'or maximum est#etics
and 'unction(
- These two pontic designs wor$ well because a natural-appearing
emergence profile can be achieved, leading to a more esthetic
result.
28
- .owever, certain re"uirements are necessary to accomplish a
favourable esthetic outcome(
a< The pontic must have the proper incisogingival or
occlusogingival length in relation to the abutment teeth.
b< Excessively open interproximal embrasures or Cblac$ trianglesC
must be avoided in the anterior region.
c< # proper labiolingual or buccolingual relationship with the
abutment teeth should be obtained, creating a proper emergence
profile.
- To accomplish these three re"uirements, proper edentulous ridge
tissue form is re"uired. !reprosthetic surgery is often needed to
enhance the edentulous area to achieve the desired esthetic
results.
,#e unnatural-loo4ing 81lac4 triangles8 caused 1y loss o' interdental tissue(
"idge augmentation lus sculting 'or o&ate ontics %as done during t#e interim
#ase(
29
,%o 'our-unit 'ixed artial dentures %ere 'a1ricated %it# o&ate ontics and t#e atient>s
smile did not gi&e a #int o' missing teet#(
5. -rearation o' ,issue:
- # diagnostic waxing of the fixed partial denture will aid in
assessing the pontic-ridge relationship to determine if the three
design re"uirements will be met.
- &f the relationship reveals that an esthetic result would be
enhanced through modification of the edentulous ridge area, then
further adjunctive therapy should be considered to correct the
pontic-tissue site.
- The edentulous ridge with ideal dimensions both buccolingually
and occlusogingivally can be treated with a modified ridge lap
pontic design, meeting all three esthetic design re"uirements.
- 5idge contour for the modified ridge-lap pontic should be slightly
convex in a labiolingual direction and gently concave mesiodistally.
Modi'ied ridge la ontic( A2 +-D artially seated( 52 +-D seated
- 3or the edentulous ridge that has excessive hard or soft tissue,
surgical reduction can be performed.
30

,o ma4e a roer ontic site2 tissue surgery %as done( A natural-aearing toot#
relacement due to a 'a&oura1ly s#aed tissue site(
- &f the soft tissue is thic$, scalloping of the tissue may create a
favourable pontic site. &f the hard tissue is excessive with a
minimal soft- tissue covering, osseous resection may be
necessary.
- Ovate pontic designs are generally used in two types of clinical
situations( the healed edentulous ridge and new extraction sites.
O&ate ontic( A2 +-D artially seated( 52 +-D seated(
31
- #t the time of extraction, the abutment teeth can be prepared and
the fixed partial denture provisional fabricatedA then, the ovate
pontic provisional can be placed so that it emerges from the
extraction site. This type of procedure "uite often leads to a highly
acceptable esthetic effect.
# :
A2 Atraumatic toot# extraction( 52 $ross section &ie% o' t#e immediate ro&isional
+-D demonstrating o&ate ontic 'orm(
$ '
$2 -ro&isional restoration( Note t#e 2(?-mm aical extension o' t#e o&ate ontic( D2 ,#e
seated ro&isional to reser&e t#e interdental ailla(
Ad3uncti&e ,issue ,reatment
- #djunctive treatment involves a deficient edentulous ridge.
'eficient pontic areas may occur as a result of trauma,
developmental defects, or disease.
- The edentulous area may be deficient in height, width, or both,
depending on the individual situation.
- 'ei"ert classi#ied the de#icient ridge based on the dimension
of the defect as follows(
- $lass I de'ect( # buccolingual loss of tissue with normal
ridge height.
- $lass II de'ect( #n apicocoronal loss of tissue with
normal ridge width.
32
- $lass III de'ect: # combined loss of ridge contour in
both the buccolingual and apicocoronal dimensions.
- 3or the deficient ridge, adjunctive treatment involves surgical site
augmentation, which can be accomplished using an autogenous or
allogenic graft of hard or soft tissues, an alloplastic graft, or a
combination of these grafts depending on the amount of
augmentation needed.
- The goal of the pontic site tissue preparation procedure is to
provide a ridge in which the pontic loo$s natural in its emergence.
- &f attempts at surgery are unsuccessful resulting in small blac$
triangles, then esthetic mas$ing must ta$e place in the fabrication
of the prosthesis. This can ta$e the form of either fixed or
removable tissue inserts.
- The fixed tissue insert can be fabricated from tissue- colored
ceramic material. Dreater longevity if ceramics are used to replace
the interdental tissue should be expected.
a
Small 1lac4 triangles &isi1le in anterior 'ixed artial denture
b
,#e old 'ixed artial denture %as remo&ed and t#e a1utments rereared(
33
c
,#e ne% 'i&e-unit 'ixed artial denture included 'ixed in4 orcelain to resem1le
gingi&al ailla to mas4 t#e interdental sace(
d
A maximum smile re&eals an est#etic result(
,#is eig#t-unit 'ixed artial denture 'eatured 'our anterior ontics %it# a in4 orcelain
'ixed-tissue insert %as constructed to 1lend in %it# t#is atient@s tissue(
- #s an alternative, some patients use a removable tissue insert
fabricated from acrylic resin.
34
$. -ontic Materials:
- The type of material used to fabricate the pontic also depends on
the esthetic result re"uired.
- !ontic material types can be( all metal, metal ceramic, all
ceramic, or metal with acrylic resin.
- !orcelain covering all visible areas is the selection of choice for
an esthetic situation. # well fabricated metal-ceramic pontic is
strong, easy to $eep clean, and loo$s natural. .owever,
mechanical failure can occur.
- #crylic resin veneered pontics have had limited acceptance
because of their reduced durability =wear and discoloration<.
- The newer fiber-reinforced ,omposite 5esin can be used in fixed
partial dentures without a metal substructure. # substructure matrix
of impregnated glass or polymer fiber provides structural strength.
The physical properties of this system, combined with its excellent
marginal adaptation and esthetics, ma$e it a possible metal-free
alternative for 3!'s, although long-term clinical performance is not
yet $nown.
a b
a. +i1er rein'orced comosite su1structure 'or a t#ree unit 'ixed artial denture(
1. $omosite &eneers o&er +"$ su1structure(
- !roper pontic-tissue contours and surface finish is the $ey to
healthy tissue response.
- !ontic design has been found to be the most important factor in
obtaining inflammatory-free pontic-ridge relationships.
- #ccording to 1tein, the ideal pontic design is the modified ridge
lap with a pinpoint contact on the facial slope of the residual ridge.
"e'erences
35
- (osenstiel '.). et al ( ,ontemporary fixed prosthodontics =*
th
edition<, />>B.
- 'hillin"erg *.. et al ( 3undamentals of fixed prosthodontics,
%EEF.
- +oldstein (. E. et al: Esthetics in dentistry, vol=/< - /nd
Ed.,/>>/.
- +oldstein (.E. ( ,hange your smile. =6rd ed<, ,arol 1tream, &8(
Guintessence, %EEF.
36