JICDRO is a UGC approved journal (Journal no. 63927)

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CASE REPORT
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 82-85

Ovate pontics: Phoenixing the gingival contour


Department of Prosthodontics, Bhabha College of Dental Sciences, Bhopal, Madhya Pradesh, India

Date of Web Publication21-Dec-2017

Correspondence Address:
Dr. Medha Vivek Bhuskute
c/o Shri Shirish Huddar, 51 B, Sada-Vijay, Shiva Kunj Rly Housing Society, 12. No. Bus Stop, Arera Colony, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_26_17

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   Abstract 


In today's busy world, most patients do not have time for long, drawn-out dental treatment. The time span between extraction and healing after loss of tooth in the anterior esthetic zone can be esthetically and psychologically devastating on the part of the patient. Especially, when a maxillary anterior tooth must be extracted and replaced, immediate tooth replacement with an ovate pontic on a provisional bridge is a good alternative. Ovate pontic helps in preservation of the interdental papilla, which in turn preserves the natural gingival contour that would have otherwise been lost after extraction. An immediate tooth replacement using ovate pontic not only eliminates the psychologically disturbing partially edentulous phase but also results in a much more esthetically pleasing replacement of tooth that is both hygienic and natural in appearance. Another added advantage of the use of ovate pontic is that it rules out the dissatisfaction resulting from an unesthetic ridge lap pontic placed directly over edentulous ridge. Just like the long-lived bird “Phoenix,” arising out of its own ashes, the ovate pontic creates an illusion that the pontic is emerging from the gingiva, even after tooth loss. This case report discusses how an integrated approach of fabricating heat cure provisional bridge with ovate pontics before extractions, benefitted a young patient in whom fractured anterior teeth were proposed for extraction.

Keywords: Emergence profile, gingival contour, ovate pontics


How to cite this article:
Bhuskute MV. Ovate pontics: Phoenixing the gingival contour. J Int Clin Dent Res Organ 2017;9:82-5

How to cite this URL:
Bhuskute MV. Ovate pontics: Phoenixing the gingival contour. J Int Clin Dent Res Organ [serial online] 2017 [cited 2019 Sep 21];9:82-5. Available from: http://www.jicdro.org/text.asp?2017/9/2/82/221394




   Introduction Top


The loss of a single anterior tooth can be difficult for almost any patient, but replacing it with an implant or a fixed partial denture results in a predictable esthetic outcome unless significant bone and soft tissue were lost with the tooth.[1] Even then, in the hands of a skilled clinician, the result is generally acceptable. Several factors need to be addressed successfully. These include the size, shape, shade, and position of the pontic, as well the emergence profile from the soft tissues.[2] To mimic the appearance of a natural tooth, the pontic should appear to emerge from the gingivae and support the buccal/labial soft tissue as well as the adjacent papillae.

The ovate pontic is a technique used to create the illusion that the tooth is emerging out of the gum.[3] However, an ovate pontic design is not usually utilized by clinicians on a regular basis. One of the most challenging issues in a dental treatment plan is to preserve interproximal tissue after the removal of a tooth. To avoid alveolar bone collapse is highly desirable in restorative dentistry. It is important to preserve the socket size, shape, and the space of the gingival tissue to preserve the tissue height. When a tooth is extracted the recession of the interproximal papilla, and the collapse of the buccal bone must be prevented and this means that the extracted socket must be preserved in the same shape and location. It is highly important to preserve the papilla during the extraction procedure and to fill the extraction site with the provisional pontic as soon as possible.

This case report deals with one such instance of restoration of traumatized anterior teeth using ovate pontic design in a young patient for a predictable esthetic outcome.


   Case Report Top


A 19-year-old female patient reported to the clinic with fractured maxillary right central incisor and lateral incisor. Her medical history was noncontributory. The dental history was significant as she accidentally traumatized her right maxillary central and lateral incisor 2 days back in an attempt to board the bus and was unable to chew food and the teeth were painful [Figure 1]. After rendering primary treatment which included extirpation of pulp, removal of fractured palatal segment under local anesthetic and analgesics to relieve the pain, the following treatment options were discussed with the patient and her parents.
Figure 1: preoperative photograph showing fractured right maxillary central and lateral incisor

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  1. Forced orthodontic eruption of 11, along with crossbite correction of 22 followed by implant-supported crowns with 11 and 12
  2. Extraction of 11 and 12 and immediate provisional bridge with ovate pontics
  3. Postendodontic therapy, post and core restoration, (with guarded prognosis due to lack of sufficient tooth structure with 12 and fractured palatal segment with 11).


Option 2 was chosen by the patient as a provision for immediate replacement of her damaged teeth was considered and was cost-effective. The teeth adjacent to the traumatized teeth were prepared, and a fixed provisional restoration with an ovate pontic extending 3 mm subgingivally was fabricated. The teeth were extracted atraumatically and the provisional bridge was tried, relined, and cemented [Figure 2] and [Figure 3]. The tissue surface of the provisional ovate pontics was modified and polished as per the soft tissue changes at subsequent visits [Figure 4]. After a follow-up for 3 weeks, the patient skipped her appointments and returned with a loose provisional and the lost gingival contour [Figure 5].
Figure 2: abutment teeth prepared prior to extraction of fractured teeth

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Figure 3: atraumatic extraction of 11and

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Figure 4: 1 weeks postoperative photograph showing satisfactory aesthetic outcome

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Figure 5: 3 weeks recall picture: Gingival contour lost

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Phoenixing the gingival contour

Just like the long-lived bird “PHOENIX” which grows from its own ashes, it was proposed to recreate the interdental papilla. Sounding was done under local anesthetic and using a football-shaped diamond bur the socket was recontoured, and papilla was recreated [Figure 6] and [Figure 7]. A new provisional was fabricated and placed [Figure 8]. The tissue was allowed to heal. After satisfactory healing, the final impressions were made. A metal trial was done. Pattern resin (GC America Inc,) was used to record the details of tissue surface to facilitate the exact reproduction of tissue in the same position as it is with the provisional restoration [Figure 9]. This aids the technician in reproducing adequate intaglio contours.[4] A pickup impression was then made and sent to the laboratory. The final ovate pontic anterior bridge was fabricated and delivered to the patient with acceptable esthetic outcome as shown in [Figure 10].
Figure 6: sounding done under LA

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Figure 7: football-shaped diamond used to recreate interdental papilla

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Figure 8: 1 week later photograph with phoenixed gingival contour

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Figure 9: pattern resin used to record intaglio contours similar to that of provisional restoration

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Figure 10: fixed anterior bridge placed in mouth

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   Discussion Top


Anterior tooth loss can be esthetically and psychologically disturbing for a patient. Usually, patients demand immediate restorations with a predictable esthetic outcome. Multiple tooth loss and if adjacent to each other becomes even more challenging for the restorative dentist. In most circumstances, a combination of implants and ovate pontics is needed.

In this case, ovate pontic design was intended to form a concave soft-tissue outline in the site of the alveolar ridge mucosa for a satisfactory esthetic outcome.[5] The tissues were sculpted for guided papilla growth and stabilization.[2]

Advantages of the use of ovate pontics in anterior esthetic zone:

  1. Preservation of the interdental papilla and natural gingival contour
  2. Eliminates the psychologically disturbing partially edentulous phase
  3. Hygienic and esthetically pleasing replacement natural in appearance
  4. Rules out the dissatisfaction resulting from an unaesthetic ridge lap pontic
  5. Eliminates unaesthetic “black triangles.”


Instructions to the patient during the temporization phase regarding cleaning and need for regular recalls have to be emphasized. Failure to address this vital issue resulted in the loss of tissue contour and an additional chairside procedure was performed prolonging the treatment time.

So as to replicate the gingival contour and to develop an appropriate gingival profile, the transfer of sculpted tissue beneath the provisional restoration accurately, is critical. This aids the laboratory technician to simulate the contours of the provisional in permanent prosthesis. Irrespective of the techniques, the viscosity of impression material may record the sculpted tissue in an altered state.[2] Collapse of tissue due to removal of provisional may magnify this problem. Pattern resin has low polymerization shrinkage and due to high hardness and strength exhibits high stability even in thin layers. It is dimensionally stable even after hours or days and no dimensional changes due to room temperature. The use of pattern resin thus precisely captures the tissue details as opposed to techniques previously described which involved the modification of master cast.[6],[7],[8] The patient was also advised orthodontic correction of crossbite with tooth 22, for an improved smile in the future.


   Conclusion Top


The final choice of treatment for individual patient must occur on a case-by-case basis. It is extremely important to recognize in advance the various potential outcome possibilities that exist as a result of each patient's presenting condition to make the most informed and realistic decisions about the best treatment options.[1] The control of the gingival contours is just as important as the form of the teeth for a desired outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Spear FM. The use of implants and ovate pontics in the esthetic zone. Compend Contin Educ Dent 2008;29:72-4, 76-80.  Back to cited text no. 1
    
2.
Edelhoff D, Spiekermann H, Yildirim M. A review of esthetic pontic design options. Quintessence Int 2002;33:736-46.  Back to cited text no. 2
    
3.
Noriega EB. Ovate Pontic: Natural Look. Active Member of the American Academy of Cosmetic Dentistry No. 001568.  Back to cited text no. 3
    
4.
Jambhekar SS, Kheur MG, Matani J, Sethi S. Easy accurate transfer of the sculpted soft tissue contours to the working cast: A clinical tip. J Indian Prosthodont Soc 2014;14:337-40.  Back to cited text no. 4
    
5.
Dylina TJ. Contour determination for ovate pontics. J Prosthet Dent 1999;82:136-42.  Back to cited text no. 5
    
6.
de Vasconcellos DK, Volpato CÂ, Zani IM, Bottino MA. Impression technique for ovate pontics. J Prosthet Dent 2011;105:59-61.  Back to cited text no. 6
    
7.
Chee WW, Cho GC, Ikoma MM, Arcidiacono A. A technique to replicate soft tissues around fixed restoration pontics on working casts. J Prosthodont 1999;8:44-6.  Back to cited text no. 7
    
8.
Ferencz JL. Maintaining and enhancing gingival architecture in fixed prosthodontics. J Prosthet Dent 1991;65:650-7.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]



 

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