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The proximal contact point or the area refers to the surface point or area where the proximal surfaces of neighbouring teeth come in contact. Contact point/area is usually found in the occlusal one third of the natural crown of the most of the teeth.
The pontic, \pŏn΄tĭk\, is an artificial tooth on a fixed partial denture that replaces a missing natural tooth, restores its function, and usually restores the space previously occupied by the clinical crown. An ideal correctly designed posterior pontic should have the following features.
- All surface should have convexity with proper finish.
- The contact with buccal contiguous slop should be minimal (pinpoint)) and with pressure free (modified ridge lap).
- Buccal and lingual shunting mechanism should conform with those of the adjacent teeth.
- Occlusal table should be in functional harmony with the occlusion of all of the teeth.
- The overall length of the buccal surface should be equal to that of the adjacent abutment teeth or pontic.
The Pontic design can be classified into two types.
A. Pontic having mucosal contact
- Sanitary/Hygienic/Fish-belly and
- Modified sanitary type
B. Pontic with no mucosal contact
- Saddle/Ridge lap
- Modified Ridge Lap
Sanitary or Hygienic Pontic or Fish-Belly
Sanitary pontic makes no contact with the edentulous ridge. It is made in an all-convex configuration, faciolingually and mesiodistally. The space between the pontic and the mucosa should be 2 or 3 mm. It is most commonly used in mandibular molar replacement. It has the advantage of providing good access for maintaining hygiene with the disadvantage of poor esthetics.
The tissue facing surface of the modified sanitary design pontic has a hyperbolic parabola. The pontic is designed as a concave archway mesiodistally while the under surface is convex faciolingually. It in indicated in molar replacement, provides access to undersurface for good hygiene, alongwith poor esthetics.
It looks like crown of the tooth because it replaces all the contour of the missing tooth. It maintains a large concave contact with the underlying ridge and obliterates facial, lingual and proximal embrasures. Esthetic wise it provide best result but due to impossible access to under surface for cleaning, its use is limited for the replacement of maxillary incisors.
Modified ridge lap combines esthetics with easy cleaning, and makes contact with ridge tissues in a shape of ‘ T ‘ whose vertical arm ends at the crest of the ridge. This design is most commonly used in the area of the mouth that is visible during function, e. g. anterior teeth, premolars and sometimes maxillary molars.
Conical pontic design is mostly limited to the replacement of thin knife edged ridges in the non-display zone of the mouth. It has a convex surface with only touching the centre of the residual alveolar ridge. It helps maintain good hygiene with poor esthetics. Conical design in indicated for the replacement of molars.
Ovate pontic design is the most aesthetically suitable appealing design that looks like emerging from the gingiva. When ridge resorption is corrected by ridge augmentation, ovate design appears to be emerging through gingiva just like natural tooth. it is indicated for the replacement of maxillary incisors, canines, and premolars. It has the advantage of best esthetics, negligible amount of food entrapment and easy cleaning. The disadvantage is the requirement of surgical preparation of the receiving site before prosthesis fabrication.
There are MCQs on pontic design in “Free silver Course“, which you may like to attempt.
- Eur J Dent. 2018 Jul-Sep; 12(3): 375–379. doi: 10.4103/ejd.ejd_232_18
- Rosenstiel & Tyllman respectively
So, you are ready to start your crown work for the patient who is eagerly waiting to regain the lost functional ability, phonation and aesthetics. The functional ability, aesthetic value, speech enhancement and self-confidence of the patient will enhance when you look for the following anomalies in the oral cavity and rectify them, before the commencement of the crown preparation. You can make your crown & bridge without giving a dam for these factors, and get the quick bucks. But, it would be a good idea to consider them before you jump on for crown preparation part. And believe me, in long run, you will gain the faith of your patient, converting into your most reliable source of referral and image builder. These factors are given below:
- General overall health of the oral cavity
- Expectations of the patient
- Extremely tilted teeth
- Mobile teeth
- Type of occlusion
- The type of crown you want to fabricate for your patient
When we start examination, we look for the general health of the oral cavity. Is it healthy? Does the oral hygiene acceptable? Does the periodontal status of the tooth concerned adequate? Is the tooth tilted, rotated, supra or infra erupted? Does the patient need oral prophylaxis? What are the other systemic diseases the patient is suffering with; for example, cardiac, endocrine, orthopaedic, and physiological? If any of the answer is yes, then the dentist needs to take care of them first, before the commencement of the crown preparation. Of course, few chronic diseases cannot be cured but they should be kept under control by the patient’s’ physician.
That preparatory phase, the phase that involve the work done inside the mouth so that the longevity of the prosthesis remains satisfactory, includes the scaling and root planing, the removal of hopeless mobile teeth, orthodontic correction of tilted tooth, and occlusal surface adjustment of the supra erupted tooth. The other decayed teeth should be appropriately restored.
You should also know that what type of crown you plan to provide or what type of crown the patient is wishing for? What are the expectations of the patients from a particular type of crown? Will the patient understand the significance of the particular type of crown? Does patient understand the inherent drawbacks of that particular crown? Does patient know and ready to accept the post insertion maintenance care?
The other consideration is the type of occlusion in a patient. Is it canine protected or group function? Will you be needing to alter it for the betterment of the function and longevity? Does patient has any TMJ issue?