Prosthodontics

A review of esthetic pontic design options

Daniel Edelhoff, Dr med dentVHubertus Spiekermann, Prof Dr med Dr med denlV
MuratYildirim, Dr med dent'
Advances in the field of restorative materials allow a lost tooth to be replaced by artificial tooth structure
that is virtually indiscernible (rom the original. However, in fixed partial dentures the standards for the pontic area and the adjacent soft fissue in the maxillary anterior region have increased in partioular. The pontio
design in this region is primarily influenced by esthetic and phonetic considerations. Local defects of the
alveolar ridge often complioafe restorative measures. Treatment methods proposed to solve this problem
involve modification of the pontic design and prefreatment of the recipient site for the pontic. This article reviews the different clinioal and technical options that are available for designing esthetic and funcfional
pontics for the anterior region. (Quintessence ini 2002:33:736-746)
Key words: all-ceramic gingival mask, gingival shade guide, ponfio design, ridge preservation, soft tissue
conditioning

he restoration of anterior edentulous areas with

Bxed partial dentures (FPDs) presents a particular
challenge for the clinician. Because of their ease of use
and favorable long-term results,' conventional FPDs
represent the most popular treatmetit measure today.^'
In these restorations, the pontic must fulfill the eomplex
roles of replacitig the function of the lost tooth, achieving an esthetic appearanee, enabling adequate oral hygiene, and preventing tissue irritation. In addition, the
pontic must meet certain structural requirements to ensure the mechanical stability of the restoration.-*
Numerous proposals for selection of pontics, some
of which involve contradictory design options, have
been presented in the past. In most cases, the rceommended pontic designs are based on empirically developed opinions.'-'Although pontics in the posterior region are primarily designed to satisfy functional and
hygiene requirements, those in the anterior region
must fulfill certain esthetic criteria.

'Associate ProfessOi, Department o( Prostiiodontics, Sctiool of Dentistry,

University of Aactien, Aachen, Germany.
'Professor and Chairman, Department of Prosthodontics, School of
Dentistry, University of Aaciien, Aachen, Germany
Reprint requests; Dr Daniel Edelhoff, Associate Professor, Department of
Prosthodontics, School of Dentistry, Medical Center, University of Aaciien,
52074 Aachen, Germany E-mail' dedeilioff@ijkaachen.de
This article has been translated from "sthetische Gestaltung des
BriJckenzwischengliedes." Die Quintessenz 2[)[)[1;51:233-245.

736

The extraction of a tooth in the anterior region

often involves simultaneous local alveolar ridge deficiencies.'"" In the past, primarily prosthodontie methods were used to eompensate for these defects.'^ As a
resuh of the recent advances in periodontology and
the requirements of modern implantology, a number
of techniques have been developed to preserve the
alveolar ridge and surgically rebuild defective sites.''-'*
Today, these techniques are also used in crown-andbridge prostheties for ridge preservation before'^'^" or
directly after extraction,^'-^^ as well as for buccal
crown-lengthening procedures and ridge augmentation procedures,^^-^^ leading to an increased frequency
of satisfying ridge contours.
In addition, the basal contour of the pontic in particular has been modified to enhance esthetics and
function in the anterior area.''''^ Long-term provisional restorations arc an integral part of this stage of
the treatment.'^
In situations where surgical pretreatment is undesired or contraindicated, various prosthodontie techniques are available to compensate for lost papillae or
alveolar ridge defects, sueh as adjustment of the contact point,^' reduction of the embrasure space to create a papillary illusion, and use of pink ceramics.'^"''"
The purpose of this article is to provide a review of
the clinical and technical options that are available for
fabricating esthetic pontics and to illustrate the practical procedures.
Volume33, Number 10, a002

 Edeliioft et al

PONTIC DESIGN OPTIONS

A large number of studies have been publisbed in dental literature on the subject of tbe ideal pontic design.
The terminology used in this field is not always standardized- The designs range from conical pontlcs,
which are placed directly in the extraction socket,-" to
pontics that require large^''-''- or very smalH^ receptor
sites, to hygienic (sanitary) pontics, which do not
come in contact with the soft tissue at all.'^
The majority of researchers studying pontic design
assumed that inftammation of the alveolar mucosa
under pontics is caused by the accumulation of plaque
on tbe basal surface of the pontic.''-+^ As a result,
glazed ceramics were believed to be the material of
choice for pontics,-" '^ *^ because of their low rate of
plaque accumulation. Podshadley^ and Stein,-*^ however, refuted this assumption in independent studies;
they did not find any histologie differences in the soft
tissue reactions to pontics fabricated of gold alloys,
resin, glazed ceramics, or unglazed ceramics.
Stein-i^ also demonstrated that the shape of the
pontic and the orai hygiene measures of the patient,
rather than the material itself, represent the most significant factors to be considered in the prevention of
inflammation. To preserve the health of the soft tissue,
therefore, a number of autbors have advocated the use
of pontics with a well-polished and smooth, convex
stirface that makes pressure-free-'^ or minimum-pressure" contact with the alveoiar ridge in a small
area.^""
In a retrospective study of partially edentulous patients, 91% of the edentulous anterior sections of the
jaw exhibited alveolar defects of various extents.'" A
suitable classification for alveolar ridge defects was
provided by Seibert" (Table 1)- The combined defect
(Class III) occurs most often.'""
In a survey conducted among patients witb FPDs
in the maxillary anterior region, 20% of the respondents were dissatisfied with the appearance of their
denture, and 40% complained about entrapment of
food particles." On the whole, pafients with horizontal defects (Class I) reported greater subjective satisfaction with their restorations than did those patients
whose ridge defect included a vertical component
(Classes 11 and III).
Frequently, the contour of the alveolar ridge rsorption requires that a pontic with an unsuitable concave
basal configuration be used in tbe area that comes in
contact with the alveolar mucosa.-"* The convex basal
surface should enable tbe dental floss to make contact
with all the surfaces. This type of pontic design, however, cannot always be used without allowing for some
esthetic (high smile line), phonetic, or functional
(trapping of food particles) restrictions.
Quintessence International

TABLE 1 Classification and incidence of maxillary

anterior ridge defects*
Ciass

Definition

No delects
Horizontal loss ot tissue with
normai vertical ridge height^^
Vertical loss ot tissue with
normai horizontal ridge height
Combination ot Class I and II:
loss ot normal height and width=^
'Classilicafmn ot anterior ridge defects, as described by Seibert.'" and
the incidence of Ihese defecls in the anterior rnaiilla. as reported by
Abfams eta^'and Hawkins etal."

Conical pontic

In a study by Reichenbacb,-" tbe conical pontic was

used to prevent the extraction site from collapsing
after the removal of a tooth and to imitate the natural
emergence profile of the tooth (Fig 1). After extended
periods of service, however, the adjacent soft tissue
tended to become inflamed, and the alveolar bone resorbed.^''" Based on tbe information available today,
these reactions probably occurred because tbe pontic
did not allow adequate oral hygiene. This method is
still used in a modified application, the immediate
pontic technique,^'^^ to maintain the topography of
the alveolar ridge after the extraction of a tooth.
Hygienic pontic

The hygienic pontic fitlfills the prerequisites for maintaining a healthy periodontium, because it does not
come in contact with the underlying soft tissue and
provides easy access for oral hygiene aids to clean the
abutment teetb.^ The gap between tbe pontic and tbe
alveolar ridge, bowever, is large enougb to trap food
particles and to allow the tongue to enter. Because of
functional and, above all, the esthetic and phonetic
drawbacks, this type of pontic sbould be used only in
the posterior region of the mandible.
Saddie pontic

The saddle-shaped ponfiC^ achieves highly esthetic results, if the alveolar ridges are free of defects. The
emergence profile, which is very similar to that of the
natural tootb, ensures that no palatal gap forms,
which could cause phonetic problems (Fig 2).
Trapping of food particles is not expected, because the
pontic seamlessly adapts itself to the alveolar ridge.
Today, however, it is generally agreed that tbis technique should not be used, because tbe large concave
737

Edeihofletal

Fig 1 Conical pontio. The conical pontic is

placed in the extraction site. This type of
pontic is no ionger used, because it proved
too difficult to clean Furtheimore, rsorption
ot the alveciar bone occurred too frequentiy.

Fig 2 Saddie pontic. The esthetics, tunetion, and phonetics achieved with this type
ol pontic are highiy satisfactory. The risk that
tood particies wiil become trapped is minimai. Nevertheiess, hygiene procedures are
iimited by the concave design of the pontic.

contact area witb tbe alveolar ridge prevents tbe removal of adberent plaque,"^^ In clinical recalls, cbanges
in tbe soft tissue-" and severe inflammation, including
ulcration,'" were associated with 85% of the saddleshaped pontics.

Fig 3 Ridge iap pontic. This type of pontic

achieves the same esthetic resuits but is
easier to ciean (see Fig 2). The formation of
a paiatai gap, however, may result in phonetic probiems and increased food impact ion.

sion is compensated for by tbe restoration, the pontics

look unnaturally long (long pontic design) and can he
associated with functional problems: Because of the
lack of interdental gingiva, open interproximal spaces
appear, increasing the exchange of saliva and air and
presenting a higher risk of food impaction,*"

Ridge iap pontic

Ovate pontic
A reduction of the surface area (ridge lap pontic) does
not significantly improve hygiene underneath the pontic, because the basal contour remains concave,"*' unsuitable to provide a tight contact to the dental floss
(Fig 3).
Modified ridge lap pontic
The modified ridge lap pontic is the most popular type
of pontic (Fig 4), The convex basal surface, which
rests on a small area of the alveolar ridge, fulfills the
recommendations made in the dental literature with
regard to hygiene procedures and prevention of irritation of the underlying soft tissue,''^'*^ Frequently, however, the contour of the alveolar ridge requires that a
compromise be made in the design to prevent the impairment of esthetics, function, or phonetics,^^ In particular, the vertical loss of dimension of the ridge, occurring in the majority of the patients, can cause
difticulties in this respect. If this vertical loss of dimen738

In contrast to the classic requirements for pontics,

which suggest the importance of pressure-free contact
over a small area,*' the ovate pontic cornes in contact
with a larger area of the underlying soft tissue'''" and
applies light pressure (Fig 5), This design has been
found to produce bighly esthetic results following suitable pretreatment of tbe alveolar ridge.
Because this design produces an emergence profile
that looks very similar to that of the natural tooth, it
fulfills ideally the esthetic and functional requirements
of a pontic for the anterior region. This type of pontic
design, however, requires an adequate amount of soft
tissue, which has to be sculpted accordingly. Various
techniques are available for this purpose, ranging from
controlled regeneration directly after the extraction of
the tooth (immediate pontic technique)^^-^^ to plastic
surgery (gingival grafting),^^'" which is accompanied
hy tissue conditioning in the course of the subsequent
prosthodontic treatment,'^
Vciume 33, Number 10, 2002

Edelhotelal
Fig 4 Modified ridge iap pontic The most
hygienic pontic form lor the anterior region.
In certain applioations, the design ol the
base has some limitations, resuiting in esthetic and tunctionai shoricomings.

Fig 5 Ouate pontic Because ot its particular interaction with the soft tissue, this poniio
produces outstarrding results with regard to
esthetics, funotion. and phonetics. The risk
ot food impact ion is minimal.

Figs 6a and 6b Ouate pontic The pontic

appears to emerge trom the gingiva like a
naturai tooth.

Tbe large pontic-ridge contact site requires tbat the

patient be particularly well motivated to conduct oral
hygiene procedures.""' The patient's compliance, therefore, must be evaluated during the pretreatment phase.
If all the mentioned prerequisites are fulfilled, this
pontic design is capable of satisfying the highest of esthetic standards- It is particularly suitable for patients
with a high smile line (Figs 6a and 6b). Hygiene procedures are easy to perform because of the convexity of
the base (Fig 7).

TREATMENT PLANNING

Fig 7 Ovale pontic. The ovate pontic aliows thorough piaque removai because of the convex shape

Before beginning treatment, study casts are fabricated

and radiographs are taken of the abutment teeth and
Quintessence International

739

 Edelhott el al
Fig e Soft tissue conditioning. Foiiowing a 6-weeK healing
pfiase, the soft tissue can be contoured by relining the base of the
iong-term provisionai restoration.
Fig 9 Soft tissue ccnditioning. Soft tissue situation after 6 rrionths
of controlled pressure applied by the long-lerm provisional
restoration. The vertical shaping of the pseudopapiliae has been
successfuliy completed

the edentulous parts of the arch. This information will

help to evaluate the quality of the abutments and to analyze the positional relationship of the pontic to the
alveolar ridge, the abutment teeth, and the gingiva, as
well as to assess the size of the edentulous space. The
cementoenamel unctions of the abutment teeth or
those of the adjacent teeth are used as a vertical reference point. For esthetic and functional reasons, the new
tooth should be harmoniously integrated into the row of
teeth both horizontally (lip support) and vertically.*'*
The following aspects of the dentition should be
clinically evaluated: the line, color, and texture of the
gingiva; the lip line in repose and during speaking;
and the height of the smile line. The position of the lip
line has a significant influence on the selection of the
design of the pontic. If the contact area with the alveolar ridge is visible when the patient speaks or smiles,
special esthetic considerations must be observed.
To achieve esthetically pleasing results, the tooth to
be restored sbould emerge from the soft tissue of the
alveolar ridge at the same level as the cementoenamel
junction of the adjacent teeth. The surgical treatment
required to generate this emergence profile is determined by the type of alveolar ridge defect."" The classiflcation proposed by Seibert" sbould be used for tbis
purpose (see Table 1).
The ideas and expectations of the patient should
be given special attention during the planning phase.
PROSTHETIC SOFTTISSUE CONDITIONING

Generally, the residual ridge soft tissue that is to be

the recipient site for the ovate poritic has to be shaped
740

by gingivoplastic or prostbodontic site-conditioning

measures. In this treatment phase, relineable longterm provisional restorations play an important role in
detertnining the contact area of the pontic and in remodeling the soft tissue recipient site. In three-unit
FPDs, the pontic should be in tbe middle between the
two adjoining papillae. Careful planning is necessary
for the preparation of several adjacent pontic sites
(middle line). If tbe alveolar ridge is narrow, the contact area can be moved labially.
For further shaping of the soft tissue, the basal surface of the long-term provisional pontic is slightly
roughened with diamonds or by air abrasion.
Subsequently, a ligbt-curing, low-viscosity resin composite is used to build the pontic up in small increments
(Fig 8).
Tbe FPD is tried in to evaluate whether the residual
ridge soft tissue must be additionally reshaped with
large, coarse-grit diamond balls (Fig 9). The ponticsidcd crown area can also be built up in a convex
shape (half-pontic design) to support the interproximal
soft tissue. The correct amount of pressure is applied to
the newly developed tissue if the blood circulation returns to normal" in the anemic zone after 5 minutes of
try-in under pressure (biting on cotton rolls). Finally,
the built-up base is polisbed and the provisional
restorations are placed with a temporary cement.
The aforementioned measures are repeated at intervals of 2 weeks until the soft tissue contour has developed satisfactorily and pseudopapillae have formed
(Fig 9). The long-term provisional restoration should
be used for a time period of at least 6 to 12 months.
After this time, the fine adjustment phase, in which
the functional and esthetic aspects of the restoration
Voiume33, Number to, 2002

 Edelhotf el al
Fig 10 Fabrication of the ovate pontic The
base of the framework is built up with selfcuring resin during tbe try-in procedure, according to the guidelines established during
soft tissue conditioning by the long-term
pro^'isionalrestoration.
Fig 11 Fabrication of tiie ovate pontic.
Final relining is carried out with a mediumviscosity polyether for the correct transfer of
the soft tissue situation to the master cast.

Fig 12 Section ot a prefabricated gingival shade guide ior

metal-ceramio veneering materials.

Fig 13 Local alveolar lidge defects masked with pink ceramic

veneering materials piacecf en the pontics of an anterior FPD.

are worked out with the patient, should come to an

end. Furthermore, the condition of the soft tissue
should be stable (see Fig 9). An anatomic elastic impression of the clinically proven provisional restorations provides the dental technician with important
information about the design of the permanent
restoration.
Because the newly created pseudopapillae tend to
coUapse when the provisional restoration is removed,
information about the condition of the soft tissue of
the pontic site cannot be properly transferred when
impressions are taken of the abutment teeth. This information, therefore, is gained when the bridge framework is tried in. For this purpose, the basal area of the
FPD framework is built up with a self-euring acrylic
resin, as described for the modification of long-term

provisional restorations (Fig 10),^^ Finally, this area is

relined with a medium-viscosity polyether (Fig 11). To
transfer the soft tissue situation to the master cast, the
plaster is removed in this area and replaced with a
tooth-colored silicone material.'"

Quintessence International

GINGIVA-COLORED CERAMICS

if augmentative measures are contraindicated or undesirable, small alveolar deficiencies and missing papillae
can be reconstructed by restorative measures," First,
the exact shade of the gingiva has to be established.
This ean be accomplished with special gingival shade
guides that are supplied with the different commercially available pink veneering materials (Figs 12 and
741

 Edeihott el ai

Fig 14 Aii-ceramic gingival masks. The masks are made ot a

pressed glass-ceramic, which is subsequenliy customized with
staining materials.
Fig 15 Ail-ceramic gingivai masks. Finai situation after the adhesive placement ol the gingivai masi<s

13). The basal surface must demonstrate a convex

shape similar to the ovate pontic designs for the dentai
floss to establisb tigbt contact witb all the surface areas.
ALL-CERAMIC GINGIVAL MASKS

Separately fabricated ceramic gingival masks can be

used to make subsequent adjustments in permanently
placed restorations.-'" Tbis metbod is particularly suitable for patients witb a local alveolar ridge defect that
has not been corrected by augmentation of the soft tissue. For this purpose, an impression is taken of the
labial surface of tbe restoration using a customized
tray and a medium-viscosity polyether material. The
color of the gingiva is determined with an individually
fabricated shade guide."
The gingival masks are fabricated in the laboratory,
in a leucite-reinforced glass-ceramic for example.
Special characterization materials are used to customize the masks (Fig 14). The masks are bonded to
the existing restoration with a light-curing, low-viscosity resin composite, according to the procedure descrihed by Edelboff et aP' (Fig 15).

GINGIVAL PROSTHESES

Gingiva-colored removable prostheses made of soft

silicone materials offer an uncomplicated solution for
correcting large alveoiar ridge defects that are associated with esthetic and phonetic problems.^' They can
be fixed to tbe restoration with precision attachments.'^ Alternatively, if certain prerequisites are met,
they can be subsequently attacbed to the permanently
742

placed restoration. This solution, however, increases

the risk of plaque accumulation.
Because the material ages quickly, the prosthesis
has to be replaced on a regular basis. Furthermore,
some patients have reported that the prosthesis feels
like a foreign body.
DISCUSSION

Based on classic clinical studies, a number of autbors

have advocated the use of modified ridge lap pontics
with a well-polished and smooth, convex surface tbat
results in pressure-free-t^ or mild"" contact with the
alveolar ridge over a very small area'"' for a better
preservation of tbe soft tissue bealth. However, the
modified ridge lap pontic design has certain limitations, depending on the pattern of alveolar ridge rsorption, and cannot always be used without compromising esthetics and functions.''**
Because the aforementioned factors are decisive in
restoring anterior teeth, new alternatives in pontic design were developed,^-" giving the illusion that the replaced tooth emerges from the gingiva like a natural
tooth (Figs 16a and 16b). This ovate pontic design requires the preparation of a suitable recipient site, which
can be achieved by tbe application of modern ridge
preservation techniques, including an atraumatic extraction and the direct support of the extraction socket
by the use of the immediate pontic technique.^^'^ The
insertion of an acrylic resin splint in the shape of an
ovate pontic immediately after extraction resulted in an
esthetic concave recipient site in the edentulous ridge
in rats" and was recommended for the use in humans
to improve the anterior esthetic appearance of FPDs.^*
Voiume 33, Number 10, 2002

Edelhoffetal

Figs 16a and 16b Lateral view of two permanently piaced ail-ceramic anterior FPDs in the maxilla
(lett central inoisor to lett canine and right canine to right central incisoi). The contour ot the pontios
replacing the lett and right lateral inoisors is oval (ovate pontic design).

Certain guidelines for this technique have to be

carefully followed, including the use of a long-term
provisional, which has to be modified several times
during tbe first montbs after tootb removal," Besides
case reports, very few scientific data are available so
far to indicate tbe long-term stability of tbe preconditioned soft tissues.
When conventional tecbniques were used for tootb
removal, 91% of tbe edentulous anterior sections of
tbe jaw exhibited alveolar defects of various extents,'"
In recent years, plastic surgical methods for the augmentation of local alveolar defects have greatly improved the chances for outstanding esthetics of anterior fixed partial dentures.-'"
When surgical approaches are used to develop the
recipient site of the ovate pontic, primary and secondary shrinkage of the grafts is an important issue.
Depending on the thickness of the graft, volumetric
shrinkage ranging from 25% (thick) to 450/0 (very thin)
has been reported.''' Mormann et a l " stated tbat
sbrinkage was completed in 28 days; Seibert" found
that the greatest amount of shrinkage appeared to take
place within 6 weeks after the surgical procedure.
As an integral part of the treatment, the ridge contour achieved by tbese tecbniques bas to be remodeled
as a recipient site for an ovate pontic, A suitably concave ridge contour is usually generated by tbe application of mild pressure to the soft tissue by a relineable,
long-term provisional prostbesis as described earlier.
Apart from numerous case descriptions, very few scientific data have been publisbed about tbe long-term
bebavior of augmented ridge sections and their relationship with the restoration.
In contrast to traditional guidelines, extended contact of the basal pontic contour with the soft tissue is
established to create a suitable emergence profile. The
application of pressure to the soft tissue has to be adjusted carefully to avoid any unfavorable biologic reQuintessence Inlernationai

Fig 17 Orai hygiene procedures conducted on an ovale pontic.

sponse, Cavazos'" reported that mild pressure applied

to the residual ridge tissue, created by an 0,25-mm
overcontour of the pontic, would not aftect the biologic
response, altbougb an overcontour of 1,00 mm resulted
in increased infiammation of tbe residual ridge,
Tripodakis and Constantinides'"' found that hyperpressure of the pontic causes morphologic modifications of the underlying soft tissue, resulting in a histologically thinner epithehal layer and shorter rete
pegs. However, no signs of infiamtnation were found
when the patients flossed underneath the convex
pontic. Instructing patients in the correct use of oral
hygiene procedures is therefore an integral part
of the treatment (Fig 17). If these measures are
neglected, inflammation of the soft tissue of the residual ridee is i
743

Edeihtf el al

The morphologie relationship hetween the soft tissue and the underlying bone contour is an important
prerequisite for a stable long-term result, Tarnow et
aP' showed that the presenee of the interproximal
papilla is closely related to the distance between the
erest of bone and the contact points of two adjacent
teeth. At the maximum, this distance ideally should be
5 mm. These findings confirm the hypothesis that the
underlying bone contour supports the soft tissue contour, Jemt^^ observed, in a retrospeetive study of single-tooth implants, that the majority of the papillae recovered spontaneously during the 1- to 3-year clinical
followup by the effect of maturation.
Because no reliable seientifie data are available so
far, long-term provisional restorations should be employed for at least 6 to 12 months to ensure soft tissue
stability and to increase the predictability for the final
restoration.
If augmentative measures are contraindieated or
undesired, prosthodontic solutions should he used to
compensate for the alveolar ridge defieieney. These
measures compensate for the ridge defcet with toothcolored pontics, resuiting often in an unfavorably long
pontic design.-"* Better esthetics are aehieved if the defect is covered with pink ceramic masks or a removable flexible gingival prosthesis made of silicone material. The latter option, however, inereases the risk of
plaque accumulation and the silicone prosthesis has to
be replaced on a regular basis, because the material is
altered by the oral environment. Some patients feel
discomfort associated with gingival prosthesis, because
of an unfavorable foreign body sensation.
Because the described method entails more extensive treatment than that required for the plaeement of
conventional fixed partial dentures, excellent patient
compliance is needed throughout the treatment and
postpiacement periods. The ideas and expectations of
the patient should be given special attention during
the planning phase and throughout the treatment
procedure.
Further clinical studies are needed to focus on the
long-term prognosis of the alveolar ridge preservation
techniques, as well as on the long-term stability of
ridge augmentations and their relationships with the
restoration.

CONCLUSION

The following conelusions can be drawn for esthetic

pontie design in the anterior region:
1. Procedures for the preservation of the alveolar
ridge contour as well as for the augmentation of
ridge defects are a promising alternative to the
744

purely prosthodontic solutions. An integral part of

this treatment is the use of a relineable long-termprovisional prosthesis.
2. Surgical proeedures are particularly suitable for patients with a high smile line and a defect with a vertical component. They can be combined with surgieal implant measures, if implant-supported FPDs
are planned.
3. The presence or development of an adequate
amount of soft tissue allows the use of an ovate
pontie. Because of its partieular interaction with the
mucous membrane, outstanding esthetic and functional improvements are achieved.
4. The extensive treatment procedure requires close
collaboration witb tbe patient. The compliance of
the patient includes meticulous hygiene procedures
in the postplacement period,
5. A lack of oral hygiene measures and inadequate hype rpressure will inevitably lead to inflammation underneath the pontic.
6. If augmentative measures are contraindieated or
undesired, prosthodontic solutions should be used
to compensate for the alveolar ridge deficiency.
These measures usually involve the use of pink ceramics.
ACKNOWLEDGMENTS
The aulhor.i would like to thank Mr Andreas Rubben, CDT, and Mr
Volker Weber. MDT, Aachen, Germany, for the prosthdornic work.

REFERENCES
1. Creugers NHJ, liayser AF, van't Hof MA. A meta-analysis of
durability data on conventional fixed bridges. Community
Dent Oral Epidemioi 1994;22;448-452.
2. Marinello CP, Meyenberg KH, Zitzmann N, Luthy N, Soom
U, Imoberdorf M. Single-tooth replacement: Some clinical
aspects. J Esthet Dent 1997 ;9:169-178.
3. Studer S, Pietrohon N, Woliiwend A. Maxillary anterior singic-tooth replacement: Comparison of three treatment
modalities. Pract Periodontics Aesthct Dent 1994;6:51-60.
4. Smyd ES, Mechanics of dental structures: Guide to teaching
dental engineering at undergraduate level. J Prosthet Dent
1952,2:668-692.
5. Becker CM, Kaldahl WB. Current theories of crown contour, margin placement and pontic design. J Prosthet Dent
1981;45:268-277.
6. Eissmann HF, Radke RA, Noble WH. Physologic design criteria for iixed denial restorations. Dent Clin North Am
1971;15:543-568.
7. Howard WW, Ueno H, Pruitt CO. Standards of pontic design. J Prosthet Dent 1982;47:493~495,
8. Manary DG. Evaluating the pontic-tissue relationship by
means of a clinical technique. ] Prosthet Dent 1983:50:
193-194.
Volume 33. Number 10, 3002

 EdelhofI et ai
9, Podshadley AG, Gingival response to politics, ] Prosthet
Dent t968;19:51-57.
10. Abrams H, Kopczyk RA, Kaplan AL. Incidence o anterior
ridge defonnities in partially edcnliikius patients, J Prosthet
Dent 1987 ;57:191-194.
11. Hawkins CH, Sterrett JD, Murphy HJ, Thomas |C. Ridge
contour related to estheties and function, ] Prosthet Dent
1991;66;165-168.
12. Dutiuner PM, Giddcn |. Tlie upper anterior sectional detiture. J Prosthet Dent 1979:41:146-152.
13. Ashma.n A. The use of synthetie bone materials in dentistry.
Compend Contin Educ Dent 1992:13:1020-1034,
14. Buser D, Dula K, Belser U, Hirt H-P, Berthold H. Localized
ridge augmentation using guided bone regeneration. 1.
Surgieal p r o c e d u r e in the maxilla. Int J P e r i o d o n t i c s
Restorative Dent 1993:13:29-45.
15. Edel A. Clinical evaluation of free connective tissue grafts
used to increase the width of keratinized gingiva, J Clin
Periodontol 1974:1:185-196.
16. Landsberg CJ, Biebacho N. Modified surgi cal/prosthetic approach for optimal single implant supported crowns. I. The
socket seal surgery. Pract Periodontics Aesthet Dent 1994;
6:11-17.
17. Saadoun AP, Landsberg CJ. Treatment classifications and
sequencing for post extraction implant therapy: A review.
Pract Periodontics Aesthet Dent 1997,9:933-941.
18. Salatna H. Garber D, Salama M. Adar P, Rosenberg ES,
Fifty years of interdisciplinary site development: Lessons
and guidelines irom periodontal prosthesis, I Esthet Dent
1998:10:149-156.
19. Ingber JS. Forced eruption. II. A method of treating nonrestorable teeth-Periodontal and restorative considerations. J
Periodontol 1976:47:203-216,
20. Salama H, Salatna M. The role of orthodontic extrusive remodeling in the enhancement of soft and hard tissue profiles prior to implant placement: A systematic approach to
the management of extraction site defects. Int J Periodontics
Kestorative Dent 1993:13:312-333,
21. Dewey KW. Zugsmitb R. An experimental study of tissue reactions about porcelain roots for fixed bridgework, J Dent
Res 1933:13:459-472.
22. Bodirsky H. Die Immediate-Pontic-Technik-Eine Methode
zur E r h a l t u n g der sthetik nach E x t r a k t i o n v o n
Frontzhnen und Prmolaren [Immediate pontic technique-A method to preserve esthetics after extraction of anterior teeth and premolars]. Quintessenz 1992:43:251-265.
23. Spear FM. Maintenance of the interdental papula following
anterior tooth removal. Pract Periodontics Aesthet Dent
1999:11:21-28,
24. Prestipino V, Passero P, Ingber A, Wyman B Preserving the
topography of the extraction site: Extemai gingivai support
spiint J Esthet Dent 1994;6:259-266.
25. Bahat O, Deeb C. Golden T, Komamyckij O. Preservation
of ridges utilizing h y d r o x y a p a t i t e . Int J P e r i o d o n t i c s
Restorative Dent 1987;7(6):35-41.
26. Quinn JH, Kent JN. Alveolar ridge maintenance with solid
nonporous hydroxylapatite root implants. Oral Surg Oral
Mod Oral Pathol 1984:58:511-521.
27. Kent JN, Q u i n n JH, Z i d e MF, Finger liVl, J a r c h o M,
Rothstein SS. Correction of alveolar ridge deficiencies with
nonresorbahle hydroxylapatite. J Am Dent Assoc 1982;105:
993-1001.

Quintessence International

28. Suhonen JT, Meyer BJ. Polylactic acid (PLA) root replica in
ridge maintenance after loss of a vertically fractured incisor.
Endod Dent Traumatol 1996;12:155-160.
29. Ahrams L. Augmentation of the deformed residual edentulous ridge for fi\ed prostheses, Compend Contin Educ Dent
1980:1:205-214.
30. Hurzeler MB, Weng D. A single-incision technique to harvest subepithelial connective tissue grafts from the palate.
Int J Periodontics Restorative Dent 1999; 19:279-287,
31. Langer B, Calagna L. The subepithelial connective tissue
graft. J Prosthet Dent 1980:44:363-367.
32. Seibert JS. Soft tissue grafts in periodontics. in: Robinson
PJ, Guernsey LH (eds). Clinical Transplantation in Dental
Specialities. St Louis: Mosby, 1980:107-145.
33. Scibert JS. Reconstruction of deformed, partially edentulous
ridges, using full thickness onlay grafts. 1. Technique and
w o u n d healing. Compend Contin Educ Dent 1983:4:
437-453.
34. Garber DA, Rosenberg DS, The edentulous ridge in fixed
p r o s t h o d o n t i c s . Compend Contin Educ Dent 1981:2'
212-224.
35. Glauser R, Thievent B, Schrer P, Ovate Pontic-kiinische
und technische Aspekte [Ovate pontic-Clinic al and technical aspects]. Teamwork Interdiszipl J Proth Zahnheilkd
1998:1:258-277
36. Pietrobon N, Lehner CR, Sehrcr P. Langzeitprovisorien in
der Kronen- und B rcken-Proth et i k [Long-term provisionals for c r o w n s and fixed parlial d e n t u r e s ] . Schweiz
Monatsschr Zahnmed 1996;106:237-244.
37 Tamow DP, Magner AW, Fletcher P. The effect of the distance from the contact point to the crest of bone on the
presence or absence of the interproximal dental papilla. J
Periodontol 1992;6:995-996.
38. Blatz MB, Hurzeler MB. Strub JR. Reconstruction of the
lost inlerproximal papilla-Presentation of surgical and nonsurgical approaches. Int ] Periodontics Restorative Dent
1999:19:395-406.
39. Cronin RJ, Wardle WL. Loss of anterior interdental tissue:
Periodontal and prosthodontic solutions, J Prosthet Dent
1983:50:505-509.
40. Studer S, Naef R, Schrer P. Adjustment of localized alveolar ridge defects by soft tissue transplantation to improve
mucogingival esthetics: A proposal for clinical classification
and an evaluation of procedures. Quintessence Int 1997;28:
7S5-805.
41. Reichenbach E. Untersuchungen zur Frage einer zweckmigen Gestaltung des Brckenkrpers [Investigation on a
stiitable pontic design], V Sehr Zahnheilkd 931i47:
125-138.
42. Masterton JB. Recent trends in the design of pontics and retainers. Dent Pract Dent Rec 1964:15:131-139,
43. Stein RS. Pontic-residual ridge relationship. A research report, I Prosthet Dent 1966:16:251-285.
44. Clayton JA, Green E. Roughness of pontic materials and
dental plaque. ] Prosthet Dent 1970:23:407-411,
45 Henry PJ, Johnston JF, Mitchell DF, Tissue changes beneath
fixed partial dentures. J Prosthet Dent 1966:16:937-947.
46, Gade E. Hygienic problems of fixed restorations. Int Dent J
1963:13:318-330.
47 Cavazos E. Tissue response to fixed partiai pontics, J
Prosthet Dent 1968:20:143-153,

745

 Edelhoftelal

48. Tripodakis AP, Const an ti nid es A. Tissue response under hyperpressure from convex pontics. Int Periodontics
Restorative Dent 1990;10:409-414.
49. Council on Dental Materials and Devices, American Dental
Association. Pontics in fixed prostheses: Status report. J Ani
Dent Assoc 1975 ;91:613-617.
50. Pamcijer JHN, Soft tissue master cast for esthetic control in
crown and bridge procedures. Esthet Dent 1989;l:47-50.
51. Edelhoff D, iVIarx R, Spiekermann H, Yildirim M. Klinische
Einsatzmgliehkeitert der intraoralen Silikatisierung
Clinical use of an intraoral silicoating technique]. Dtsch
Zahnarztl Z 1999;54:745-752.
52. Iselin W, Meier C, Lufi A, Lutz F. Die flexible Zahnfleiscliepithese [The flexible gingival epithesis]. Schweiz
Monatsschr Zahnmed 1990;100:967-976.
53. Caldern Y, Haviv E, Zalkind M, Sela I, Sterrt N. Esthetic
pontic receptor site development: A histologie study in rats.
j Esthet Dent 1995;7:95-98.
54. Corn H, Marks MH, Gingival grafting for deep-wide recession-A status report. II. Surgicai procedures. Compcnd
Contin Educ Dent 1985;4:167-180.
55. Mortnann W, Schaer F, Firestone AR. The relationship between success of free gingival grafts and trartsplant thickness. Revascularization and shrinkage-A one-year clinical
study, J Periodontol 1981;52:74-80.
56. femt T, Regeneration of gingival papillae after single-im pi ant
treatment. Int J Periodontics Restorative Dent 197;17:
526-333.

Mastering Dental
Photograptiy
Wolfgang Bengel
Images are fundamentei in the day-today practice of dentistry. They serve as
documentation o dental procedures and as
forensic evidence, and
they play an essential
role in dentist-patient
communication, providing the basis for
patients' expectations
for treatment. However, many dentists,
daunted by modern
photographic technology, do not realize the
full potential of imagery in their practices.
This book, written by an experienced dentist and
leader of numerous photographic seminars, offers
practical insights, instructions, and tips that will enable any dental practitioner to achieve excellence in
dental photography. In more than 500 photos, the
book provides examples of high-quality results and
the steps needed to achieve them. Covered topics
include conventional and digital photography; techniques for various forms of clinical photography;
production of slide series; and archiving,
270 pp; 516 illus (471 color); ISBN 3-87652-383-4;
US $98

Contents

Fundamentals of Photography
Camera Systems Appropriate for Dental Photography
Perioral and Intraoral Photography
Portrait and Profile Photography
Photographing Objects for Dentistry and Dental
Technology
Photography of Dental Casts
Print Reproduction
Reproduction of Radiographs
Slide Reproduction
Making Presentation Slides
Storing and Archiving Your Photographs
Digital Photography
Intraoral Video Systems: Selection and Lise
Legal Considerations

To Order
Call toll free
or Fax
Website
E-mail

800-621-0387
30-682-3288
www.quintpub.cam
service@quinfbook.com

Bnca

746

book/

Quinfessence Publishing Co, Inc