By Michael Maroon, DMD, FAGD

Patients and clinicians are always striving for ways to make the "artificial" look "natural." This is especially important when replacing missing teeth with a fixed bridge. In recent years, the ovate pontic style has gained popularity due to the ability of the clinician and laboratory to fabricate a restoration that achieves the all important "natural" look. Another benefit of the ovate pontic is that it is easily cleaned since the entire surface of the pontic is convex allowing a patient to easily pass floss over the entire tissue surface.

To properly get the "rolled" tissue appearance it is important to develop the pontic site prior to making a final impression. This way the laboratory can have a precise working model of the tissue to create a beautiful end result. I will describe how to achieve the perfectly developed ovate pontic site.

Situation #1- The Hopeless Tooth

In this situation a patient may have fractured a tooth and it is non-restorable. The tooth needs to be removed and the restoration of choice for this particular situation is a three-unit bridge. (Fig 1A) BEFORE extracting the tooth you should make a preliminary impression utilizing Clear Temporary Matrix Impression Material by Discus Dental www.discusdental.com or Image+ Microselect Clear Impression Material by Microdental Laboratories www.microdental.com utilizing a triple tray technique. My personal favorite triple trays for this technique are Exacta Trays from Exacta Dental Products, Inc. www.exactadp.com - 800-474-7665 or Quad Trays from Clinician's Choice www.clinicianschoic.com. Place the impression material into the tray, seat it in the patient's mouth and have them close normally. The material sets up in about 2 minutes. Remove the impression and place it aside for later use.

Next, after anesthetizing the patient, the tooth should be extracted using a very gentle technique so as not to disturb the buccal plate of bone. I prefer to use elevators for this procedure using a gentle probing and rocking motion until the root becomes loose. The socket site should appear intact. (Fig's 1B & 1C)

The provisional bridge should be made utilizing the clear impression that was previously taken. Thankfully, today there are a wide range of provisional materials available in a cartridge delivery system that can be used. Luxatemp by Zenith/DMG, Perfect Temp by Discus Dental, Turbo Temp by Danville, Pro-Temp by Espe, Flex Span by Jeneric Pentron, Exacta Temp by Exacta Dental Products, etc., are all excellent products. For this procedure I used Luxatemp by Zenith/DMG www.zenithdmg.com. Express the Luxatemp into the impression and seat into the mouth for approximately 2 minutes, then remove. Simple hydraulic pressure will have sent some material into the socket site to create the beginnings of the ovate pontic. To properly define the ovate pontic it is best to add some flowable composite to the pontic site at this time. You can then finish and polish the pontic to the appropriate contour to allow you to achieve optimum results. (Fig's 1D & 1E) Be sure to finish and polish the pontic surface. My preferences are Jiffy Cups & Points by Ultradent www.ultradent.com , the Enhance Cups & Points by Dentsply/Caulk www.dentsply.com and the Top Finishing System by Cosmedent www.cosmedent.com.

The provisional bridge is cemented (Fig 1F) and the patient is dismissed. You should allow the tissue to mature for 4 to 6 weeks before having the patient back for final impression.

On the final impression appointment the tissue should appear healthy. (Fig 1G) Simply remove the provisional restoration and make your impression. You should see a properly developed pontic receptor site which will allow you a wonderful final result. (Fig's 1H & 1I)

As you can see from the photos below...with tissue development like this the final results are sure to be natural-looking.