aesthetic zone after XLA article
1
interproximal papilla and the facial and palatal gingivae with slight positive pressure. The distance to the bone crest should be no less than 1-1.5mm and is determined by bone sounding with a periodontal probe. Temporary conventional or implant bridges can be used to form ovate pontics, as can adhesive bridges or partial dentures. Clinical case The patient attended with ageing anterior crowns and a failing post crown UR1, which had suffered recurrent abcessess (Figures 1 and 2). After considering the treatment otions the patient elected for a fixed bridge to replace the UR1 and a replacement crown UL2. The tooth was atraumatically extracted preserving the buccal plate. Bio-Oss and a Bio-Gide membrane were placed into the socket (Figure 3). An ovate pontic Figure 2 61 Dentistry www.dentistry.co.uk 1 September 2014 CLINICAL Dentists often face the challenge of replacing failing anterior teeth with conventional or implant supported bridgework, whilst trying to achieve optimum aesthetics. Important factors to consider are achieving gingival and tooth symmetry and a natural emergence profile. In the aesthetic zone, particularly in patients with high smile lines, the ovate pontic is often the best aesthetic choice for maintaining facial gingival architecture and interdental papilla following extraction. It also prevents the passage of saliva and air, and so is more desirable from a phonetic aspect and, with correct design, its axial contours can deflect food. The ovate pontic design dates back as far as the 1930s, but its use only became popular when concerns it caused chronic gingival inflammation were discredited. The ovate pontic design is often combined with alveolar ridge preservation techniques. The tooth/teeth are extracted taking care to minimise trauma to the alveolar bone. A material such as Bio-Oss is placed into the socket to the level and form of the alveolar crest to minimise resorption. A collagen-based material such as Bio-Gide is then placed over this and the subgingival ovate pontic immediatley placed. My favoured design of ovate pontic would generally extend 1-2mm below the alveolar crest with a highly polished convex ‘egg shaped’ finish. It should support the Figure 1: Patient presenting ageing anterior crowns Figure 2: Patient has a failing post crown UR1 Achieving excellence in the aesthetic zone after tooth extraction Dominic Hassall presents the use of the ovate pontic and ridge preservation technique Figures 4 and 5: Ovate pontic temporary bridge constructed from diagnostic wax up and matrix Dominic Hassall BDS MSc (Manc) FDS RCPS (Glasg) MRD RCS (Edin) FDS (Rest Dent) RCS is the director of the Dominic Hassall Training Institute and associate clinical professor of restorative and aesthetic dentistry at the University of Warwick. President of the British Academy of Aesthetic Restorative and Implant Dentistry, he is a GDC registered restorative, prosthodontic and periodontal specialist. Figure 3: Bio-Oss and a Bio-Gide membrane placed into the socket after extraction Figure 6: Provisional bridge with socket preservation materials and ovate pontic Figure 7: Final zirconia bridge post tooth whitening temporary bridge was constructed from the diagnostic wax up and clear matrix (Figures 4 and 5). Flowable composite was added to the pontic apically to form the subgingival area (Figure 6). During the four month healing period, whitening was undertaken and the final zirconia ovate pontic bridge constructed (Figure 7). The patient was delighted with the final result, which improved tooth symmetry and shade but also preserved the soft tissue architecture and papilla achieving an excellent emergence profile. Figure 1 Figure 3 Figure 2 Figure 2 Figure 2 Figure 2 Figure 2 Figure 5 Figure 4 Figure 6 Figure 7 ARE YOU LOOKING TO LEAVE THE NHS? We can help you evaluate your options for a pain-free transition Visit www.practiceplan.co.uk/nhs or call 01691 684120 to find out more. The UK’s number one provider of practice-branded Patient Membership Plans.
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Transcript of aesthetic zone after XLA article
interproximal papilla and the facial and palatal gingivae with slight positive pressure. The distance to the bone crest should be no less than 1-1.5mm and is determined by bone sounding with a periodontal probe.
Temporary conventional or implant bridges can be used to form ovate pontics, as can adhesive bridges or partial dentures.
Clinical caseThe patient attended with ageing anterior crowns and
a failing post crown UR1, which had suffered recurrent abcessess (Figures 1 and 2).
After considering the treatment otions the patient elected for a fixed bridge to replace the UR1 and a replacement crown UL2.
The tooth was atraumatically extracted preserving the buccal plate. Bio-Oss and a Bio-Gide membrane were placed into the socket (Figure 3).
An ovate pontic
Figure 2
61Dentistry www.dentistry.co.uk 1 September 2014
clinical
Dentists often face the challenge of replacing failing anterior teeth with conventional or implant supported bridgework, whilst trying to achieve optimum aesthetics. Important factors to consider are achieving gingival and tooth symmetry and a natural emergence profile.
In the aesthetic zone, particularly in patients with high smile lines, the ovate pontic is often the best aesthetic choice for maintaining facial gingival architecture and interdental papilla following extraction. It also prevents the passage of saliva and air, and so is more desirable from a phonetic aspect and, with correct design, its axial contours can deflect food. The ovate pontic design dates back as far as the 1930s, but its use only became popular when concerns it caused chronic gingival inflammation were discredited.
The ovate pontic design is often combined with alveolar ridge preservation techniques. The tooth/teeth are extracted taking care to minimise trauma to the alveolar bone. A material such as Bio-Oss is placed into the socket to the level and form of the alveolar crest to minimise resorption. A collagen-based material such as Bio-Gide is then placed over this and the subgingival ovate pontic immediatley placed.
My favoured design of ovate pontic would generally extend 1-2mm below the alveolar crest with a highly polished convex ‘egg shaped’ finish. It should support the
Figure 1: Patient presenting ageing anterior crownsFigure 2: Patient has a failing post crown UR1
Achieving excellence in the aesthetic zone after tooth extractionDominic Hassall presents the use of the ovate pontic and ridge preservation technique
Figures 4 and 5: Ovate pontic temporary bridge constructed from diagnostic wax up and matrix
Dominic Hassall BDS MSc (Manc) FDS RCPS (Glasg) MRD RCS (Edin) FDS (Rest Dent) RCS is the director of the Dominic Hassall Training Institute and associate clinical professor of restorative and aesthetic dentistry at the University of Warwick. President of the British Academy of Aesthetic Restorative and Implant Dentistry, he is a GDC registered restorative, prosthodontic and periodontal specialist.
Figure 3: Bio-Oss and a Bio-Gide membrane placed into the socket after extraction
Figure 6: Provisional bridge with socket preservation materials and ovate pontic
Figure 7: Final zirconia bridge post tooth whitening
temporary bridge was constructed from the diagnostic wax up and clear matrix (Figures 4 and 5). Flowable composite was added to the pontic apically to form the subgingival area (Figure 6).
During the four month healing period, whitening was undertaken and the final zirconia ovate pontic bridge constructed (Figure 7).
The patient was delighted with the final result, which improved tooth symmetry and shade but also preserved the soft tissue architecture and papilla achieving an excellent emergence profile.
Figure 1
Figure 3
Figure 2Figure 2Figure 2Figure 2Figure 2
Figure 5
Figure 4
Figure 6
Figure 7
ARE YOU LOOKING TO LEAVE THE NHS?We can help you evaluate your options for a pain-free transition
Visit www.practiceplan.co.uk/nhs or call 01691 684120 to find out more.The UK’s number one provider of practice-branded Patient Membership Plans.
G17771 PP14 Plan Adverts V2.indd 3 21/05/2014 09:13
