Pontic Site Development Research Articles

Pontic Site Development using Soft-tissue Augmentation with Connective Tissue Graft in Maxillary Anterior Region: A Case Report

Pontic Site Development using Soft-tissue Augmentation with Connective Tissue Graft in Maxillary Anterior Region: A Case Report

Two and a Half Years Follow of the Pontic Site Development with Root Submergence Technique: A Case Report

A soft tissue drape that is formed around the tooth, as it emerges from the bone, has both aesthetic and functional significance. Post-extraction soft and hard tissue changes are inevitable and it leads to a buccal concavity. The pontics for tooth or implant supported fixed partial denture in such cases appear longer. Preservation of a part of root preserves the periodontal apparatus and hence facilitates the optimal region for the pontic site development. This case report describes root submergence technique for pontic site development in maxillary anterior tooth-supported FPD with a follow up of two and a half years.

Clinical Comparison of the Volumetric Changes in Single Pontic Site Development through Connective Tissue Grafting Using Modified Pouch Technique versus Pouch Technique in the Maxillary Esthetic Zone: A Randomized Controlled Clinical Trial.

The aim is to compare the volumetric changes between pouch technique versus the modified pouch technique in pontic site development using connective tissue graft in patients that have Seibert class I ridge defects in the maxillary esthetic zone. Methodology. This randomized, controlled, double-blinded, parallel-grouped clinical trial included sixteen patients with a single pontic site in the maxillary esthetic area presenting Seibert Class I ridge defects. Patients were randomly assigned into two equal groups: test group (n: 8) received soft tissue augmentation with connective tissue graft using the modified pouch technique and control group (n: 8) received soft tissue augmentation with connective tissue graft using pouch technique. The volumetric evaluation was carried out by taking impressions at baseline, 3 and 6 months after the surgery. Keratinized tissue thickness was also measured at baseline, 3 and 6 months after the surgery. Visual analogue scale (VAS) was recorded by the patients at day 3, day 7, and day 14 after the surgery. The test group had more increase in soft tissue volume than the control group at baseline, 3 months, and 6 months. The keratinized tissue width at baseline in the test group had a higher value than that of the control group. At 3 months, both groups had the same mean value, while at 6 months, the test group had a higher value than the control group. Regarding postoperative pain, the visual analogue scale shown at day 3 in the test group had a higher value than that of the control group, while at day 7, the control group had a higher value than the test group. At day 14, both groups had the same mean value. Soft tissue augmentation using both the traditional pouch technique and the modified pouch technique led to successful soft tissue volume augmentation in pontic site development in Seibert Class I ridge defects with no statistically significant difference between the two techniques.

Pontic site development for fixed dental prostheses with and without soft tissue grafting: 1-year results of a cohort study

AimTo describe and compare the pontic site development for fixed-dental prostheses (FDPs) with and without soft tissue grafting up to one-year post insertion of FDPs.Materials and methodsA convenience sample of 24 patients participating in an ongoing RCT was provided with three-unit tooth-borne FDPs. Six patients received a subepithelial connective tissue graft (SCTG) at the pontic site, whereas 18 patients were treated without any soft tissue graft (CONTROL). Digital impressions were taken prior to tooth preparation, after tooth preparation, after insertion of the final FDP, and at the 1 year of follow-up. The obtained stereolithography files (STL) were superimposed and profilometric as well as linear changes of the soft tissue profile were assessed at the pontic regions. Profilometric outcomes included changes of the ridge contour, the alveolar ridge width, and the crown height of the pontic. Further outcomes assessed included: the papilla index, the pink esthetic score (PES), probing depth (PD), bleeding on probing (BOP), and plaque control record (PCR). Descriptive and nonparametric statistics were applied for all outcome measures.ResultsThe median profilometric contour between tooth preparation and 1 year after the insertion of the final FDP decreased by − 0.25 mm [Q1, Q3: − 0.36, 0.14] in the CONTROL group and increased by 0.61 mm [Q1, Q3: − 0.18, 1.06] in the SCTG group (intergroup p = 0.038). The alveolar ridge width between prior to tooth preparation and the one-year follow-up amounted to − 0.12 mm [Q1, Q3: − 0.74, 0.70] (= loss) in the CONTROL group and to 2.23 mm [Q1, Q3: 0.62, 3.86] (= gain) in the SCTG group (intergroup p = 0.032). At one year, the median crown height of the pontic tended to decrease by − 1.24 mm [Q1, Q3: − 2.05, − 1.05] in the SCTG group (intragroup p = 0.094) and by − 0.22 mm [Q1, Q3: − 0.58, 0.66] in the CONTROL group (intragroup p = 0.831), with significant differences between the groups (intergroup p = 0.022). The papilla index between prior to tooth preparation and one year of follow-up improved significantly in both groups (p < 0.05). Between FDP delivery and one year of follow-up, the PES values decreased significantly in the CONTROL group (intragroup p = 0.007), while in the SCTG group the change was not significant (intragroup p = 0.875). Clinical parameters (PD, BOP, and PCR) remained stable over time and did not differ between the groups at any time point (intergroup p > 0.05).ConclusionWithin the limitations of the present study, soft tissue grafting tends to limit contour changes at pontic sites, thus maintaining the esthetic outcomes over time. The lack of soft tissue grafting results in stable clinical outcomes; however, it may lead to a decrease in aesthetic outcomes over time.Clinical relevanceAutogenous soft tissue grafting seems to be a valid therapeutic option for the development of the pontic site to restore ridge defects prior to the delivery of fixed dental prostheses and to limit dimensional changes over time.

Use of a Rotational Flap with Soft Tissue Graft and Tunneling Technique for Ovate Pontic Site Development for a Highly Esthetic Outcome: A Case Report

The objective of therapy was to replace the missing teeth with a restoration that closely adhered to the natural teeth and soft tissue contour to provide an esthetic outcome. A 19-year-old male reported a failed fixed partial denture (FPD) in the maxillary left central incisor. The abutment extended to the maxillary right central incisor and the maxillary left lateral incisor. Radiographic examination revealed that the neighboring maxillary right central incisor abutment was nonrestorable. The treatment plan was the extraction of the maxillary right central incisor with socket preservation, modification of the pontic sites for placement of an ovate pontic for the replacement of the missing maxillary upper central incisors with an FPD with the maxillary lateral incisors serving as the abutment teeth. The pontic sites were corrected with a U-shaped flap extended 5 mm palatal from the mid-crestal line. The incision was avoided at the interdental papilla area. The facial flap was elevated. The facial soft tissue was vertically tunneled. The flap was flipped into the facial tunnel and stabilized with horizontal nylon matrix sutures. The surgical site was stabilized with a provisional FPD with an ovate pontic. The final restoration was a full zirconia facial veneered FPD. Surgical site showed significant healing with a natural emergence profile, and interdental papillae filling the gingival embrasure, showing no evidence of recession. At the 1-year follow-up, the gingival thickness improved and the pontic emergence profile was natural. A very stable result for soft tissue volume and interdental papillae were seen. According to the result obtained with rotational flap, it can be used for small anterior defects with promising results, without the need for bone graft procedures or additional tissue graft. With proper case selection, the use of a rotational flap with a tunnel technique and an ovate pontic in the anterior esthetic region is an alternative treatment option that can successfully restore masticatory and esthetic function.

Pontic site development by modified vascularized interpositional periosteal-connective tissue graft: A case series

Pontic site development by modified vascularized interpositional periosteal-connective tissue graft: A case series

Pontic site development with an implant submergence technique for unaesthetic implant in the anterior maxilla

Pontic site development with an implant submergence technique for unaesthetic implant in the anterior maxilla

PC136: Pontic site development in the anterior maxilla with a de‐epithelialized free gingival graft using a modified connective tissue platform technique

PC136: Pontic site development in the anterior maxilla with a de‐epithelialized free gingival graft using a modified connective tissue platform technique

Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery.

Diverse clinical advancements, together with some relevant technical innovations, have led to an increase in popularity of tunneling flap procedures in plastic periodontal and implant surgery in the recent past. This trend is further promoted by the fact that these techniques have lately been introduced to a considerably expanded range of indications. While originally described for the treatment of gingival recession-type defects, tunneling flap procedures may now be applied successfully in a variety of clinical situations in which augmentation of the soft tissues is indicated in the esthetic zone. Potential clinical scenarios include surgical thickening of thin buccal gingiva or peri-implant mucosa, alveolar ridge/socket preservation and implant second-stage surgery, as well as soft-tissue ridge augmentation or pontic site development. In this way, tunneling flap procedures developed from a technique, originally merely intended for surgical root coverage, into a capacious surgical conception in plastic periodontal and implant surgery. The purpose of this article is to provide a comprehensive overview on tunneling flap procedures, to introduce the successive development of the approach along with underlying ideas on surgical wound healing and to present contemporary clinical scenarios in step-by-step photograph-illustrated sequences, which aim to provide clinicians with guidance to help them integrate tunneling flap procedures into their daily clinical routine.

The Pontic-Shield: Partial Extraction Therapy for Ridge Preservation and Pontic Site Development.

Augmentive ridge preservation techniques aim to manage the postextraction ridge. The partial extraction of teeth may better preserve the ridge form by maintaining the bundle bone-periodontal ligament apparatus. Root submergence has been demonstrated to retain the periodontal tissues and preserve the ridge beneath dentures or fixed prostheses. The socket-shield technique entails preparing a tooth root section simultaneous to immediate implant placement and has demonstrated histologic and clinical results contributory to esthetic implant treatment. A retrospective 10-patient case series treating 14 partial extraction sites demonstrates how a modification of the socket-shield technique can successfully develop pontic sites and preserve the ridge.

A root submergence technique for pontic site development in fixed dental prostheses in the maxillary anterior esthetic zone

This case report discusses the effect of a root submergence technique on preserving the periodontal tissue at the pontic site of fixed dental prostheses in the maxillary anterior aesthetic zone. Teeth with less than ideal structural support for fixed retainer abutments were decoronated at the crestal bone level. After soft tissue closure, the final fixed dental prostheses were placed with the pontics over the submerged root area. Radiographic and clinical observations at the pontic sites were documented. The submerged roots at the pontic sites preserved the surrounding periodontium without any periapical pathology. The gingival contour at the pontic site was maintained in harmony with those of the adjacent teeth, as well as the overall form of the arch. The results of this clinical report indicate that a root submergence technique can be successfully applied in pontic site development with fixed dental prostheses, especially in the maxillary anterior esthetic zone.

Efficiently Plumping the Deficient! Pontic Site Development

ABSTRACTReplacing a missing tooth in a maxillary anterior esthetic zone displaying a Seibert's class III ridge defect is a big challenge in the field of perioesthetics. In order to achieve maximum esthetics, form and function, an ideal pontic should have a natural emergence profile and support the labial soft tissue as well as the adjacent papillae. This is of paramount importance, especially if the patient has a high smile line. Augmentation protocols differ based on the treatment plan for implants or fixed prosthesis. The most popular techniques for soft tissue ridge augmentation for Seibert's Class III ridge defects include the roll technique, the wedge technique and the pouch technique among others. This article presents a case of an 18-year-old female patient with a challenging Seibert's Class III ridge defect treated for pontic site development using a combination of the pouch and the roll technique followed by a fixed prosthesis with ovate pontics.How to cite this articleRathod AA, Padhye AM, Ram S, Chandavarkar S. Efficiently Plumping the Deficient! Pontic Site Development. J Contemp Dent 2014;4(3):173-177.

Pontic site development with a root submergence technique for a screw-retained prosthesis in the anterior maxilla

Techniques for pontic site development usually involve various hard and soft tissue augmentation procedures. This article describes an alternative approach to developing a pontic site by using a root submergence technique for a screw-retained fixed dental prosthesis in the anterior maxilla.

Pontic site development and soft tissue transfer of the esthetic area: a case report

Soft tissue collapse around prepared teeth and pontic is inevitable after removal of the provisional restoration during the impression taking procedures. When inserting gingival retraction cord, soft tissue is displaced to an undesired contour. Viscosity of impression material also causes gingival displacement. Therefore, the consideration to transfer the prosthetically contoured soft tissue to master cast is required, especially in the esthetic area. In this report, the methods to maintain the soft tissue contour and transfer to the mastercast will be introduced. Harmonious contour of the soft tissue can be achieved with provisional restoration and be transferred to the master cast with two different techniques mentioned in this case report. (J Korean Acad Prosthodont 2013;51:323-31)

Implementing Socket Seal Surgery as a Socket Preservation Technique for Pontic Site Development: Surgical Steps Revisited – A Report of Two Cases

Tooth removal is always followed by the loss of vital soft and hard tissues. When occurring in the anterior region of the maxilla, the resulting ridge deformation may cause severe functional and esthetic problems. Diverse soft and hard tissue regenerative procedures have been developed for correcting ridge defects with the aim of establishing functional and esthetically pleasing pontic or implant restoration sites. However, these technically demanding procedures may be regarded as non-predictable in the hands of most clinicians. To reduce the need for restoring challenging ridge defects, an alternative exists in the form of a simple, minimally invasive socket-preservation procedure immediately following tooth extraction known as socket seal surgery. This article describes the currently improved surgical steps to be implemented with the objective of achieving a functional and esthetically acceptable pontic site. Immediately following tooth extraction, the socket bony walls are debrided and decorticated, and the soft tissue walls are de-epithelialized by a coarse round diamond bur. The socket is filled with particles of a slowly resorbing bone substitute material except for 2 to 3 mm coronally. A cylindrically shaped soft tissue graft that matches the socket orifice contours is harvested from the palatal mucosa and placed atop the bone graft. The soft tissue graft is usually stabilized with six to eight simple interrupted 6-0 monofilament polyamide or 7-0 polypropylene sutures or, when the case allows, by a broad-based pontic restoration that is placed at a minimal distance from the graft. Two cases, each representing a different technique for stabilizing the soft tissue graft, demonstrate successful graft survival. Clinically and radiographically, successful regeneration of the ridge's hard and soft tissues, including the ability to develop functional and esthetically acceptable pontic sites, was demonstrated. Socket seal surgery is an efficacious procedure for ridge preservation and is effective in providing the necessary conditions for the development of functional and esthetic pontic sites.