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Authors : Dr. Shikha Rastogi , Dr. Rohan Hattarki.

ABSTRACT

AIM: The present article aims to provide a few yet simple steps which will be clinically helpful in placement of the pontic.

BACKGROUND: The healing period after implant placement is generally 3-4 months and the appearance of a gap from a missing tooth can be a concern, especially if it is in the display zone of a patient’s smile. If the treatment plan includes prosthetic replacement of the missing tooth rather than space closure, then space maintenance is also an issue.

TECHNIQUE: This article describes a clinically helpful technique for the placement of riding pontic.

CONCLUSION: The technique described here is simple, easy and inexpensive.

CLINICAL SIGNIFICANCE: Riding pontics are alternative cosmetic option which helps to improve esthetics and the smile during orthodontic treatment and contribute to the psychological well being of the patient of any age.

KEYWORDS: riding pontic, essix retainer, single tooth implant

INTRODUCTION

An expectation of a beautiful smile at the end of treatment is a primary concern for all patients, but most are also concerned with appearance while undergoing treatment. The anterior maxilla is often referred to as the aesthetic zone. Missing maxillary lateral incisors creates an aesthetic problem with specific orthodontic and prosthetic considerations, therefore treatment planning always poses a challenge to the clinicians.1

Treatment alternatives for missing teeth include removable partial dentures, conventional fixed bridges, resin bonded fixed bridges, autotransplantation and dental implants. Treatment of tooth loss or agenesis in the anterior maxilla with single-tooth implant supported crowns is well documented. Depending on the type of final restoration that is chosen, interdisciplinary management of these patients often plays a vital role in the facilitation of treatment. One of the most common treatment alternatives for the replacement of congenitally missing teeth is a single-tooth implant.2 The main advantage of this type of restoration is that it leaves the adjacent teeth intact.

The healing period after implant placement is generally 3-4 months and the appearance of a gap from a missing tooth can be a concern during healing phase, especially if it is in the display zone of a patient’s smile. If the treatment plan includes prosthetic replacement of the missing tooth rather than space closure, then space maintenance is also an issue.3 In an appearance conscious patient, use of riding pontics as space maintainers is a good option during treatment.

This article aims to provide simple steps which will be clinically helpful in placement of the riding pontic. A female patient aged 20 years with a missing upper right lateral incisor (Figure 1A and 1B) came to the department. The presence of stable posterior occlusion and good bone height and width favours replacement of tooth rather than attempting space closure. Hence, an implant supported prosthesis was decided for replacement.

Implant was loaded in the region of missing tooth under anaesthesia and post operative instructions were given. The healing period after implant placement was 3-4 months and the appearance of a gap from a missing tooth was a concern during healing phase, especially because patient had high aesthetic demands. So, an interim restoration was planned along with an Essix retainer.
 
Figure 1 A- intraoral frontal view of patient showing missing lateral incisor Figure 1 B- intraoral lateral view of patient showing missing lateral incisor


CLINICAL TECHNIQUE

The following are the steps for fabrication of riding pontics.
  1. Color matching- The color of the acrylic tooth was matched to the color of adjacent natural tooth.4

  2. Mesiodistal width determination – When a single anterior tooth is missing, mesiodistal width of the pontic should be determined by considering the width of the contralateral natural tooth. When teeth are missing bilaterally, the mesiodistal width of the pontic should be determined by analyzing the space available and the dimensions of the remaining natural teeth.4 so in this case, the mesiodistal width of the contralateral natural tooth was considered.

  3. Height determination- The cervical end of the pontic should touch the gingiva with a smooth contour. If the cervical end of the pontic does not touch to the gingiva, then the negative space between the pontic and the gingiva can affect the aesthetics, especially in high smile line patients. The incisal edge or cusp tip of the pontic should be in harmony with the adjacent natural tooth for maximum esthetics.4

  4. While selecting an acrylic tooth, mesiodistal dimension helps to determine harmony with adjacent teeth along with cusp tips and incisal edges. But height determination should also be based on interarch relationships with any interference cleared.5

  5. Trimming: While trimming not only the cervical portion but the whole gingival surface bucco-lingually should be contoured to the shape of the ridge. 5

  6. Once the selected acrylic tooth is ready, upper and lower impressions are made in alginate impression material and poured in dental stone.

  7. Then the selected acrylic tooth (riding pontic) is waxed up on the dental cast with the help of sticky wax. (Figure 2A and 2B)

  8. An Essix retainer is fabricated over the dental cast using vaccum formed thermoforming machine. (Figure 3)

  9. Patient with Essix retainer containing riding pontic on upper right lateral incisor. (Figure 4A and 4B)
 
Figure 2 A- maxillary dental cast occlusal view showing waxed up lateral incisor riding pontic Figure 2 B- maxillary dental cast lateral view showing waxed up lateral incisor riding pontic
 
Figure 3- maxillary dental cast showing Essix retainer with riding pontic Figure 4 A- intraoral frontal view of patient showing Essix retainer with riding pontic Figure 4 B- intraoral frontal view of patient showing Essix retainer with riding Pontic


CONCLUSION

These simple guidelines have allowed for the predictable treatment of many patients who would otherwise have had to wear their removable dentures during the healing period or even go without them during the initial postoperative period.

CLINICAL SIGNIFICANCE

Appliance modifications are being done to respond to the esthetic demands of present day patients in orthodontics. Riding pontics are alternative cosmetic option which helps to improve esthetics and the smile during orthodontic treatment and contribute to the psychological well being of the patient of any age.

REFERENCES
  1. Kokich VG. Maxillary lateral incisor implants: Planning with the aid of orthodontics. Int J Oral Maxillofac Surg 2004; 62: 48-56.
  2. Mitha M Shetty, Akshai KR Shetty, N Kalavathy, MR Dinesh, J Sridevi Restoration of congenitally missing lateral incisors with single stage implants: an interdisciplinary approach International Journal of Oral Implantology and Clinical Research, May-August 2011;2(2):111-115
  3. Sabri R. Management of missing maxillary lateral incisors. J Am Dent Assoc. 1999 Jan;130(1):80-4.
  4. Ashok kumar jena, BS Chandrashekhar, Ritu Duggal Riding pontic: Anesthetic aid in orthodontics. Orthodontic cyber j sep 2007
  5. Sarabjeet Singh, Navreet Sandhu, Rita Kashyap, Garima Gupta Clinical strategies and multiple functions of riding pontics: a tool to keep patients smiling Orthodontic cyber j sep 2011

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