Prosthodontics
A hygienic multiple-pontic design
Gabriel R. Zuckermati^
Abstract Fixed partial dentures should be designed fur function, estlietics. and easy
maintenance. The gingivohngual embrasures between multiple adjacent pontics
are unnecessary for function and esthetics and create crevices where food, plaque,
and calculus can accumulate. These spaces make oral hygiene procedures more
difficultfor the patient and the dentist to accomplish A hygienic design for multiple
pontics is suggested that ehminates these unnecessary embrasures and still displays
an anatomically realistic, cosmetically acceptabie facade.
(Quintessence Int 1997:28:259-262.)
Clinical relevance overcome these problems. When an FPD has multiple,
adjacent pontics, maintenance of good oral hygiene
A design that eliminates the unnecessary linguo- becomes more important and more difficult. Beh-
gingival embrasures between adjacent pontics is rend^''" suggested the use of "fused" multiple pontics
suggested to promote oral hygiene and facilitate oral as early as 1977. Porter" described a similar pontic
hygiene procedures. design in 1984. These designs overcome the problems
associated with oral hygiene maintenanee but ean be
cosmetically objectionable if the patient displays the
gingival third of these teelh during funetion. Tjan'-
described a sanitar>' "arc-fixed partial denture"' that
iDtroduction
had a large open space beneath the pontics as a
Repom'"^ ofthe undesirable changes in the tissues solution for maintenance of oral hygiene. This design
under and around the pontics of fixed partial dentures is effective for sanitary purposes but is unsuitable for
(FPDs) have appeared in the literature. These changes pontics that are visible during fLinction. Since 19S4,
are described as inflammatory. Histologie studies by the subject of pontic design has received little attention
Waerung* and König and Muhlemann' concluded ihat in the dental literature.
the accumulation of bacterial plaque on the surface of The mandibular incisors are prone to heavy calculus
the prosthesis in contact with the tissue is responsible and plaque deposits and are frequently crowded
for this inflammatory reaction. This information because of insufficient arch space. These teeth are
prompted Gade'* to recommend that fixed restorations often lost prematurely as a result of periodontal
be designed to be as self-cleansing as possible and disease. An FPD, with the canines as abutments, is
easily cleaned by the patient. often used to replace these teeth. This prosthesis must
The diSiculties associated with maintaining ade- be designed to diseourage accumulation of calculus
quate oral hygiene around and beneath an FPD have and plaque and to create the most favorable conditions
been recognized and addressed previously. In 1966. for the removal of these undesirable accretions,
Stein' suggested a modified single-pontic design to particularly around the abutment teeth. If the prosthe-
sis is made with gingival embrasures between the
pontics. these crevices will encourage the accumula-
* Privale Practice, Easl Northporl. New York. tion of food, calculus, and plaque. The patient and the
Reprint requesls: Dr Gabriel R. Zuckerman, 1199 I-"iñt: Avenue, Easl dentist will find these areas hard to clean.
Northporl, New York 11731.
Quintessence International Voiume 28, Number 4/1997 259
Fig 1 Facial view ol the FPD. Line A-A indicates the Fig 2 Facial view of the prosthesis with the porcelain
location of the horizonial seclion of the prosthesis shown in removed to reveal the metal framework. Open gingival
Fig 4. Lines B-B and C-C indicate the location ot the vertical embrasure (1); webbed labiogingival embrasures (2)
sections through the pontic illustrated in Fig 5.
Meial surfaces 10 which porcelain will be lused
Polished melal surfaces
Fig 3 Lingual view ot the FPD with porcelain removed to Fig 4 Horizontal section through tfie prosthesis at line A-A
expose the metal tramework Open gingival embrasure (1), (see Fig 1), Open gingival embrasure (1); webbed labiogin-
porcelain-metal finishing line (3). givai embrasures (2).
Design and materials the lingtiogingival embrasures between adjacent pon-
A hygienic multiple-pontic design that does not affect tics (Figs 3 and 4), and wide embrasures between the
the esthetics ofthe FPD is proposed (Fig I ). Ahhough pontics and the retainers. These open embrastires
most of the features of this design are not new, the facilitate the introduction of oral hygiene devices for
concept is worthy of reconsideration because newer plaque removal around the abutment teeth and under
materials and technology have become available for the pontics. The pontics are formed with a well
construction of FPDs. The increased use of nonpre- rounded linguogingival line angle (Fig 5). The gingival-
cious metals for porcelain-fused-to-metal restoration facing sutface ofthe pontics makes light contact with
make this design more economically attractive. This the crest and anterior slope ofthe ridge and is highly
design is particulariy well suited for long-span FPDs polished to reduce plaque and calculus accumulation
because the metal casting is extremely rigid. and sitnplify oral hygiene procedures. Figures 6 to 8
The significant features of this FPD design are illustrate an FPD with these features. The shallow,
incompletely developed labiogingival embrasures be- web-shaped labiogingival embrasures create shadows
tween adjacent pontics (Figs 2 and 4), elimination of that define the facial contour ofthe individual pontici
260 Quintessence International Volurne 28, Number 4/199''
Fig 5 \fertical sections through the pontic at lines B-B and Fig 6 Lingual view of a porcelain-fused-to-metal FPD with
C-C (see Fig 1). Porcelain-metal finishing line (3|; rounded canine retainers and a four-unit hygienic ponlic.
linguogingival line angle (4).
Fig 7 Facial view ol the prosthesis shown in Fig 6 Fig 8 Inlraoral view of the FPD shown in Figs 6 and 7
without producing deep crevices that would collect another. The author has been placing FPDs of this
food and plaque and be difficult for the patient to design successfully for more than !5 years. With
elean. elimination ofthe gingivolingual embrasures between
When the available edentulous arch space is insutfi- pontics, the prosthesis collects less food, calculus, and
cient to accommodate four well-proportioned mandib- plaque and is more easily maintained by the patient and
ular incisor pontics, it is advisable to design the the dentist. The modified labiogingival embrasure
prosthesis with three pontics. This modification, when between pontics is cosmetically acceptable in a maxil-
appropriately applied, is more estheticaliy acceptable lary prosthesis for patients with a high lip line.
than four diminutive incisor pontics.
References
Discussion I AlliMin JR, Bhalia HL Tissue cliün|zei under acrylic and porcelain
ponlies. J Dtnt Res l958;J7:66-67.
This hygienic design concept can be used with any -> Cavazos E. Tissue response lo fi\ecl partial demure ponlics. J
FPD in which two or more pontics are adjacent to one ProsUielDent t968;20:M3-l53.
261
Quintessence International Volume 28, Number 4/1997
Zuckemian
í. Podshiidki A t l . viil response lo politics. J Priistln:! Dcnl
4. Hctirv PJ, iolinsloti JF, Miteliell DP. Tissue clinnges benealti fixed
panial deiilurcs. J Prostliel Dem 1966:16:937-947.
5. Slein RS. Pomie-residuiil ridge relaliunship; A research rcporl. J
Proslhel Dem I966J6:Í51-2K5.
b. WaetungJ.EIÏeelurrouBhsurfai l lissues. J Dent Rci
7. König KG. Mlihlum:mn UR. Allcraliuns in ral ^mgivae due tu
plaque aeeiimuialions. Hciv Odonlol Acta \9i9:l:A4.
8. Gade E. Hygienic problems of Qxed resioratiuns. Inl Dent J
9. Bdireiîd DA. The mandibular fued partiul demure. ¡ Prosihet Dent
1977:37:622.
iO. Bdirend DA. The design or multiple piintics. J Prosthei Dent
Porter CB. Anlerior pomic design: A logical proprcssion. J Proslhel
Dem 1984:51:774-776.
12. Tjan AH. A sanita .-ri.\ed partial demure ' ) Pnisthei Dem
1983;50:33S-34l. Minimally Invasive
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