Dental Implants: Pontic Area

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Dr. Kaplowitz asks:
I have a patient where I am redoing a dental implant bridge in the mandibular anterior from 27 to 22. 

Her chief complaint was that when she said certain sounds, she spit between the pontic embrasures.  One of the problems is that there is a lot of vertical bone and soft tissue loss in the pontic area.  The case would be more aesthetic with a soft tissue graft.  One option I have considered is remaking the bridge but closing up the embrasures with pink porcelain. I would appreciate any thoughts on this and any other options others may suggest.

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6 Responses to “ Dental Implants: Pontic Area ”

• Dr.Ossama Ghorab May 2nd, 2006

  
  

  from my point of view , the way to solve this problem depends on patient age and the overall medical condition of the patient, if she`s old, doing the embrasure with pink porcelain is fine , if the case is young age, soft tissue graft could do well.

• Dr. R Mosery May 2nd, 2006

  
  

  If patient is spitting because embrasures are opened too wide why don’t you close these embrasures. Soft tissue grafting to correct a verical bone deficiency would only get you into a downward spiral of defeat, Ideally it would have been nice to work out these contour and embrasure issues in the temps. Once you get patient satisfied in acrylic where you could add. widen take away etc. then you have the lab duplicate the same parameters. If you’re redoing this case go through the motions with temps as described above.
  Pink porcelain looks like pink porcelain not healthy tissue and pts age has nothing to do with her concerns . If a pt is 22 or 92 if they’re unhappy with something I wouldn’t treat them differently if they were both healthy. Solve this patient’s problem with the same mindset don’t let their age cloud it up as it has for a prevous respondant to your question. Just because they’re old it wouldn’t mean that “pink porcelain ” would be ok for them but not ok if they were younger.

• Gary D. Kitzis, DMD May 3rd, 2006

  
  

  Pink porcelain done well, looks exactly like gingiva. Very often, pink porcelain is made too pale and it looks fake. Unless my patient has atypical pigmentation, I tell the ceramist to make it match his own gingiva, and that usually works very well. Photos are also helpful with gingival pigmentation. There are also pink gingival porcelain color tabs, which I recommend you purchase. If you are making a bridge from 22-27, and there is significant resorption, use the framework and pink porcelain rather than soft tissue grafts to close spaces. A flat gingival contour under a mandibular anterior bridge is much easier for the patient and dentist/hygienist to maintain cleanliness, and a smooth gingival contour is less likely to change over time than a group of created papillae that are subject to change over the long-term. Save your surgical and prosthetic talents (and frayed nerves) for those soft tissue and papilla regenerative procedures where they are really needed–the maxillary anterior in patients with a high lip-line.

• DR.M.ALI DDD.MS. May 3rd, 2006

  
  

  esthetic evaluation is needed for this case ,if teeth are showing during smiling and showing gingival tissue in the pontic areas it will be challenge to overcome this problem,most of pations are showing incisal one third to tow third of lower ant. teeth. if this is the case pink porcelain done by good lab to close the embrasures will do v. good,ridgelap pontic design is recommended as long as your implant restoration is reteivable for hygenic purpose,most of implant cases specially with a lot of bone loss will be restored with hybrid restorations when you replace teeth as well as bone and soft pink tissue(hybrid screw retained restoration).again clinical evaluation is needed,good luck. from DR.ALI

• Ira Langstein, DDS, FICOI May 5th, 2006

  
  

  Best thing to do is post a photo of the case, along with a good digital pa. There are many ways to rebuild the interdental tissue architecture. Much of this depends on the placement of the implant platforms in relation to the adjacent cejs.

• scott hamblin dds May 15th, 2006

  
  

  Dr Kitzis-can you give me some names of good labs that are giving you nice looking pink gingival porcelain? and where i can get gingival porcelain shades. I have acrylic gingival shades for “hybrid prosthesis”, but starts to stain and “smell” over the years. thanks soctt hamblin

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