The ovate pontic was first discussed in 1933, but didn’t become a popular design until many years later. The obvious advantages of an ovate pontic are esthetic. The creation of a concave tissue profile and a convex pontic allow the illusion of emergence profile an root form where none exists. Pontics are ideally designed to be passive against the tissue. Ovate pontics in contrast require a larger contact area with the tissue and light pressure to form the tissue and papilla and create the appropriate gingival esthetics. Another consideration is that ovate pontics require an adequate thickness of tissue and width of the ridge. Achieving this may necessitate a surgical augmentation. Even with these challenges I opt for an ovate design anytime I can, and find that my patients do not resist the idea of surgical augmentation in order to create a more esthetic result.
My preference is to create the ovate pontic site myself and utilize the provisional to help guide the tissue as it matures. Much like with implant esthetics we have some measure of control of papilla form and height and labial gingival position as a result of the shape of the provisional under the tissue.
Ideally I want a 1mm base of tissue under the provisional and over the ridge. I aim for the base of the pontic to be 3mm from the free gingival margin on the labial, if I have less depth my ability to alter tissue profile diminishes. With the patient anesthetized you can sound to bone over the pontic site to determine if we have adequate tissue thickness.
For many years I create my ovate pontic sites with a round diamond in a high speed handpiece. Today I do this with my Deka CO2 laser. The process results in minimal to no bleeding allowing ease of temporary cementation, quick healing and very little post operative discomfort for the patient. I take an impression of the site and prepare the ovate pntic site on a model first. I then fabricate the provisional indirectly, or add to an existing temporary to create the ovate pontic on the model. With the provisional in hand I go to the mouth and begin to remove the tissue for the pontic. I reseat the provisional and continue to remove tissue until i no longer have blanching. Now I can cement the provisional, and allow the appropriate 6-12 weeks for healing and tissue maturation before final impressions.
Chris Vanderpool says
So ideally you need 4mm of tissue (1mm left between base of pontic and bone + 3mm from base of pontic to gingival margin) prior to sculpting your ovate pontic space? If you have less than this, I’m assuming you must remove some alveolar bone?