An original procedure for ovoid pontic technique in ortho-restorative cases

Objectives: In the multidisciplinary treatments, especially in case of missing teeth in aesthetic area, the compliance of patient during retention time post orthodontic therapy is evidently very high, even among teen patients, in particular when we adopt clear retainers comprising absent teeth. The purpose of this paper is to show an original use of the ovoid pontic technique associated with retainers to model soft tissues and achieve an ideal emergence profile around pontic to give the illusion of a natural gingival margin around prosthodontic restoration.
Material and methods: The ovoid pontic technique is a procedure developed to adapt the gingiva to the prosthodontic bridge element as naturally as possible.
The authors presented two clinical cases in which two different methods were utilized to perform ovoid pontic technique during retention time:
1. by means of the analogic technique, using a thermoformed 1.5mm thick PETG Essix;
2. by means of digital workflow, using a Vivera® retainer (Align Technology, San Josè, CA, USA).
The objective of the ovoid pontic technique is not only to achieve the ideal emergence profile around prosthodontic restorations but overall to avoid a traumatic second surgery to implement soft tissues. For this purpose is strategic to select patients with thick gingival tissues for obtaining best final results. A minimum thickness of 3 to 5 mm of soft tissue is required from the gingival crest to the alveolar ridge.
In both procedures, the pontic was gradually increased by using a light-cured biocompatible fluid composite to determine increasing pressure over the gingival tissue, modeling the edentulous area and finally leading to a natural look of the prosthodontic restoration. Then, a gradual and controlled hyperpressure can transform an unfavorable tissue configuration. There is also a possibility of closing undesirable interdental ‘black holes’ through papilla ‘formation’, by pressuring the gingival tissues.
Conclusions: The proposed method allows to manage gingival tissues during retention time, which is usually a passive phase of the orthodontic therapy, accelerating the treatment for the final restorative phase and improving the esthetic outcome. In conclusion, according to the thermoformed retainer based ovoid pontic technique, orthodontists can manage gingival tissues on their own before referring the patient to a restorative dentistry specialist.
Clinical significance: This paper presents an original way of managing the ovoid pontic technique during the
orthodontic retention time to accelerate the following restorative phase, allowing to take advantage from a passive treatment stage while conditioning soft tissues and thus limiting the aesthetic discomfort for the patient.