ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Ovate Pontics Shape the Soft Tissue Emergence Profile of Anterior Extraction Sites
Clinical Question In adult patients, is the use of an ovate pontic immediately after extraction of an anterior tooth superior to no pontic/other pontic designs to shape soft tissue at an anterior extraction site to gain a favorable emergence profile and an esthetic result?
Clinical Bottom Line Although there is limited systematic evidence available to validate the use of ovate pontics in fixed partial dentures (FPDs) to shape the emergence profile of anterior extraction sites, the ovate pontic is the most appropriate design to achieve a highly esthetic and natural soft tissue result.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 12553617Edelhoff/2002Patients with replacement of missing tooth via fixed partial denture with various pontic designsNarrative Review
Key resultsThe use of an ovate pontic to shape soft tissue immediately following an atraumatic extraction resulted in an esthetic concave recipient site of the edentulous ridge in rats. This technique was suggested for use in humans to enhance the anterior esthetic appearance of FPDs. Certain measures, such as grafting, can be taken following extraction to achieve a more favorable esthetic result. Additionally, the pontic design must be designed to carefully exert pressure on the ridge in order to shape soft tissue without eliciting a biological response from the tissue.
#2) 26265806Guruprasada/201542-year-old male with non-restorable #9 indicated for extraction followed by replacement of FPD 8x10.Case Report
Key resultsOvate pontics are a favorable pontic design for anterior teeth in the esthetic zone due to their ability to create an illusion of a free gingival margin and interdental papilla to diminish black triangles. However, success in achieving an esthetic result is technique sensitive, timely, and relies on good patient oral hygiene.
Evidence Search ("review"[Publication Type] OR "review literature as topic"[MeSH Terms] OR "review"[All Fields]) AND ("esthetics"[MeSH Terms] OR "esthetics"[All Fields] OR "esthetic"[All Fields]) AND ("denture, partial, fixed"[MeSH Terms] OR ("denture"[All Fields] AND "partial"[All Fields] AND "fixed"[All Fields]) OR "fixed partial denture"[All Fields] OR "pontic"[All Fields]) AND design[All Fields] AND ("Options Policy Pract"[Journal] OR "options"[All Fields]) Ovate[All Fields] AND ("denture, partial, fixed"[MeSH Terms] OR ("denture"[All Fields] AND "partial"[All Fields] AND "fixed"[All Fields]) OR "fixed partial denture"[All Fields] OR "pontic"[All Fields]) AND anterior[All Fields] AND ("denture, partial, fixed"[MeSH Terms] OR ("denture"[All Fields] AND "partial"[All Fields] AND "fixed"[All Fields]) OR "fixed partial denture"[All Fields] OR ("fixed"[All Fields] AND "partial"[All Fields] AND "denture"[All Fields]))
Comments on
The Evidence
The article by Edelhoff is a narrative review of a variety of pontic designs, uses, and esthetics. A narrative review is considered a modest quality for evidence, but is not nearly as strong as a systematic review/meta analysis. The article specifically discusses the use of pontics in the anterior region, especially when esthetics is of concern. The article mentions that there is insignificant scientific data presented to suggest the long-term stability of preconditioned soft tissues. It discusses the benefits of using ovate pontics in anterior esthetic zones to create a favorable emergence profile in comparison to other pontic designs, but states that this evidence is mostly based on case studies. The article by Guruprasada is a case report that studies only one individual and recounts his journey to achieve an esthetic soft tissue profile through the use of an ovate pontic. A case report is low quality evidence, but it does support the fact that ovate pontics can be used in the anterior region following an extraction to achieve a natural emergence profile. However, this patient was not studied over time so the stability of the soft tissues is unknown.
Applicability The evidence presented is applicable to my patient because it encourages the use of an ovate pontic FPD design to enhance soft tissue esthetics in the anterior region. The subjects presented in the evidence are representative of my patient and lead to a desirable outcome. The technique proposed by the evidence is achievable in the clinic setting.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Prosthodontics)
Keywords Ovate pontics, esthetics, anterior esthetic zone, fixed partial denture, emergence profile
ID# 3134
Date of submission: 03/06/2017spacer
E-mail parksw@livemail.uthscsa.edu
Author Wendi Parks
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Shannon Roberts, DDS
Faculty mentor/Co-author e-mail dobelbower@uthscsa.edu
Basic Science Rationale
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