Pontic design and localized ridge augmentation in fixed partial denture design.
The endpoint of fixed prosthesis design is an esthetic and functional pontic that is compatible with soft-tissue health. In the posterior segment, where esthetics is not as critical, a sanitary pontic form is most compatible with function and hygiene. In the maxillary anterior region, a properly contoured modified ridge-lap pontic design constructed of glazed porcelain most readily fulfills both the esthetic and physiologic requirements. Although the ovate pontic form may satisfy esthetic demands to a greater degree, this is often at the expense of underlying soft-tissue health. In maxillary edentulous regions, ridge deformities may preclude a good pontic fit and esthetic result and dictate the need for surgical augmentation of the collapsed ridge. Selection of the appropriate surgical procedure and graft material depends on the nature and extent of the defect and availability of donor tissue. The subepithelial graft employing the tunnel approach is appropriate when augmentation in only a labial dimension is necessary. When the employing the trapdoor approach or full thickness gingival onlay graft may be employed. In large defects, sequential grafting procedures may be necessary to achieve the desired result. An esthetic and functional result can be attained through proper execution of an appropriate surgical technique and adherence to the principles of proper pontic design.