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Rahul C S et al: Orthodontic Pontics
CASE REPORT
Orthodontic Pontics: Smile ‘Through’ the Path
to Beauty
C. S. Rahul1, Binu Purushothaman2, Rasool Karim Nizaro Siyo3, Naseem K T4, Sreesan5
1- Postgraduate Student, Department Of Orthodontics, K.M.C.T Dental College, Calicut,
Kerala. 2- Professor and Head, Department Of Orthodontics, K.M.C.T Dental College,
Calicut, Kerala. 3-Professor, K.M.C.T Dental College, Calicut, Kerala. 4- Reader, K.M.C.T
Dental College, Calicut, Kerala. 5- Senior Lecturer, K.M.C.T Dental College, Calicut, Kerala.
Correspondence to:
Dr. C. S. Rahul, Postgraduate Student,
Department Of Orthodontics, K.M.C.T Dental
College, Calicut, Kerala.
Contact Us: www.ijohmr.com
ABSTRACT
In an era in which adults seeking orthodontic treatment are on the rise, aesthetic treatment is a prerogative. Realization
of an attractive smile after culmination of orthodontic treatment is the aspiration of all patients, but many of them
display concern regarding their smile during treatment. The presence or appearance of a large edentulous space due to a
missing or impacted tooth can be demoralizing to the patient, especially if it affects the smile. Maintenance of space
during fixed orthodontic treatment is also of prime importance if the prosthetic replacement of the missing tooth is
planned. In an appearance conscious patient use of orthodontic pontics as space maintainers is a good option during
treatment. This article tries to showcase the advantages of an orthodontic pontic, the method of placement of the same
with the help of case reports.
KEYWORDS: Adult orthodontics, pontics, aesthetics
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INTRODUCTION
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All patients expect a beautiful smile at the end of
orthodontic treatment, but most are also concerned with
their appearance while undergoing treatment. Smaller
brackets, lingual or “invisible” brackets, self ligating
brackets, aesthetic archwire, plastic brackets and
translucent ceramic brackets1 are all modifications of the
original fixed orthodontic appliance made by different
manufacturers to cater this demand of patients.
In an era in which adults seeking orthodontic treatment
are on the rise, aesthetic treatment is a prerogative. It is
not very unusual for a patient with orthodontic treatment
needs, to have missing anterior teeth2. In some patients,
extraction of an anterior tooth with poor prognosis would
have been carried out even before the commencement of
orthodontic treatment. Some of these cases can be
managed by orthodontic space closure alone. However in
others, replacement of missing teeth with prosthesis may
be necessary. In such clinical scenarios, pre-prosthetic
orthodontic treatment is mandatory to aid in restorative
treatment by repositioning the teeth for the optimal
aesthetic and functional results. It is important to
maintain the aesthetics of these individuals undergoing
fixed orthodontic treatment. Orthodontic pontics3 provide
a quick fix solution for these patients.
CASE REPORT
ORTHODONTIC PONTICS: Orthodontic pontics are
acrylic teeth used as temporary prostheses during fixed
appliance treatment in patients with missing teeth in the
smile zone. It can be used in space of any missing teeth.
It is particularly useful when multiple or bilateral anterior
teeth are missing.
Fabrication3, 4: The following are the steps for fabrication
of orthodontic pontics.
1. Colour matching- The colour of the acrylic tooth
ought to be matching to the colour of adjacent
natural tooth.
2. Mesiodistal width determination – When only a
single anterior tooth is missing, mesio-distal
dimension of the pontic can be determined by taking
into account, the width of the contra-lateral natural
tooth. In cases were teeth are bilaterally missing, the
mesiodistal dimension of the pontic should be
determined by considering the space available and
the dimensions of the remaining natural teeth.
3. Occluso-gingival height determination- The gingival
end of the pontic should contact the soft tissue along
a smooth contour. Failure of the pontic to touch the
gingival margin results in a negative space between
the pontic and the gingiva which hampers the
aesthetics, especially in patients with a high smile
line. The incisal edge/tip of the pontic should be in
concordance with the adjacent natural tooth for
optimal aesthetics.
4. Trimming: While trimming not only the cervical
portion but the whole gingival surface buccolingually should be contoured to the shape of the
ridge. This can help prevent rotational movement of
the pontic on round archwires.
5. Accurate bracket positioning: Mark the incisal
margin of the bracket on the acrylic tooth by ligating
the unbonded bracket to the archwire in place in the
mouth. This step is done chair side after the required
trimming.
6. Bonding the bracket on the acrylic tooth
How to cite this article:
Rahul CS, Purushothaman B, Siyo RN, Naseem KT. Orthodontic Pontics: Smile ‘Through’ Path to Beauty. Int J Oral Health Med Res 2016;2(5):109-111.
International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2016 | VOL 2 | ISSUE 5
109
CASE REPORT
Rahul C S et al: Orthodontic Pontics
7.
8.
Try in- The pontic should be held in the edentulous
space with an instrument before ligation to examine
the eventual result. Final trimming/reshaping can be
done to obtain the optimum aesthetic result.
Ligation- ligature wire or elastic module can be used
for securing the pontic to the archwire. Tight ligation
using ligature wire yields the greatest stability. Play
between the arch wire and bracket slot should be
minimal. The reduction of play can be achieved by
having a figure of 8 consolidations to both mesial
and distal teeth of the pontic.
Case No: 1: A 23 year old female patient presented with a
chief complaint of missing tooth in maxillary anterior
region with a history of avulsion following trauma
(Figure 1). Treatment plan was to align both the arches
with fixed appliance mechanotherapy (MBT 0.022’’slot),
prosthetic replacement of right lateral incisor with
implant. The space for the implant prosthesis was
maintained with the use of orthodontic pontics which
improved the patient smile during the pre-restorative
phase (Figure 2, 3).
She had a pleasing profile (Figure 4), Angles Class II
molar relationship with missing maxillary left lateral
incisor, diastema between maxillary centrals, and
moderate crowding in the mandibular anterior region
(Figure 5, 6). Non-extraction treatment was planned.
Treatment objectives were closure of midline diastema,
regaining the space for prosthetic replacement of lateral
incisor, relieving the crowding and maintaining the
existing Class-I molar relationship.
Figure 4: Extraoral views
Figure 5: Lateral ceph and OPG
Figure 1: Extraoral and intraoral view
Figure 6: Intraoral views
The malocclusion was treated with fixed mechanotherapy
(MBT, .022″). Alignment and levelling of maxillary and
mandibular arches was accomplished and space for the
lateral incisor was created (Figure 7). Orthodontic pontics
Figure 2: ligated pontic in place
Figure 7: After space regaining and pontic try in
Figure 3: OPG after placing implant drill and post implant placement
Case No: 2: A 20 year old female reported to the
Department of Orthodontics with chief complaint of
space between her upper front teeth region. She had no
history of any tooth extraction and orthodontic treatment.
Figure 8: Pontic in place during treatment
International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2016 | VOL 2 | ISSUE 5
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Rahul C S et al: Orthodontic Pontics
were prepared, trial and adjustment was done, and ligated
to the rectangular archwire by stainless steel ligature
(Figure 8). The smile of the patient showed considerable
improvement after ligating orthodontic pontics (Figure 9).
CASE REPORT
prostheses are some of them7. It is of utmost importance
to preserve the esthetics of an orthodontic patient,
especially those demanding for invisible/lingual or
cosmetic appliances. Orthodontic pontic can be
considered as an aesthetic aid for these kinds of patients8,
9, 10.
This procedure can be easily performed by the dentist
in his office as requires no special skill and
armamentarium. This article provides information on
fabrication and ligation, uses and placement of
orthodontic pontics with the help of two case reports.
CONCLUSION
Orthodontic pontic can be considered as an aesthetic aid
for the orthodontic patients with missing one or more
anterior teeth. It helps to improve patient’s aesthetics and
smile during orthodontic treatment.
REFERENCES
Figure 9 smile with and without orthodontic pontics
DISCUSSION
Benefits of using orthodontic pontics:
 Enhancement of aesthetics during orthodontic
treatment.
 Prevention of development of deleterious habits such
as tongue thrusting and defective speech
 Maintainence of exact mesiodistal width of the
missing tooth for further prosthetic replacement
 Midline matching along with orthodontic pontic is
easier when unilateral incisor is missing.
 Improvement of psychosocial status of the patient.
Dentists often come across patients with missing teeth or
malformed teeth. Treatment options include either
orthodontic space maintenance/opening for future
restoration or orthodontic space closure. A tooth with
poor prognosis will have to be extracted prior to
orthodontic treatment. When this situation occurs in the
anterior region and the treatment plan calls for
maintaining or opening the space the esthetics during
treatment can be a compromised.5 Most adults seek
orthodontic treatment either to improve aesthetics or to
improve occlusal function.6 There are numerous factors
which have elevated the interest in adults for orthodontic
treatment. The
availability
of
an
array
of
aesthetic/cosmetic appliances and a heightened desire for
treatment of dental mutilation problems using
orthodontics and fixed restorations rather than removable
1.
Russell JS. Aesthetic orthodontic brackets. J Orthod. 2005
Jun; 32(2): p. 146-63.
2.
Peter, M , Roth, et a. Congenitally missing lateral
incisortreatment. J. Clin. Orthod. 1985; 4: p. 258-62.
3.
Jena AK, Chandrashekar BS, Duggal R. Riding Pontics:
An Esthetic Aid in Orthodontics. The Orthodontic Cyber J.
2007 Sep.
4.
Sarabjeet S, Sandhu N. Clinical strategies and multiple
functions of riding pontics: A tool to keep patients smiling.
The Orthodontic Cyber J. 2011 March.
5.
Sabri R. Management of missing maxillary lateral incisors.
J Am Dent Assoc. 1999 Jan; 130(1): p. 80-4.
6.
Proffit WR. Contemporary Orthoodntics. 5th ed.
7.
Graber , Vanarsdall , V. Orthodontics: Current principles
& technique. 4th ed.
8.
Preeti B. Esthetic Management of Missing Lateral Incisor
during Orthodontic Treatment- A Case Report. The
Orthodontic Cyber J. 2010 july .
9.
Sharma N S. Riding Pontic: A Tool to Keep Patients
Smiling. Int J Clin Pediatr Dent. 2013; 6(2): p. 127-131.
10. Sarabjeet S, Navreet ,. GG. Use of riding pontics for
traumatised anteriors- An Orthodontic Aproach. Dentistry.
2011 January-February; 29.
Source of Support: Nil
Conflict of Interest: Nil
International Journal of Oral Health and Medical Research | ISSN 2395-7387 | JANUARY-FEBRUARY 2016 | VOL 2 | ISSUE 5
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