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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 11  |  Issue : 1  |  Page : 29-32

Laser-assisted natural gingival profile creation of an ovate pontic site


1 Department of Periodontology and Oral Implantology, M.A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India
2 Department of Prosthodontics and Oral Implantology, M.A. Rangoonwala College of Dental Sciences and Research Centre, Pune, Maharashtra, India

Date of Web Publication23-Jun-2017

Correspondence Address:
Aparna Venkatasubramanyam
Department of Periodontology and Oral Implantology, M.A. Rangoonwala College of Dental Sciences and Research Centre, Azam Campus, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdl.jdl_5_17

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  Abstract 

Patient's desire for natural-appearing tooth replacements has prompted the development of various techniques designed to achieve a natural appearance of the soft tissues. Specifically, use of the ovate pontic is among the most versatile and effective means for obtaining the desired results. Creating a gingival profile of an ovate pontic site allows the cervical third of the pontic to merge with the surrounding tissues thereby making it appear to have emerged from the alveolar ridge. Use of lasers offer several advantages over conventional procedures for preparation of ovate pontic site by providing sterile area, hemostasis, precise soft tissue contouring, less time consumption, and reduced postoperative pain. This report presents the use of diode laser in creating a gingival profile in a 43-year-old male patient for an ovate pontic design of a fixed partial denture prosthesis.

Keywords: Diode, laser(s), ovate pontic


How to cite this article:
Venkatasubramanyam A, Sigtia S, Sheth E, Hegde R, Muglikar S. Laser-assisted natural gingival profile creation of an ovate pontic site. J Dent Lasers 2017;11:29-32

How to cite this URL:
Venkatasubramanyam A, Sigtia S, Sheth E, Hegde R, Muglikar S. Laser-assisted natural gingival profile creation of an ovate pontic site. J Dent Lasers [serial online] 2017 [cited 2022 Jan 22];11:29-32. Available from: https://www.jdentlasers.org/text.asp?2017/11/1/29/208946


  Introduction Top


The absence of teeth in the anterior region affects the patient's day-to-day activities and confidence level, therefore achieving good and immediate esthetics is a prime requirement in dentistry. Patient's desire for natural-appearing tooth replacements has led to the development of designs that help achieve natural appearance of the soft tissues. Specifically, use of the ovate pontic is among the most versatile and effective means for obtaining the desired results.[1] The convex outline of the pontic intends to form the concave soft tissue outline at the site of alveolar ridge mucosa. This design eliminates the black triangle which is created after loss of tooth and interdental papilla and also allows for better plaque control and esthetically healthy gingival tissue.[2] Ovate pontic design is used for obtaining the natural esthetic outcome while designing a fixed partial denture. Creating a gingival profile of an ovate pontic site allows the cervical third of the pontic to merge with the surrounding tissues thereby making it appear to have emerged from the alveolar ridge.[1]

Laser-assisted dentistry involves minimally invasive procedures aimed at achieving good predictable outcomes. Lasers offer advantages over conventional procedures by providing sterile area, hemostasis, and precise soft tissue contouring, less time consumption, and reduced postoperative pain. Lasers can offer advantages in restorative field by delivering good tissue contour and hemostasis for the purpose of immediate temporization thereby continuing the maintenance of an adequate gingival profile.

This report presents the use of diode laser in creating a gingival profile in a 43-year-old male patient for an ovate pontic design of a fixed partial denture prosthesis


  Case Report Top


A 43-year-old male patient reported to the outpatient department of periodontics for the purpose of replacing a missing anterior tooth. A thorough case history was recorded and preoperative photographs and diagnostic casts were fabricated [Figure 1]. Patient was explained about the various treatment options for replacing the missing anterior teeth. Considering the anterior esthetic zone which was involved, ceramic fixed partial denture with ovate pontic design was chosen for replacing the left maxillary central incisor. Clinically, the edentulous ridge did not have a good contour for the acceptance of ovate pontic design and there was also inadequate crown length with regards to maxillary right central incisor.
Figure 1: Preoperative view

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Before the procedure was carried out, routine blood investigation and informed consent was obtained as a procedural protocol. When modifying the ridge surgically it is necessary to know the thickness of soft tissue above the bone which is obtained by probing to the bone. Under 2% lignocaine infiltration a careful transgingival probing was carried out. A minimum of 2mm of tissue height should be available following the creation of ovate pontic site. On bone sounding, it was found that 4 mm of soft tissue height was available, thus it was concluded that the site required only soft tissue contouring to establish a good profile for the final outcome. Diode laser was chosen for the ovate pontic site preparation as it had an advantage over conventional procedure of being minimally invasive, good healing tendency, minimal postoperative bleeding of the site, and in contact mode, it is ideal for gingival sculpting.

A 980 nm diode laser (Zolar Photon Plus) with a fiber tip 2.5 W, continuous wave, contact mode was used for the ovate pontic site preparation and for simultaneous crown lengthening of the maxillary right central incisor. The formation of ovate pontic site started with the removal of tissue from the center of the site and swirl outward to the periphery boundary of the ovate pontic [Figure 2]. The diameter was then increased ending it 2 mm from the adjacent abutment mesially and distally. By leaving 2 mm of gingival tissue mesially and distally, the interproximal papillae were created[Figure 3].[3] All laser safety precautions were used during the procedure which included wearing wavelength specific glasses and minimizing the reflective surfaces in the operating site. Around 2 mm of the soft tissue contouring was carried out at the ovate pontic site for re-establishing the zenith and a maintainable gingival profile. During the procedure, good hemostasis was achieved hence immediate temporization was carried out considering patients esthetic demands and also for achieving a uniformly convex profile for the seating of the ovate pontic in the final prosthesis [Figure 4] and [Figure 5]. During the follow up period of 1 month, excellent gingival contour was obtained and healing was uneventful. Final full ceramic fixed partial denture with an ovate pontic design was delivered 3 months posttherapy [Figure 6]. Esthetic outcome was pleasing and the patient's satisfaction was high.
Figure 2: Ovate pontic site preparation of maxillary left central incisor using diode laser with continuous wave, contact mode

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Figure 3: Immediate postoperative following the use of diode laser

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Figure 4: Temporary prosthesis with an ovate pontic design

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Figure 5: Immediate temporization following the use of laser

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Figure 6: Final full ceramic fixed partial denture with an ovate pontic design delivered 3 months post therapy

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  Discussion Top


As patient's esthetic demands increase, dentists face the difficult challenge of meeting these demands without compromising overall function and health. When a fixed partial denture is opted as an ideal treatment protocol, the ovate pontic design is considered the best esthetic option. The ovate pontic receptor site is of great value when trying to create a natural maxillary anterior fixed bridge. It also serves an important periodontal function by maintaining the interdental papilla next to the abutment teeth after extraction.[4]

The receptor site is a depression or socket created in a soft tissue that allows the prosthesis to appear as if it has emerged from the soft tissue of the alveolar ridge. In highly esthetic areas like maxillary anterior region, it is necessary to create a receptor area that is 1.0–1.5 mm below the tissue on the facial aspect. This will create an appearance of free gingival margin and optimal esthetics.[5]

There are many causes of unsuitable pontic site. Two of the most common causes are insufficient compression of alveolar plates after an extraction and nonreplacement of a fractured alveolar plate.[6] Unsuitable pontic site results in unesthetic and nonself-cleansing pontic design.[6] For favorable pontic design, re-contouring of soft, and bony tissue may be needed.[7] When modifying the ridge surgically it is necessary to know the thickness of soft tissue above the bone which is obtained by probing to the bone. A minimum of 2 mm of tissue height above the bone should be reduced to create a desired pontic form.[5] Certain factors should be taken in to consideration like ridge height needs to match the ideal height of interproximal papillae where interproximal embrasures are next to abutment teeth. Second, the gingival margin height must also be at the ideal level, or the pontic will appear too long. Third, the ridge tissue should be facial to ideal cervical facial form of the pontic so that the pontic can emerge from the tissue.[5]

Over the years, dental profession has witnessed a wide array of changes with relentless technological innovations aimed at improving the standard of care for patients. The introduction of the lasers to the specialties of dentistry like prosthodontics and periodontics has brought a revolution in the treatment delivery with increased precision of procedures and comfort for the patients. The conventional ovate soft tissue design is created with gingivoplasty using either a round bur or carbide bur. However, a major disadvantages of this technique are tissue mutilation, bleeding, inability to take the final impression during procedure and delayed tissue development and healing.[3] So to overcome the above complications, lasers are now being used as an alternative to the conventional methods.

The use of diode laser in ovate pontic site preparation offers a lot of advantage like, the sculpting of gingival tissue is exceptionally precise with laser. Controlled laser energy for these procedures minimizes postoperative swelling, decreases postoperative pain and reduces healing time.[3] These procedures can be performed at the initial treatment, whereas using conventional methods would mean performing these soft tissue alterations several weeks before preparation/impression stage. Soft tissue surgery may be performed with any of the soft tissue lasers and osseous surgery may be performed with erbium family of lasers.[6],[7] However in this case, only soft tissue contouring was carried out without any further need for osseous contouring.

There is scarce literature on use of lasers for ovate pontic site preparation. In this case, the use of diode laser provided a bloodless and painless field, predictable gingival contouring, and minimal discomfort to the patient.[8] The patient was comfortable throughout the procedure and the healing period with no problem in maintenance of the laser ablated site.


  Conclusion Top


Dental lasers are useful clinical tools in the hand of a skilled operator enhancing his clinical efficiency and maximizing the advantages and benefits to the patients.[8] This article demonstrates use of laser to successfully add and complement to the esthetic concern of the patient. The end result brought a hassle free smile for an esthetically compromised patient. Thus proving that use of advanced laser system is a fitting example of technology being at the helm of modern day dentistry.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shinde P, Dugal R, Kheur M, Jain N, Matani J. Soft tissue and hard tissue modulation for enhancing anterior esthetics. Univers Res J Dent 2015;5:116.  Back to cited text no. 1
    
2.
Mhatre S, Ram SM, Shah N. Modified ovate pontic design for immediate anterior tooth replacement. J Contemp Dent 2012;2:64-8.  Back to cited text no. 2
    
3.
Convissar R. Principles and Practice of Laser Dentistry. 2nd ed. St. Louis USA, Mosby Elsevier; 2011. p. 147-50.  Back to cited text no. 3
    
4.
Modi R, Kohli S, Bhatia S. Anterior esthetic restoration of a patient using modified ovate pontic design: A Case Report. Ann Dent Spec 2014;2:158-62.  Back to cited text no. 4
    
5.
Carranza F, Newman M, Takei H, Klokkevold P. Carranza, S, Clinical Periodontology. 10/e: St. Louis, Missouri, USA: Saunders Elsevier; 2010. p. 1061-3.  Back to cited text no. 5
    
6.
Punia V, Lath V, Khandelwal M, Punia KS, Lakhyani R. The current status of laser application in prosthodontics. NJIRM 2012;3:170-5.  Back to cited text no. 6
    
7.
Miserendino LJ, Pick RM. Lasers in Dentistry. Chicago: Quintessence Publishing; 1995. p. 133-68.  Back to cited text no. 7
    
8.
Hari Iyer V, Manali S. Interdisciplinary approach using diode laser for esthetic management of missing anterior teeth. Int J Laser Dent 2013;3:24-8.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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[Pubmed] | [DOI]



 

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