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ABSTRACT
During the past two decades, significant advancements with the integration of periodontal plastic surgery into esthetic
restorative dental procedures have received increased attention. While ovate pontics have traditionally been used as a
restorative design following augmentation procedures to enhance esthetics, an alternate E-pontic design aims to
predictably support and maintain the gingival architecture between a single missing anterior tooth adjacent to a natural
tooth or an implant that is in harmony with the lip line and face. In addition, the E-pontic design promotes the gingival
facial tissue to coronally migrate over the pontic, creating a gingival sulcus. This article describes an innovative new
technique and a pontic design that predictably will develop, support, and maintain the gingival architecture to provide a
long-term esthetic and functional outcome.
CLINICAL SIGNIFICANCE
Over the past 14 years, it has been the authors observation that the E-pontic design and conservative surgical
technique, when properly performed, will develop, support, and maintain the gingival architecture more predictably
than any other pontic design observed. When the goal of tooth replacement is to achieve the optimal esthetic and
functional outcome, the utilization of the E-pontic design for a fixed partial denture involving either natural teeth or
implants is recommended.
(J Esthet Restor Dent 27:1328, 2015)
INTRODUCTION
The past two decades has seen signicant advances
with the integration of periodontics into esthetic
dentistry with more awareness being given to the
signicance of the perio-restorative interface.1,2
Restoration of lost hard and soft tissues of the
periodontium has become a reality, and a combination
of procedures has been used in a periodontal plastic
surgery approach to restore these tissues to enhance
the esthetic outcome. An adequate alveolar ridge is a
prerequisite for esthetic and functionally optimal
reconstruction of the soft tissue architecture
for a xed partial denture (FPD) or an implant
restoration.
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FIGURE 3. A, A preoperative view of a six-unit fixed partial denture with pontics in the maxillary right and left central incisor
position displaying poor esthetics. B, A 3.5-year postoperative view. The E-pontic mimics the emergence angles and soft tissue profile
of a natural tooth and illustrates the stability of the periodontal-restorative interface with this innovative design.
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FIGURE 5. A and B, Note the anatomical shape and sharp 90-degree line angles of the E-pontic design. It has a flat design on the
tissue surface that resembles the anatomical cross-section of an anterior tooth at the CEJ. C, Classification of pontic designs:
(A) ridge lap, (B) modified ridge lap, (C) ovate, (D) modified ovate, and (E) E-pontic.
CASE PRESENTATION
Age at initial presentation: 66 years.
Initial presentation: April 2005.
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FIGURE 11. A and B, The patient presents with esthetic concerns about her smile. Compromised anterior esthetics as a result of
soft tissue gingival form and poor ceramics.
DISCUSSION
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FIGURE 18. A and B, A 5-month postoperative view reveals ideal papillary height and symmetry with complete tissue fill of the
gingival embrasure space. C and D, A 7-month postoperative view of the definitive fixed partial denture illustrates coronal migration
of the facial gingival tissue over the pontics.
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CONCLUSION
FIGURE 19. A postoperative X-ray illustrates the E-pontic
design with 6.5 mm of interdental tissue above bone.
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