CLINICAL - CROWN AND BRIDGE

Bridge design, part four: aesthetic

enhancement for anterior fixed
bridge restorations
By Paul Tipton, BOS, MSc, DGDP (UK)

Following on from his previous articles on

Pleasing central incisors of pleasing proportions are an essen-

fixed-movable and fixed-fixed bridgework,

tial aspect of a successful aesthetic rehabilitation .

Paul Tipton now examines aesthetic issues

regarding anterior fixed bridge restorations

Because the pontic gingival interface is important for

proper aesthetics in visible anterior regions alveolar ridge
deformities present special challenges during fixed bridge
reconstruction. Seibert ( 1983) originally presented a system
for classifying various edentulous ridge deformities:

The premature loss of anterior teeth can lead to several aes-

Class I - Bucco-lingual loss of ridge contour

thetic problems. If the tooth has been removed some time

Class II - Apico-coronal loss of ridge contour

previously without any ridge preservation techniques, then in

Class Il l - Combined bucco-lingual and apico-coronal loss of

all probability there wi ll have been horizontal and vertical bone

ridge contour.

loss, often with complete loss of the buccal cortical plate of

T he previous paper in this series concentrated on the

bone. This makes the aesthetic replacement of the missing

technical aspects of fixed-fixed bridgework. T his paper w ill

tooth, be it with a fixed bridge or dental implant, a very diffi-

reflect on the aesthetic principles involved in fixed bridgework.

cult task.
The final restoration needs also to conform to certain aes-

RIDGE PRESERVATION

thetic requirements. The general direction of the incisal plane

Recently much work has been done in an effort to save the

of the maxillary teeth and the gingival margin outline must be

precious buccal cortical plate of bone by a series of ridge

parallel to the interpupillary line.This harmony must be further

preservation techniques. The first of these is the atraumatic

reinforced by the incisal plane following the lower lip line dur-

extraction of the tooth by the use of periotomes, whereby

ing smiling (Chiche, 1994).The dental midline perpendicular to

the socket is not expanded during t he extraction procedure.

this interpupillary line serves to anchor the smile on the face

Socket space can then ideally be fi lled with an immediate

(Golub, 1988).The maxillary centre line should therefore coin-

replacement implant such as 'Replace' from Steri-Oss which is

cide with the mid line of the face.

Paul Tipton BOS, MSc,

tapered and a similar shape to the tooth that has been

Lombardi ( 1973) pointed to the impor-

extracted. Alternatively, should the patient wish to delay or

DGDP (UK), is a specialist

tance of the proportion between width and

forgo implant treatment, the socket can be fil led with a bone

in prosthodontics and runs

length in the dimensions of individual teeth.

substitute, provided primary closure is established. Primary

a private referral

This proportion has been called the D ivine

closure it self can be difficult in these circumstances, and often

restorative and implant

or Golden Proportion (Levin, 1981) and clas-

a membrane can be placed over t he socket or a connective

practice at the St Ann's

sically has a proportion of I .6 18: I .That is, the

tissue graft taken from the palate for primary closure. The

Dental Clinic in

width of the central incisor to the lateral

alternative is to bury the root by cutting off the crown and

Manchester. The clinic

takes referrals for both the
surgical and prosthetic
aspects of implantology.
He also runs one-year
practical restorative and
implantology courses from
St Ann's Dental Education
Centre, Manchester

116

incisor should be in that proportion when

preparing the root face subgingivally and allowing the soft tis-

viewed from the front (this is not to be con-

sue to proliferate and heal over the top.The root can then be

fused with the actual width but the width as

removed at a later date via a small palatal incision and the use

seen by the viewer). The width of the lateral

as previously mentioned of the periotome. Primary closure

incisor to that of the canine should be in the

can then proceed as normal.

same proportion and so on.

Pleasing proportions of the central

OVATE PONTIC

incisors are also expressed in a w idth to

T he ovate pontic is the ideal pontic form with a rounded base

length ratio of approximately 7S% to 80%.

and is indicated where aesthetics are of paramount impor-

RESTORATIVE

& A ESTHETIC

PRACTICE

VOLUME

2 N o. 8

SEPTEMBER

2000