J Esthet Restor Dent - 2024 - Gomez Meda - Perio‐Prosthodontic Pontic Site Management Part II Pontic Site Reconstruction

Received: 25 October 2023 Revised: 15 December 2023 Accepted: 16 December 2023
DOI: 10.1111/jerd.13192
CLINICAL ARTICLE
Perio-prosthodontic pontic site management, part II: Pontic

site reconstruction strategies to enhance the esthetic and
biological outcomes
Ramon Gomez Meda DDS 1 | Jonathan Esquivel DDS 2
1
Adjunct Assistant Professor, Department of
Prosthodontics, Louisiana State University Abstract
School of Dentistry, New Orleans,
Objective: Ridge deformities are present in most patients after tooth extraction;
Louisiana, USA
2
Adjunct Associate Professor, Department of
these defects make the management of future implant and pontic sites challenging to
Prosthodontics, Louisiana State University deal with. The restorative team should be able to diagnose and treat these deformi-
School of Dentistry, New Orleans,
Louisiana, USA ties to allow for successful outcomes. Many approaches have been described to
reconstruct pontic sites, each with specific indications. This article describes the dif-
Correspondence
Jonathan Esquivel DDS, 609 Metairie Rd
ferent approaches to reconstructing pontic sites and their indications to allow for a
#8106, Metairie, LA 70005, USA. proper esthetic and biological environment for future restorations.
Email: jesquiveldds@gmail.com
Clinical Considerations: Depending on the severity of the defect, location, and the
esthetic necessity, pontic site enhancement can be done through different
approaches, some requiring soft tissue grafting, hard tissue grafting, or both. Under-
standing the indications of the treatment options is essential to allow the clinician to
make the right therapeutic decision and achieve the best possible perio-
prosthodontic outcomes.
Conclusions: An adequate balance between the soft tissue and prosthetics is essen-
tial to achieve successful results on implant-supported or tooth-supported fixed den-
tal prostheses (FDPs). Selecting the right approach to treat ridge deformities is
necessary to increase treatment success, reduce over-treatment, and create a biologi-
cally sound environment for restorations.
Clinical Significance: Pontic site enhancement through reconstructive surgery will
allow for esthetically pleasing and biologically stable results, allowing restorations to
emulate natural structures lost after tooth extraction.
KEYWORDS
dental implants, esthetic dentistry, fixed dental prosthesis, guided bone regeneration, pontics,
soft tissue grafting
1 | I N T RO DU CT I O N prosthetic design, cleanability, phonetics, and the restoration's prog-

nosis (Figure 1A,B).1,2
A good soft tissue and prosthetic interphase is necessary to achieve a Clinical approaches to prevent and correct the lost tissues bound-
proper esthetic and functional outcome on tooth or implant supported ing future fixed dental prostheses (FDPs) have been described and
fixed dental prostheses (FDPs). After a tooth is extracted the overall evolved over time.3,4 Pontic site reconstruction can be done through
dimensions of the tissue will change, and this may affect the outcome different approaches and materials, such as connective tissue, free-
of the future prosthesis. Tissue collapse can affect the esthetics, gingival grafts, and soft tissue allografts (Figure 2A–C). The selection
J Esthet Restor Dent. 2024;36:737–745. wileyonlinelibrary.com/journal/jerd © 2024 Wiley Periodicals LLC. 737
17088240, 2024, 5, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jerd.13192 by Readcube (Labtiva Inc.), Wiley Online Library on [07/05/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
738 GOMEZ MEDA and ESQUIVEL
F I G U R E 1 (A) Immediate
post-delivery image of 6 unit
fixed dental prostheses (FDP)
from the lower left to lower right
canine. (B) Collapse of facial soft
tissue contour in the pontic sites.
F I G U R E 2 (A) A mild defect on a pontic site treated with an acellular dermal matrix introduced in a tunnel. (B) Tissue conditioning of
enhanced site through a provisional fixed dental prostheses (FDP). Facial view of the final soft-tissue outline. (C) Proper emergence profile and
pontic site conditioning was obtained through provisional restoration.
of the surgical reconstructive procedure will depend on the character- have been classified based on their dimensions into mild (<3 mm),
istics of the defect and the clinician's judgment, and even though moderate (3–6 mm), or severe (>6 mm), and their extension has been
there are many options for pontic site reconstruction, a clear consen- analyzed using the neighboring papilla tips as a reference.5,16 Seibert
5–10
sus on the most effective method is pending. categorized ridge defects into classes I, II, and III based on their ana-
A perio-prosthodontic approach is critical to achieving a better tomical involvement. Class III defects, involving both vertical and hori-
result. Long-term provisional restorations (6–12 months) are helpful zontal bone loss, are the most common.7,8,14,15,17
after a reconstructive procedure as tissue dimensions shrink during Perio-prosthodontic methods for handling pontic sites include:
healing, especially during the first year. These provisional restorations
allow tissue conditioning by changing the restoration's contours as 1. Immediate pontics
the tissues change.11 The pontic design will be selected based on the 2. Socket preservation
clinical scenario and the condition of the surrounding tissues after 3. Soft tissue grafting procedures
being reconstructed. 4. Guided bone regeneration on larger defects.
This article aims to provide a review of the behavior of pontic
sites after tooth extraction, the clinical approaches to preserve or The technique selection will depend on the future prosthetic
reconstruct pontic sites, as well as their prosthetic management, to design and the defect's anatomy.4–6,8,18–25
allow the clinician to make the proper decision for treatment and Mild to moderate ridge defects can be predictably treated with
obtain more esthetically pleasing and stable results. soft tissue grafting (Figure 2A–C). However, for severe defects,
especially those with a vertical component, bone augmentation pro-
cedures are needed to increase the dimensions of the ridge
2 | P O S T- E X T R A C T I O N BE H A V I O R O F T H E (Figure 3A–D).4,25,26
PONTIC SITES
After tooth extraction, the bundle bone resorbs, resulting in ridge 3 | PERIO-PROSTHODONTIC RIDGE
deformities in 91% of the cases. This phenomenom leads to food P R E S E R V A T I O N ST R A T E G I E S
impaction 40% of the time, and esthetic issues which cause patient
dissatisfaction.12–14 The defect's size, number of teeth missing, and Ridge preservation procedures during tooth extraction can help
the condition of the neighboring teeth and tissues will negatively reduce future bone collapse. The use of an immediate pontic in a post
15
affect the outcome. extraction socket has been described. In this technique, the pontic is
Several classifications of ridge defects which consider the defect's introduced 2.5 mm into the socket and then reduced by 1–1.5 mm
dimensions and characteristics have been described.5,7,8,16 Defects after 4 weeks (Figure 4A). However, this is only partially predictable,
GOMEZ MEDA and ESQUIVEL 739
F I G U R E 3 (A) Pre-operative
image on case with severe ridge
defect. (B) Severe ridge defect
treated with a connective tissue
grafts (CTG). (C) Due to the
vertical involvement, a bone
regeneration procedure is also
done on the site. (D) Proper
esthetics are achieved through
bone and soft tissue grafting and
tissue conditioning with
provisionals.
F I G U R E 4 (A) Immediate pontic technique and connective tissue grafts (CTG) done on site of lower left central incisor. (B) Natural tissue
scalloping was obtained through proper provisional and soft tissue enhancement of the pontic site. (C) Final result 3-unit fixed dental prostheses
(FDP) from lower left central incisor to the lower right lateral incisor.
F I G U R E 5 (A) Patient with failing anterior dentition. (B) Partial extraction therapy and soft tissue grafting done on multiple implants to allow
for a better outcome. Final result of the implant-supported fixed dental prostheses (FDP).
and additional soft tissue reconstruction may be necessary Socket preservation with soft tissue grafting can prevent 40%–
18
(Figure 4B,C). 60% of ridge atrophy in the first year by over-correcting pontic
Another option to preserve the bundle bone is partial extraction sites.30–34 In such cases, raising a flap for ridge preservation should be
therapy (PET), which involves keeping part of the tooth's root intact avoided to reduce bone resorption. However, a full-thickness flap
during the extraction to maintain the periodontal ligament and vascu- may be necessary in certain situations to prevent damage to the buc-
lar supply. Following the same principle, the Root Submergence tech- cal and palatal cortical plates. Ridge preservation strategies are more
nique or pontic shield are also good strategies to maintain the pontic predictable and less invasive than site reconstruction procedures after
site's volume (Figure 5A–C).27–29 the ridges have collapsed.
4 | PERIO-PROSTHODONTIC common donor sites, tissue from the tuberosity has a higher percent-
M A N A G E M E N T O F RE S O R B E D RI DG E S age of lamina propia and less submucosa. On the other hand, grafts
from the palate have more lamina propia on the gingival margin areas,
An alveolar ridge correction is necessary if the ridges have resorbed while apical areas have more glandular and fatty tissue.40–42 The graft
after tooth extraction. Multiple correcting techniques, such as pedi- size is also important, as it should be 30% larger than the defect to
cled flaps and free tissue grafts, have been described; the operator's compensate for the 25%–45% shrinkage expected after the
experience and preference, the defect's size, and the prosthetic design procedure.43,44
5,6,20,21,35,36
will determine the approach (Table 1). Pediculated grafts are another option; they have less initial
Mild to moderate defects can be corrected with soft tissue graft- shrinkage than subepithelial connective tissue grafts (SCTGs) due to
ing alone, while larger ones may require multiple soft tissue recon- increased vascularity. Class I defects can be repaired using pedicle
36,37
structions with or without hard tissue augmentation. The flaps or the modified roll technique, as depicted in Figure 7.21,36,45
edentulous site enhancement (ESE) approach to increase soft tissue Another option is preparing the pedicle graft from the same palatal
volume in mild or moderate defects has been described.38 As illus- area of the defect and rotating it into a previously created pouch
trated in Figure 6, this involves making an incision on the crest, mov- (Figure 8A–D).24 Procedures involving subepithelial pouches are very
ing the flap facially, and stabilizing it with the provisional restoration predictable as there is complete coverage of the CTG. They aim to
(Figure 6). The wound then heals by secondary intention, resulting in address Class I defects; however, a variation of this technique has
increased keratinized gingiva (KG) dimensions.38 been proposed to treat Class III defects.6,7,46,47
Connective tissue grafts, which can be sliced, folded, or unfolded, Options such as SCTGs and roll flaps are widely used but may not
are another way to treat these defects and can be harvested from the solve lack of KG. The lack of KG can be addressed by using inlay and
palate or tuberosity.39 It is essential to harvest high-quality soft tissue onlay grafts as the portion of the CTG exposed becomes keratinized
and understand its characteristics. When comparing the two most tissue. Inlay grafts are reliable; severe ridge defects can be corrected
by modifying this procedure, overlapping multiple SCTGs, or staging
grafts every 2 months (Figures 9 and 10).20,36 Using onlay and inter-
T A B L E 1 Regenerative and porvisionalization strategy based on
positional grafts together is an option for treating Seibert Class III
the defect type.
defects (Figure 11), and augment soft tissues vertically and horizon-
Periodontal tally (Figure 12A–E).7,8,17,20,35,36 However, it has a higher risk of
reconstruction Provisionalization
necrosis due to decreased blood supply, unpredictable shrinkage, and
Defect type procedure strategy
potential esthetic disparities with neighboring tissues.
No defect Socket Full contour provisional
In cases of inadequate donor sites or severe multiple teeth
preservation restorations with
proper pontic contours defects, biomaterials, including xenografts, allografts, or alloplasts, are
and the emergence indicated and act as scaffolds to promote cell proliferation and revas-
profile following EBC cularization.48,49 However, connective tissue grafting is the most pre-
zones
dictable technique for soft tissue augmentation, as biomaterials have
Class 1 Inlay CTG Slightly undercontoured been shown to exhibit up to 50% shrinkage after 3.5 years.50 Bioma-
(Buccolingual provisional restoration
terials can also be used with membranes for GBR procedures and soft
defect) for 4–6 weeks
tissue grafting approaches to reconstruct the deficient ridges.37
Class 2 Onlay CTG, Highly undercontoured
(Apicocoronal Pediculated provisional restoration In addition to GBR, the split-crest technique has been indicated in
defect) Flaps for 3 months and sites with horizontal deficiencies. Orthodontic extrusion can also be
evaluate to regraft if used to develop the proper ridge volume and improve the soft tissue,
necessary
papillas, and neighboring teeth position.51,52 The appropriate treat-
Class 3 Inlay + onlay Highly undercontoured ment decision will reduce treatment time and complications. Under-
(Buccolingual CTGs, Mixed provisional restoration
standing the limitations of each technique and sound clinical
and grafts for 3 months and
apicocoronal evaluate to regraft if judgment are critical to properly selecting the right approach.
defect) necessary
Bone Highly undercontoured
augmentation provisional and 5 | RE D U C T I O N O F T H E P O N T I C S I T E
(GBR) + FGG evaluate to regraft
VOLUME
after 4 months if
necessary
Ocasionally, resective surgery may be necessary on pontic sites if the
Bone Highly undercontoured
augmentation provisional and restorative space is compromised or the hard and soft tissues' position
(GBR) + CTG evaluate to regraft is more coronal than desired. However, it is important to note that a
after 6 months if minimum of 2 mm of tissue thickness is necessary from the bone to
necessary
the basal aspect of the pontic to maintain a biological balance.53
F I G U R E 6 The Edentulous
Site Enhancement (ESE) approach
where a facially displaced flap is
stabilized with provisional
restoration to increase the
keratinized gingiva
(KG) dimensions.
F I G U R E 7 Roll-on flap to
increase the soft tissues on buccal
side of the crest and enhance
final result.
F I G U R E 8 (A) Post-extraction
ridge defect. (B) Pedicle graft
done to enhance the pontic site.
(C) Provisional restoration is
seated and actively molding the
tissue to promote the natural
looking tissue contours and
embrasure fill. (D) Clinical image
of restored site after site
reconstruction with a pedicle
graft and implant placement on
tooth #6 with a cantilevered
prosthesis to restore missing the
upper right lateral incisor.
F I G U R E 9 In an inlay graft, a
connective tissue grafts (CTG)
with a band of epithelium is
harvested from the palate and
inserted into a pouch on the facial
of the pontic site; the epithelium
band is left exposed.
The need for resection can happen in cases where the previously requiring repositioning of the bone margin to allow for proper pros-
existing teeth had super-eruption before being extracted. Pontic site thetic design. In some situations, where hard and soft tissue recon-
reduction may be necessary in cases where a gummy smile is present, struction will not achieve volumes compatible with an FP1 prosthesis,
F I G U R E 1 0 Modification of
an inlay graft; a more palatal
incision is made and the
epithelium part of the graft is left
on the palatal aspect of the crest.
F I G U R E 1 1 Onlay grafts are

used for severe defects with a
vertical and horizontal
component.
F I G U R E 1 2 (A) Patient with unesthetic appearance due to pontic site defect and lack of papillas. (B) Onlay graft done to enhance the pontic
site and provide proper tissue volume for tissue conditioning. (C) Provisional restoration from the upper left central incisor to the upper right first
premolar, conditioning site enhanced with an onlay graft. (D) Occlusal view of pontic sites after soft tissue development with provisional
restoration. (E) Final result after onlay grafting and tissue conditioning with provisionals.
reducing the pontic site's volume is necessary to hide the restorative- situation only involves the extraction, and immediate provisionaliza-
tissue interphase of an FP3 prosthesis behind the lip (Figure 13). tion, an adequate emergence profile of the abutments and proper
pontic contours are necessary.54,55 A subcontoured pontic is recom-
mended if soft tissue grafting is done for socket reconstruction to
6 | PROSTHETIC MANAGEMENT OF THE avoid any pressure on the site. After the maturation of the graft,
R E C O N S T R U C T E D OR S U R G I C A L L Y 6–8 weeks later, the pontic can be redesigned to apply pressure on
C O R RE C TE D SI T E the tissues, allowing a natural emergence profile and complete gingival
embrasure filling. However, in situations where guided bone regenera-
In all scenarios mentioned above, using provisional restorations tion (GBR) with or without soft tissue grafting is done, the maturation
becomes critical for enhancing the soft tissue contours. If the surgical of these sites will take longer. The clinician must prevent any pressure
on the areas by delivering under contoured provisionals to prevent

complications, as shown on Figures 14 and 15.
The provisional restoration will be used until the full maturation
of the hard and soft tissues, ranging from 2 months in cases with mild
soft tissue grafting to 1 year in adjacent extractions or when the
patient requires extensive grafting. Long-term provisionalization is
essential to allow for complete healing of the bone and ensure tissue
stability. Doing so will prevent prosthetic and esthetic complications
after delivery of the final prosthesis. During the healing period, grad-
ual changes to the contours of the provisionals must be made to pre-
pare the sites for future definitive restorations.
FIGURE 13 Pink porcelain used to correct the esthetic limitation.
7 | DI SCU SSION
Improving soft and hard tissues around the pontic sites through surgi-
cal procedures is essential for achieving an optimal esthetic result,
boosting the gingival phenotype, increasing KG, reducing bone remo-
deling, and eliminating esthetic alterations.56 Pontic site enhancement
can prevent phonetic alterations and food impaction. Connective tis-
sue and free gingival grafts have been shown to be clinically stable for
over 10 years.5,9,10,16 The technique, the size and quality of the graft,
and the defect's size, anatomy, and vascularity are critical factors that
will dictate the predictability of the outcome.
Mucogingival surgery has evolved over time, leading to more pre-
dictable procedures. SCTGs are still the most used and reliable
approach, and the clinician must understand the donor sites' anatomy
and histological composition well. Tunneling or pouch approaches are
preferred due to the minimal morbidity, low rate of complications, and
F I G U R E 1 4 Highly undercontoured provisional to allow for high esthetic results (Figure 15A–D). Soft tissue augmentation can
tissue maturity after grafting. solve cases with minor or moderate ridge defects. Autografts are still
F I G U R E 1 5 (A) Connective
tissue grafts (CTG) introduced
into pouch. (B) Undercontoured
provisional Maryland bridge made
to avoid pressure on the grafted
tissues. (C) Single winged
Maryland bridge delivery after
tissue maturation. (D) Final result
of Maryland bridge on the lower
right lateral incisor over the
reconstructed site.
preferred over allogenic materials due to their higher vascularization 4. Buser D, Dula K, Belser U, Hirt HP, Berthold H. Localized ridge aug-
and lower shrinkage. However, some collagen matrices behave simi- mentation using guided bone regeneration. 1. Surgical procedure in
the maxilla. Int J Periodontics Restorative Dent. 1993;13:29-45.
larly to autografts.57 However, more severe ridge deficiencies may
5. Allen EP, Gainza CS, Farthing GG, Newbold DA. Improved technique
require multiple procedures including the use of different biomaterials for localized ridge augmentation. A report of 21 cases. J Periodontol.
and bone regeneration. On some occasions multiple surgeries may be 1985;56:195-199. doi:10.1902/jop.1985.56.4.195
needed, with two-month intervals for tissue maturation.36 6. Langer B, Calagna L. The subepithelial connective tissue graft. J Prosthet
Dent. 1980;44:363-367. doi:10.1016/0022-3913(80)90090-6
If the patient is not a good candidate for site reconstruction a pros-
7. Seibert JS. Reconstruction of deformed, partially edentulous ridges,
thetic approach using pink ceramics is still an option. A thorough analy- using full thickness onlay grafts. Part I. Technique and wound healing.
sis of the patient's lip mobility, smile line, dexterity, and expectations Compend Contin Educ Dent. 1983;4:437-453.
become necessary. In these cases, a well-made prosthetic design must 8. Seibert JS. Reconstruction of deformed, partially edentulous ridges,
using full thickness onlay grafts. Part II. Prosthetic/periodontal inter-
be done, preventing concavities in the intaglio surface to avoid food
relationships. Compend Contin Educ. 1983;4:549-562.
impaction. Instead, the prosthesis must be fabricated with an ovate or 9. Studer SP, Lehner C, Bucher A, Schärer P. Soft tissue correction of a
flat pontic design.55,58 The importance of soft tissue grafting to provide single-tooth pontic space: a comparative quantitative volume assess-
a predictable reconstruction of pontic sites and better esthetic out- ment. J Prosthet Dent. 2000;83:402-411. doi:10.1016/s0022-3913
(00)70034-5
comes has been described.59 However, more research is needed in this
10. Thoma DS, Buranawat B, Hämmerle CH, et al. Efficacy of soft tissue
field to establish a future decision-making tree for practitioners using
augmentation around dental implants and in partially edentulous
biomaterials as an alternative to CTGs, thus improving efficiency and areas: a systematic review. J Clin Periodontol. 2014;41(Suppl 15):S77-
reducing the morbidity of the procedure. Pontic site reconstruction can S91. doi:10.1111/jcpe.12220
be complex, and the restorative team must understand periodontal and 11. Tan WL, Wong TL, Wong MC, et al. A systematic review of post-
extractional alveolar hard and soft tissue dimensional changes in
prosthodontic principles to achieve the desired results by applying sim-
humans. Clin Oral Implants Res. 2012;23(Suppl 5):1-21. doi:10.1111/j.
ple or more advanced surgical or prosthetic procedures. 1600-0501.2011.02375.x
12. Araújo MG, Lindhe J. Dimensional ridge alterations following tooth
extraction. An experimental study in the dog. J Clin Periodontol. 2005;
32:212-218. doi:10.1111/j.1600-051X.2005.00642.x
8 | C O N CL U S I O N S
13. Chappuis V, Engel O, Reyes M, et al. Ridge alterations post-extraction
in the esthetic zone: a 3D analysis with CBCT. J Dent Res. 2013;92:
- The use of perio-prosthodontic techniques is the most predictable 195S-201S. doi:10.1177/0022034513506713
way to approach a deficient pontic site to obtain a biological, func- 14. Abrams H, Kopczyk RA, Kaplan AL. Incidence of anterior ridge defor-
mities in partially edentulous patients. J Prosthet Dent. 1987;57:191-
tional, and esthetic rehabilitation.
194. doi:10.1016/0022-3913(87)90145-4
- Soft tissue autografts are still the gold standard for the reconstruc- 15. Studer S, Naef R, Schärer P. Amélioration esthétique des pertes de
tion of mild and moderate defects due to their simplicity and substance. Intérêt de la chirurgie mucogingivale. Clinic. 1998;19:
predictability. 547-561.
16. Studer S, Naef R, Schärer P. Adjustment of localized alveolar ridge
- Severe defects may need bone augmentation procedures, several
defects by soft tissue transplantation to improve mucogingival
staged CTGs or the use of larger quantities of biomaterials. esthetics: a proposal for clinical classification and an evaluation of
- Long term provisional restorations allow prosthetic changes to be done procedures. Quintessence Int. 1997;28:785-805.
as the soft tissues mature which increase predictability and success. 17. Seibert JS. Soft tissue grafts in periodontics. In: Robinson PJ, Guersney LH,
eds. Clinical Transplantation in Dental Specialties. Mosby; 1980.
18. Spear FM. Maintenance of the interdental papilla following anterior
CONF LICT OF IN TE RE ST ST AT E MENT
tooth removal. Pract Periodontics Aesthet Dent. 1999;11:21-28.
The authors have no conflicts of interest to declare that are relevant 19. Greenstein G, Jaffin RA, Hilsen KL, Berman CL. Repair of anterior gin-
to this article. gival deformity with durapatite. A case report. J Periodontol. 1985;56:
200-203. doi:10.1902/jop.1985.56.4.200
20. Meltzer JA. Edentulous area tissue graft correction of an esthetic
DATA AVAI LAB ILITY S TATEMENT
defect. A case report. J Periodontol. 1979;50:320-322. doi:10.1902/
Data sharing is not applicable to this article as no new data were cre- jop.1979.50.6.320
ated or analyzed in this study. 21. Abrams L. Augmentation of the deformed residual edentulous ridge
for fixed prosthesis. Compend Contin Educ Gen Dent. 1980;1:205-213.
22. Garber DA, Rosenberg ES. The edentulous ridge in fixed prosthodon-
RE FE R ENC E S tics. Compend Contin Educ Dent. 1981;2:212-223.
1. Pjetursson BE, Brägger U, Lang NP, Zwahlen M. Comparison of survival 23. Stimmelmayr M, Allen EP, Reichert TE, Iglhaut G. Use of a combina-
and complication rates of tooth-supported fixed dental prostheses tion epithelized-subepithelial connective tissue graft for closure and
(FDPs) and implant-supported FDPs and single crowns (SCs). Clin Oral soft tissue augmentation of an extraction site following ridge preser-
Implants Res. 2007;18(Suppl 3):97-113. doi:10.1111/j.1600-0501. vation or implant placement: description of a technique. Int J Peri-
2007.01439.x Erratum in: Clin Oral Implants Res, 2008;19:326–8. odontics Restorative Dent. 2010;30:375-381.
2. Dina MN, Margarit R, Andrei OC. Pontic morphology as local risk fac- 24. Sclar A. Vascularized interpositional periosteal-connective tissue
tor in root decay and periodontal disease. Rom J Morphol Embryol. (VIP-CT) flap. In: Sclar A, ed. Soft Tissue and Esthetic Considerations in
2013;54:361-364. Implant Therapy. Quintessence Publishing; 2003:163.
3. Ashman A. The use of synthetic bone materials in dentistry. Compen- 25. Misch CM, Misch CE, Resnik RR, Ismail YH. Reconstruction of maxil-
dium. 1992;13:1020-1022. lary alveolar defects with mandibular symphysis grafts for dental
implants: a preliminary procedural report. Int J Oral Maxillofac 44. Zucchelli G, Tavelli L, McGuire MK, et al. Autogenous soft tissue
Implants. 1992;7:360-366. grafting for periodontal and peri-implant plastic surgical reconstruc-
26. Lekovic V, Camargo PM, Klokkevold PR, et al. Preservation of alveolar tion. J Periodontol. 2020;91:9-16. doi:10.1002/JPER.19-0350
bone in extraction sockets using bioabsorbable membranes. 45. Scharf DR, Tarnow DP. Modified roll technique for localized alveolar
J Periodontol. 1998;69:1044-1049. doi:10.1902/jop.1998.69.9.1044 ridge augmentation. Int J Periodontics Restorative Dent. 1992;12(5):
27. Salama M, Ishikawa T, Salama H, Funato A, Garber D. Advantages of 415-425.
the root submergence technique for pontic site development in 46. Kaldahl WB, Tussing GJ, Wentz FM, Walker JA. Achieving an esthetic
esthetic implant therapy. Int J Periodontics Restorative Dent. 2007; appearance with a fixed prosthesis by submucosal grafts. J Am Dent
27(6):521-527. Assoc. 1982;104:449-452. doi:10.14219/jada.archive.1982.0209
28. Hürzeler MB, Zuhr O, Schupbach P, Rebele SF, Emmanouilidis N, Fickl S. 47. Zucchelli G, Mazzotti C, Bentivogli V, Mounssif I, Marzadori M,
The socket-shield technique: a proof-of-principle report. J Clin Periodon- Monaco C. The connective tissue platform technique for soft tissue
tol. 2010;37(9):855-862. doi:10.1111/j.1600-051X.2010.01595.x augmentation. Int J Periodontics Restorative Dent. 2012;32:665-675.
29. Gluckman H, Du Toit J, Salama M. The Pontic-shield: partial extraction 48. Fischer KR, Testori T, Wachtel H, et al. Soft tissue augmentation
therapy for ridge preservation and Pontic site development. Int J Peri- applying a collagenated porcine dermal matrix during second stage
odontics Restorative Dent. 2016;36:417-423. doi:10.11607/prd.2651 surgery: a prospective multicenter case series. Clin Implant Dent Relat
30. Harris RJ. Creeping attachment associated with the connective tissue Res. 2019;21:923-930. doi:10.1111/cid.12817
with partial-thickness double pedicle graft. J Periodontol. 1997;68: 49. Simion M, Rocchietta I, Fontana F, Dellavia C. Evaluation of a resorb-
890-899. doi:10.1902/jop.1997.68.9.890 able collagen matrix infused with rhPDGF-BB in peri-implant soft tis-
31. Harris RJ. The connective tissue and partial thickness double pedicle sue augmentation: a preliminary report with 3.5 years of observation.
graft: a predictable method of obtaining root coverage. J Periodontol. Int J Periodontics Restorative Dent. 2012;32:273-282.
1992;63:477-486. doi:10.1902/jop.1992.63.5.477 50. Tavelli L, McGuire MK, Zucchelli G, et al. Extracellular matrix-based
32. Paolantonio M, di Murro C, Cattabriga A, et al. Subpedicle connective scaffolding technologies for periodontal and peri-implant soft tissue
tissue graft versus free gingival graft in the coverage of exposed root regeneration. J Periodontol. 2020;91:17-25. doi:10.1002/JPER.19-
surfaces. A 5-year clinical study. J Clin Periodontol. 1997;24:51-56. 0351
doi:10.1111/j.1600-051x.1997.tb01184.x 51. Scipioni A, Bruschi GB, Calesini G. The edentulous ridge expansion
33. Becker W, Becker BE, Caffesse R. A comparison of demineralized technique: a five-year study. Int J Periodontics Restorative Dent. 1994;
freeze-dried bone and autologous bone to induce bone formation in 14:451-459.
human extraction sockets. J Periodontol. 1994;65:1128-1133. doi:10. 52. Salama H, Salama M. The role of orthodontic extrusive remodeling in
1902/jop.1994.65.12.1128 Erratum in: J Periodontol., 1995;66:309. the enhancement of soft and hard tissue profiles prior to implant
34. Artzi Z, Tal H, Dayan D. Porous bovine bone mineral in healing of placement: a systematic approach to the management of extraction
human extraction sockets: 2. Histochemical observations at 9 months. site defects. Int J Periodontics Restorative Dent. 1993;13:312-333.
J Periodontol. 2001;72:152-159. doi:10.1902/jop.2001.72.2.152 53. Pozzi A, Tallarico M, Moy PK. The implant biologic Pontic designed
35. Seibert JS, Louis JV. Soft tissue ridge augmentation utilizing a combi- interface: description of the technique and cone-beam computed
nation onlay-interpositional graft procedure: a case report. Int J Peri- tomography evaluation. Clin Implant Dent Relat Res. 2015;17(Suppl 2):
odontics Restorative Dent. 1996;16(4):310-321. Erratum in: Int J e711-e720. doi:10.1111/cid.12320
Periodontics Restorative Dent, 1996;16:521. 54. Gomez-Meda R, Esquivel J, Blatz MB. The esthetic biological contour
36. Prato GP, Cairo F, Tinti C, Cortellini P, Muzzi L, Mancini E. Prevention concept for implant restoration emergence profile design. J Esthet
of alveolar ridge deformities and reconstruction of lost anatomy: a Restor Dent. 2021;33:173-184. doi:10.1111/jerd.12714
review of surgical approaches. Int J Periodontics Restorative Dent. 55. Gomez-Meda R, Esquivel J. Perio-prosthodontic pontic site manage-
2004;24:434-445. doi:10.11607/prd.00.0602 ment, part I: Pontic designs and their current applications. J Esthet
37. Seibert JS, Salama H. Alveolar ridge preservation and reconstruction. Restor Dent. 2023;35:609-620. doi:10.1111/jerd.13023
Periodontol 2000. 2000;1996(11):69-84. doi:10.1111/j.1600-0757. 56. Cairo F, Pagliaro U, Nieri M. Soft tissue management at implant sites.
1996.tb00185.x J Clin Periodontol. 2008;35:163-167. doi:10.1111/j.1600-051X.2008.
38. Calesini G, Micarelli C, Coppè S, Scipioni A. Edentulous site enhance- 01266.x
ment: a regenerative approach for the management of edentulous 57. Thoma DS, Jung RE, Schneider D, et al. Soft tissue volume augmenta-
areas. Part 1. Pontic areas. Int J Periodontics Restorative Dent. 2008; tion by the use of collagen-based matrices: a volumetric analysis.
28:517-523. J Clin Periodontol. 2010;37:659-666. doi:10.1111/j.1600-051X.2010.
39. Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replace- 01581.x
ment grafts in plastic periodontal and implant surgery: critical ele- 58. Gomez-Meda R, Esquivel J. The flat and step (F and S) pontics. Novel
ments in design and execution. J Clin Periodontol. 2014;41(Suppl 15): pontic designs for periodontally reconstructed sites. J Esthet Restor
S123-S142. doi:10.1111/jcpe.12185 Dent. 2022;34:999-1004. doi:10.1111/jerd.12905
40. Bertl K, Pifl M, Hirtler L, et al. Relative composition of fibrous connec- 59. Strauss FJ, Huber BJ, Valdés A, Jung RE, Mühlemann S, Thoma DS.
tive and fatty/glandular tissue in connective tissue grafts depends on Pontic site development for fixed dental prostheses with and without
the harvesting technique but not the donor site of the hard palate. soft tissue grafting: 1-year results of a cohort study. Clin Oral Investig.
J Periodontol. 2015;86:1331-1339. doi:10.1902/jop.2015.150346 2022;26:6305-6316.
41. Dellavia C, Ricci G, Pettinari L, Allievi C, Grizzi F, Gagliano N. Human
palatal and tuberosity mucosa as donor sites for ridge augmentation.
Int J Periodontics Restorative Dent. 2014;34:179-186. doi:10.11607/
prd.1929 How to cite this article: Gomez Meda R, Esquivel J.
42. Sanz-Martín I, Rojo E, Maldonado E, Stroppa G, Nart J, Sanz M. Struc-
Perio-prosthodontic pontic site management, part II: Pontic
tural and histological differences between connective tissue grafts har-
vested from the lateral palatal mucosa or from the tuberosity area. Clin site reconstruction strategies to enhance the esthetic and
Oral Investig. 2019;23:957-964. doi:10.1007/s00784-018-2516-9 biological outcomes. J Esthet Restor Dent. 2024;36(5):737‐745.
43. Sculean A, Gruber R, Bosshardt DD. Soft tissue wound healing doi:10.1111/jerd.13192
around teeth and dental implants. J Clin Periodontol. 2014;41(Suppl
15):S6-S22. doi:10.1111/jcpe.12206

J Esthet Restor Dent - 2024 - Gomez Meda - Perio‐Prosthodontic Pontic Site Management Part II Pontic Site Reconstruction

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

J Esthet Restor Dent - 2024 - Gomez Meda - Perio‐Prosthodontic Pontic Site Management Part II Pontic Site Reconstruction

Uploaded by

Copyright:

Available Formats

Received: 25 October 2023 Revised: 15 December 2023 Accepted: 16 December 2023

Perio-prosthodontic pontic site management, part II: Pontic

Ramon Gomez Meda DDS 1 | Jonathan Esquivel DDS 2

1 | I N T RO DU CT I O N prosthetic design, cleanability, phonetics, and the restoration's prog-

F I G U R E 1 1 Onlay grafts are

on the areas by delivering under contoured provisionals to prevent

FIGURE 13 Pink porcelain used to correct the esthetic limitation.

You might also like