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Case Report

Ovate Pontics: Phoenixing the Gingival Contour

Medha Vivek Bhuskute

Department of In today’s busy world, most patients do not have time for long, drawn‑out dental
Prosthodontics, Bhabha

Abstract
College of Dental Sciences,
treatment. The time span between extraction and healing after loss of tooth in the
Bhopal, Madhya Pradesh, anterior esthetic zone can be esthetically and psychologically devastating on the
India part of the patient. Especially, when a maxillary anterior tooth must be extracted
and replaced, immediate tooth replacement with an ovate pontic on a provisional
bridge is a good alternative. Ovate pontic helps in preservation of the interdental
papilla, which in turn preserves the natural gingival contour that would have
otherwise been lost after extraction. An immediate tooth replacement using ovate
pontic not only eliminates the psychologically disturbing partially edentulous phase
but also results in a much more esthetically pleasing replacement of tooth that
is both hygienic and natural in appearance. Another added advantage of the use
of ovate pontic is that it rules out the dissatisfaction resulting from an unesthetic
ridge lap pontic placed directly over edentulous ridge. Just like the long‑lived bird
“Phoenix,” arising out of its own ashes, the ovate pontic creates an illusion that
the pontic is emerging from the gingiva, even after tooth loss. This case report
discusses how an integrated approach of fabricating heat cure provisional bridge
with ovate pontics before extractions, benefitted a young patient in whom fractured
anterior teeth were proposed for extraction.
Received: October, 2017.
Accepted: November, 2017. Keywords: Emergence profile, gingival contour, ovate pontics

Introduction in a dental treatment plan is to preserve interproximal

T he loss of a single anterior tooth can be difficult for
almost any patient, but replacing it with an implant
or a fixed partial denture results in a predictable esthetic
outcome unless significant bone and soft tissue were lost
with the tooth.[1] Even then, in the hands of a skilled
clinician, the result is generally acceptable. Several
factors need to be addressed successfully. These include
the size, shape, shade, and position of the pontic, as well
the emergence profile from the soft tissues.[2] To mimic
the appearance of a natural tooth, the pontic should
appear to emerge from the gingivae and support the
buccal/labial soft tissue as well as the adjacent papillae.
The ovate pontic is a technique used to create the illusion
that the tooth is emerging out of the gum.[3] However, an
ovate pontic design is not usually utilized by clinicians
on a regular basis. One of the most challenging issues
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tissue after the removal of a tooth. To avoid alveolar
bone collapse is highly desirable in restorative dentistry.
It is important to preserve the socket size, shape, and
the space of the gingival tissue to preserve the tissue
height. When a tooth is extracted the recession of the
interproximal papilla, and the collapse of the buccal
bone must be prevented and this means that the extracted
socket must be preserved in the same shape and location.
It is highly important to preserve the papilla during the
extraction procedure and to fill the extraction site with
the provisional pontic as soon as possible.
Address for correspondence: Dr. Medha Vivek Bhuskute,
c/o Shri Shirish Huddar, 51 B, Sada‑Vijay, Shiva Kunj Rly
Housing Society, 12. No. Bus Stop, Arera Colony, Bhopal,
Madhya Pradesh, India.
E‑mail: medhabhuskute@gmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non-commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

DOI: 10.4103/jicdro.jicdro_26_17 How to cite this article: Bhuskute MV. Ovate pontics: Phoenixing the
gingival contour. J Int Clin Dent Res Organ 2017;9:82-5.

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Bhuskute: Ovate pontics: Phoenixing the gingival contour

This case report deals with one such instance of

restoration of traumatized anterior teeth using ovate
pontic design in a young patient for a predictable esthetic
outcome.

Case Report
A 19‑year‑old female patient reported to the clinic with
fractured maxillary right central incisor and lateral incisor.
Her medical history was noncontributory. The dental
history was significant as she accidentally traumatized
her right maxillary central and lateral incisor 2  days
back in an attempt to board the bus and was unable to
chew food and the teeth were painful  [Figure  1]. After Figure  1: preoperative photograph showing fractured right maxillary
central and lateral incisor
rendering primary treatment which included extirpation
of pulp, removal of fractured palatal segment under
local anesthetic and analgesics to relieve the pain, the
following treatment options were discussed with the
patient and her parents.
1. Forced orthodontic eruption of 11, along
with crossbite correction of 22 followed by
implant‑supported crowns with 11 and 12
2. Extraction of 11 and 12 and immediate provisional
bridge with ovate pontics
3. Postendodontic therapy, post and core
restoration,  (with guarded prognosis due to lack
of sufficient tooth structure with 12 and fractured
palatal segment with 11).
Option 2 was chosen by the patient as a provision for
immediate replacement of her damaged teeth was Figure 2: abutment teeth prepared prior to extraction of fractured teeth
considered and was cost‑effective. The teeth adjacent
to the traumatized teeth were prepared, and a fixed
provisional restoration with an ovate pontic extending
3  mm subgingivally was fabricated. The teeth were
extracted atraumatically and the provisional bridge was
tried, relined, and cemented [Figures 2 and 3]. The tissue
surface of the provisional ovate pontics was modified
and polished as per the soft tissue changes at subsequent
visits  [Figure  4]. After a follow‑up for 3  weeks, the
patient skipped her appointments and returned with a
loose provisional and the lost gingival contour [Figure 5].
Phoenixing the gingival contour
Just like the long‑lived bird “PHOENIX” which grows
from its own ashes, it was proposed to recreate the
interdental papilla. Sounding was done under local
anesthetic and using a football‑shaped diamond bur Figure 3: atraumatic extraction of 11and 12
the socket was recontoured, and papilla was recreated
[Figures  6 and 7]. A  new provisional was fabricated and as it is with the provisional restoration  [Figure  9]. This
placed  [Figure  8]. The tissue was allowed to heal. After aids the technician in reproducing adequate intaglio
satisfactory healing, the final impressions were made. contours.[4] A pickup impression was then made and
A  metal trial was done. Pattern resin  (GC America Inc,) sent to the laboratory. The final ovate pontic anterior
was used to record the details of tissue surface to facilitate bridge was fabricated and delivered to the patient with
the exact reproduction of tissue in the same position acceptable esthetic outcome as shown in Figure 10.

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Bhuskute: Ovate pontics: Phoenixing the gingival contour

Figure  4: 1 weeks postoperative photograph showing satisfactory Figure 5: 3 weeks recall picture: Gingival contour lost
aesthetic outcome

Figure 7: football-shaped diamond used to recreate interdental papilla

Figure 6: sounding done under LA

Figure 8: 1 week later photograph with phoenixed gingival contour Figure 9: pattern resin used to record intaglio contours similar to that of
provisional restoration

Discussion outcome. Multiple tooth loss and if adjacent to each

Anterior tooth loss can be esthetically and psychologically other becomes even more challenging for the restorative
disturbing for a patient. Usually, patients demand dentist. In most circumstances, a combination of implants
immediate restorations with a predictable esthetic and ovate pontics is needed.

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Bhuskute: Ovate pontics: Phoenixing the gingival contour
Figure 10: fixed anterior bridge placed in mouth
In this case, ovate pontic design was intended to form
a concave soft‑tissue outline in the site of the alveolar
ridge mucosa for a satisfactory esthetic outcome.[5] The
tissues were sculpted for guided papilla growth and
stabilization.[2]
Advantages of the use of ovate pontics in anterior
esthetic zone:
1. Preservation of the interdental papilla and natural
gingival contour
2. Eliminates the psychologically disturbing partially
edentulous phase
3. Hygienic and esthetically pleasing replacement
natural in appearance
4. Rules out the dissatisfaction resulting from an
unaesthetic ridge lap pontic
5. Eliminates unaesthetic “black triangles.”
Instructions to the patient during the temporization phase
regarding cleaning and need for regular recalls have to
be emphasized. Failure to address this vital issue resulted
in the loss of tissue contour and an additional chairside
procedure was performed prolonging the treatment time.
So as to replicate the gingival contour and to develop
an appropriate gingival profile, the transfer of sculpted
tissue beneath the provisional restoration accurately, is
critical. This aids the laboratory technician to simulate
the contours of the provisional in permanent prosthesis.
Irrespective of the techniques, the viscosity of impression
material may record the sculpted tissue in an altered
state.[2] Collapse of tissue due to removal of provisional
may magnify this problem. Pattern resin has low
polymerization shrinkage and due to high hardness and
strength exhibits high stability even in thin layers. It is
dimensionally stable even after hours or days and no
dimensional changes due to room temperature. The use
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of pattern resin thus precisely captures the tissue details
as opposed to techniques previously described which
involved the modification of master cast.[6‑8] The patient
was also advised orthodontic correction of crossbite with
tooth 22, for an improved smile in the future.
Conclusion
The final choice of treatment for individual patient must
occur on a case‑by‑case basis. It is extremely important
to recognize in advance the various potential outcome
possibilities that exist as a result of each patient’s
presenting condition to make the most informed and
realistic decisions about the best treatment options.[1] The
control of the gingival contours is just as important as
the form of the teeth for a desired outcome.
Declaration of patient consent
The authors certify that they have obtained all
appropriate patient consent forms. In the form the
patient(s) has/have given his/her/their consent for his/
her/their images and other clinical information to be
reported in the journal. The patients understand that their
names and initials will not be published and due efforts
will be made to conceal their identity, but anonymity
cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Spear  FM. The use of implants and ovate pontics in the esthetic
zone. Compend Contin Educ Dent 2008;29:72‑4, 76‑80.
2. Edelhoff  D, Spiekermann  H, Yildirim  M. A  review of esthetic
pontic design options. Quintessence Int 2002;33:736‑46.
3. Noriega  EB. Ovate Pontic: Natural Look. Active Member of the
American Academy of Cosmetic Dentistry No. 001568.
4. Jambhekar  SS, Kheur  MG, Matani  J, Sethi  S. Easy accurate
transfer of the sculpted soft tissue contours to the working cast:
A clinical tip. J Indian Prosthodont Soc 2014;14:337‑40.
5. Dylina  TJ. Contour determination for ovate pontics. J  Prosthet
Dent 1999;82:136‑42.
6. de Vasconcellos  DK, Volpato CÂ, Zani  IM, Bottino  MA.
Impression technique for ovate pontics. J  Prosthet Dent
2011;105:59‑61.
7. Chee WW, Cho  GC, Ikoma  MM, Arcidiacono A. A  technique to
replicate soft tissues around fixed restoration pontics on working
casts. J Prosthodont 1999;8:44‑6.
8. Ferencz  JL. Maintaining and enhancing gingival architecture in
fixed prosthodontics. J Prosthet Dent 1991;65:650‑7.
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