Solving Esthetic Dilemmas for Provisional Restorations: Part I

Have you ever made a maxillary anterior provisional bridge and the pontic was not acceptable from an esthetic perspective?

provisional pontic figure 1
Figure 1. Low-value provisional pontic

The provisional pontic frequently appears lower in value compared to the abutment teeth. This is true whether the provisional is made of bisacryl or PMMA materials.

There are two reasons this occurs:

  1. The provisional material thickness is significantly different between the units of the bridge. The material is relatively thin on the abutment teeth and thick for the pontic.
  2. There is provisional cement used on the abutment tooth, which is typically opaque and high in value (bright).

The combination of thin, provisional material and high-value cement make the appearance of the final cemented bridge abutment higher in value and more opaque relative to the pontic, which has no cement and thicker material. 

lingual incisal third trough
Figure 2. Lingual incisal third trough

If this problem occurs, follow these simple steps to achieve the desired esthetic outcome.

  1. Grind out the inside of the pontic with a carbide bur (Brasseler H390E 016 and H139EF 023).
    1. Access the inside through the tissue side of the pontic.
    2. The facial aspect of the pontic should be thinned to the same thickness of the abutment.
  2. Air abrade the surface with 50-micron aluminum oxide at 20-40 psi at a distance of 1.0 cm. 
  3. Clean the surface with an air-water spray or in an ultrasonic using water.
  4. Apply two coats of dental adhesive, light curing only the first application.
    1. I use 3M Single Bond Pus or Ivoclar-Vivadent Adhese Universal.
  5. Place an opaque high-value composite resin into the hole that has been created. In this case, Tokuyoma Estelite Omega Bleach 1 was used.
  6. Trim to the desired ovate pontic design with the green rubber wheel shaper (Brasseler RW GPP) or similar.
  7. Polish the surface with the pink rubber polisher (Brasseler RW PPP) or similar.  
lingual contoured and polished
Figure 3. Lingual contoured and polished

By following this simple technique, you will find there is a significant improvement in the esthetic match of all units in an anterior provisional bridge.

adjusted value provisional pontic
Figure 4. Adjusted value provisional pontic

(Click this link to read more dentistry articles by Dr. Bob Winter.)

Bob Winter, D.D.S., Spear Faculty and Contributing Author


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Comments

Commenter's Profile Image Ali A.
July 10th, 2020
That’s an awesome technique. But, I’m not sure if I will invest the time and material to do this, unless the pt is going to wear it for a long time before the finals. Great piece, thanks.