Prosthodontics & Occlusion · patient case question
Which pontic design is the most difficult for a patient to keep clean?
Patient case: Punched-Out Papillae and a Tight Face
Patient: Two patients in the same session
Chief Complaint: (1) A 21-year-old student: “My gums are killing me and my breath is horrible.” (2) A 47-year-old woman referred with progressive facial tightness.
Background: Patient 1: final examinations week, sleeping four hours a night, smoking a pack a day, has not brushed properly in days. Patient 2: known systemic sclerosis, increasing difficulty opening her mouth.
Medications: Patient 1: none. Patient 2: nifedipine, omeprazole.
Vital Signs: Patient 1: T 100.6°F, HR 92, cervical lymphadenopathy. Patient 2: within normal limits.
Findings: Patient 1: punched-out, cratered, necrotic interdental papillae covered by a grey pseudomembrane, with spontaneous bleeding and severe pain. — Patient 2: taut shiny perioral skin with radial furrowing, maximum opening 26 mm, and on radiographs a uniformly WIDENED periodontal ligament space around multiple teeth which are firm and asymptomatic.
Show answer and explanation
Correct answer: C. Ridge lap (saddle) pontic
- A. The sanitary or hygienic pontic is held clear of the ridge entirely, allowing free passage of floss and a brush beneath it. It is the most cleansable design of all, and is used posteriorly in the mandible where aesthetics are not a concern.
- B. The ovate pontic sits in a surgically or provisionally developed concavity in the ridge. It gives the best aesthetics — the tooth genuinely appears to emerge from the tissue — and it IS cleansable with floss because the contact is convex and shallow.
- C. CORRECT. The RIDGE LAP or SADDLE pontic straddles the ridge, contacting both the buccal and the lingual slopes over a broad concave area. That concavity cannot be reached with floss or a proxy brush, so plaque accumulates against mucosa with no ability to clean it — the result is chronic inflammation, erythema and ulceration of the ridge. It is regarded as obsolete and should not be used.
- D. The modified ridge lap contacts only the BUCCAL slope, giving the appearance of emerging from the ridge while leaving the lingual surface open and cleansable. It is the standard aesthetic pontic for the anterior and premolar regions.
Note: The governing principle for every pontic: CONVEX tissue surface, point or small area contact, and full access for floss. Concavity against mucosa is what makes the saddle pontic unmanageable.
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