I'm welcome to chairside live I'm Megan strong and I'm Wilson a registered dental assistant here
at gladwell dental and as a registered dental assistant you often give us cases for across
the chair and I hear you've got a good one for us today you're taking it back to the biochips
and brazier case that's that good old three unit biochemist bridge and now you're talking
Ponton Megan did you know that on our prescription forms we have an area where doctors can actually
designate what plastic design that they want we do we absolutely do and do you know take a wild
guess who in the laboratory is designing these products if the doctor doesn't communicate the
Elvis Presley exactly the lab technician having never seen this patient before is designing these
projects and we have some really neat ideas for product designs and I think doctors should know
okay and I know artificial intelligence plays a role in trimming the models so I mean call wilson
myth is this iRobot it really is it Megan you and I in fact are in danger of being replaced
by robots hosting this very show don't tell me but all joking aside Jim Clive Oh is very proud
of artificial intelligence and how accurately our restorations are being designed in the lab
instead of being hand designed these days this gives doctors the perfect platform to have a
perfect well fit restoration every time as long as communication is - oh okay let's see your case
well recently I presented a chairside live video about techniques that I use when preparing healthy
embrasures for bio temps you can find the link to that episode floating around on the screen
somewhere if you'd like to use it to catch up on today's talk I used a three-unit bio temp
bridge for that demonstration and as I watched the video back myself I started to think about
the actual design of the bridge Pontic and I realized that for as much as I was promoting the
opening of the embrasures and Cleanse ability I noticed that the Pontic design itself might
not have been the best ideal shape to promote healing and long-term success of the eventual
final restoration and its aesthetics this gets me thinking more about informed choices that we
are able to make chairside with the pay right in front of us but also our willingness to share this
information with the dental lab interestingly enough it's usually the lab technicians who are
designing pond tix in fact discussions about planting design happened pretty routinely in
the lab the tech gets the model work or the scan and then has to wonder exactly what type
of Pontic they are supposed to design now I'm employed full-time in the lab environment so I
know firsthand that is a common occurrence for the design to not be chosen on the prescription
form despite the existence of a checkbox for it even if one of these boxes is checked it's
even less likely that additional information is provided so take for instance the Pontic design
on this three unit bio temp bridge now remember this is the same bridge that I talked about in
my last episode when I turn it around you can see the appearance of a ridge lap Pontic design
it's also called a saddle ridge lap because it looks like a riding saddle that's worn over the
back of a horse it's a fairly aesthetic design from any angle but its major flaw is its lack of
Cleanse ability and it often results in irritated tissue in fact most dentists that I've talked to
about this tell me that they absolutely do not use Saddle Ridge lap contacts in their practice nor do
they even consider them as an option an option that is more commonly used instead of the full
saddle ridge lap Pontic design is what is known as a modified Ridge lap this Pontic is shaped so
that the saddle laps over the buckle side only the shape and size of the ridge and restoration
dictate the lingual design but it does curve in to leave the lingual Ridge exposed this is
fairly aesthetic and more cleansing than the full Ridge lap since the purpose of today's video is to
create a clearer line of communication between the practice and the lab an important feature
to discuss about modified Ridge lap designs is exactly where and by how much should the
lingual be adjusted according to this specific patient's Ridge so let's take a look at a few
more options at your disposal the ovate Pontic design is ideal for the anterior however it's not
limited and can be used for posteriors because it is highly aesthetic and low maintenance this
design creates a bit of a depression or an indentation in the residual tissue Ridge so
that it mimics the shape of a natural root and Crown now the Pontic looks like growing out of
the gum tissue and just not resting on top of it so what if your lab tech having been given little
to no design instruction on the prescription shapes and ovate Pontic because they think it
will look the best are you sure this is going to seat would you be comfortable modifying the
tissue intro orally to match the amount that was trimmed out of the cast or would a trial
or training period in a provisional with an ovate design be more appropriate this affords you the
ability to carefully treatment plan over time and make an informed decision on the lab prescription
by specifying details for a more predictable final bridge playing off of the shape of the
ovate design a conical Pontic also called egg shape board shaped or even heart shaped has
only one point of contact at the center of the residual Ridge but it does not depress into it
as the ovate design usually will it should be made as convex as possible and this makes it easy for
the patient to clean this design is recommended more for replacing mandibular posterior areas
where aesthetics are less of a concern the final design I'd like to talk about today is
the hygienic and also called sanitary Pontic this design is easily cleanser Bowl and ideal for the
health of the tissue especially new surgical sites however it is not at all aesthetic it could lead
to food entrapment and can become annoying to the tongue over time it is fabricated to have
zero tissue contact sometimes 2 to 3 millimeters of space in fact it is traditionally shaped convex
to match the tissue it spans this shape is loosely known as a fish belly it can also be modified to
shape the gingival portion concave to resemble sort of an archway between the retainers this
allows for increased connector size and decreased stress during load-bearing these differences make
it seem like the hygienic design contradicts itself from concave to convex and fish bellies
to fixed arcs the design parameters can become elaborate and even confusing keep in mind that
you are doing your lab tech and your patient the best service by specifically addressing these
important issues doctors and assistants should all run through a mental checklist of for Barry
standards of design first the tissue surface of the Pontic should be shaped for ease of cleaning
second Pontic should never have positive pressure on the underlying tissue unless
they're meant exclusively poor provisional shaping third pond ticks and connectors must
be built to withstand occlusal forces finally pontiff's should restore aesthetics here's to
your success with future treatments thank you so much for watching I hope this bridge the
gap between the dental practice and the lab when talking about communicating designs I think it did
just that well that wraps it up for this episode of chairside live on behalf of everyone here at
gladwell dental thank you so much for watching and we'll meet you right back here next time