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