Introduction
It is common for a patient receiving clear aligner orthodontic treatment to have one or more missing teeth. One of the benefits of using clear aligners is that we can create a pontic, to fill in the missing space. 1, 2, 3, 4, 5
A pontic is a tooth-shaped substitute created in the gap left by missing or extracted teeth. Since the clear aligner does not cover a tooth in this location in the patient's mouth, there is a resulting gap in the clear aligner. However, this gap may be painted or filled to make it appear like a tooth. Conventionally, the pontic is made in the 3D printed models using light cure radiopaque composite [Figure 1]. However, it requires good dexterity to build teeth with composite matching the anatomy of the natural teeth, without flowing over adjacent teeth This process is not cost-effective and is also a time-consuming procedure.
In this clinical tip, we describe an innovative technique for creating a pontic on the 3d printed models which replicate in the clear aligner to maintain esthetics in patients in whom extraction of anterior teeth is planned or already have missing anterior teeth.
Method of fabrication
Select the acrylic tooth which is missing in the patient/model from the acrylic teeth set [Figure 2] which is generally used for denture preparation.
If required, trim the acrylic tooth according to the space available for the pontic. This can be done using a micromotor and handpiece with a stone bur [Figure 3]
Add a layer of light cure radiopaque composite at the base of the extraction space/missing tooth.[Figure 4]
Fix the acrylic tooth on the composite base manually.[Figure 5] and check that the height of the acrylic pontic should be equal to the adjacent teeth, and not interfere with the occlusion [Figure 6].
Cure the composite using LED curing light [Figure 7]
Thermoforming of the aligner is done [Figure 8]
After retrieval, remove the acrylic tooth from the models for reuse in the future [Figure 9].
The filling of pontic space in the aligner can be done using the method described by Vaid NR et al1 using flowable composite [Figure 10, Figure 11].
Advantages
The acrylic teeth used in the models for pontic can be reused in other similar cases by removing them after the aligner retrieval process to cut the production cost.
The acrylic teeth simulate the undercut and anatomy of natural teeth resulting in the better fitting of aligner and esthetics [Figure 12].
