Dentists often encounter cancer patients, who are to undergo radiotherapy or have received it in the recent past. Besides cancer therapy, these patients need dental treatment for different ailments. Therefore, it becomes paramount important for a dentist to know the effects of large doses of ionizing radiation on oral mucosa.
In this section, we shall talk about the effects of radiation on oral tissues.
The pontic, \pŏn΄tĭk\, is an artificial tooth on a fixed partial denture that replaces a missing natural tooth, restores its function, and usually restores the space previously occupied by the clinical crown. An ideal correctly designed posterior pontic should have the following features.
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| Figure 1. Schematic presentation of various pontic designs; (a) Sanitary pontic; has no contact with the edentulous ridge, (b) ridge lap pontic; forms a large concave contact replacing the contours of a missing tooth, (c) modified ridge lap; shows illusion of a tooth but it has all or nearly all convex surfaces for easy cleaning and minimize plaque accumulation, (d and e) bullet/conical; rounded and cleanable smaller tip in relation to overall size, (f) ovate; round end design currently in use where aesthetics is a primary concern[1]. |
The Pontic design can be classified into two types:
A. Pontic having mucosal contact
B. Pontic with no mucosal contact
Sanitary or Hygienic Pontic or Fish-Belly
Sanitary pontic makes no contact with the edentulous ridge. It is made in an all-convex configuration, facio-lingually and mesio-distally. The space between the pontic and the mucosa should be 2 or 3 mm [2]. It is the most commonly used mandibular molar replacement pontic design. It has the advantage of providing good access for maintaining hygiene with the disadvantage of poor esthetic.
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| Sanitary pontic design |
Modified Sanitary
The tissue facing surface of the modified sanitary design pontic has a hyperbolic parabola. The pontic is designed as a concave archway mesio-distally while the under surface is convex facio-lingually. It is indicated in molar replacement, provides access to the under-surface for good hygiene, along with poor esthetic.
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| Modified sanitary pontic design-note the concavity at the cervical region. |
Saddle/Ridge Lap
It looks like crown of the tooth because it replaces all the contour of the missing tooth. It maintains a large concave contact with the underlying ridge and obliterates facial, lingual and proximal embrasures. Esthetic wise it provides the best result but due to impossible access to under-surface for cleaning, its use is limited for the replacement of maxillary incisors.
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| Saddle/ridge lap pontic design |
Modified Ridge Lap
The modified ridge lap combines esthetic with easy cleaning and makes contact with ridge tissues in the shape of ‘T ‘ whose vertical arm ends at the crest of the ridge. This design is most commonly used in the area of the mouth that is visible during function, e. g. anterior teeth, premolars and sometimes maxillary molars.
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| Modified ridge lap pontic design: note the half concave underneath surface in contact with mucosa. |
Conical
Conical pontic design is mostly limited to the replacement of thin knife edged ridges in the non-display zone of the mouth. It has a convex surface with only touching the center of the residual alveolar ridge. It helps maintain good hygiene with poor esthetic. Conical design is indicated for the replacement of molars.
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| Image of conical pontic design- note the egg shaped design in green circle. |
Ovate
Ovate pontic design is the most aesthetically suitable appealing design that looks like emerging from the gingiva. When ridge resorption is corrected by ridge augmentation, ovate design appears to be emerging through gingiva just like natural tooth. it is indicated for the replacement of maxillary incisors, canines, and premolars. It has the advantage of best esthetic, negligible amount of food entrapment and easy cleaning. The disadvantage is the requirement of surgical preparation of the receiving site before prosthesis fabrication.
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| Ovate pontic design-note the convex under-surface of pontic embedded in mucosa (green circle). |
References:
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| Saudi Arabia Riyadh landscape at Morning – Riyadh Tower Kingdom Centre, Kingdom Tower, Riyadh Skyline – Burj Al-Mamlaka, AlMamlakah – Riyadh at Daylight – Tower View-Getty Images |
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....... Continues
With the passage of time, Ganesh became aware of the situation of his family. He started to understand the pain of his wife and the thought process of his father. He, who always cared for him, was worried about his future; the future ahead of his family life as well as financials, as it has to have a long-lasting effect on his Son too.
Both Ganesh and his wife dropped the idea of ADC as it was clear, no matter how hard they try it, it was not meant for them. Moreover, they were out of funds, rather, better word was, in negative funds. So, to regain their lost finances, they modified their plan.
The plan was to try for a gulf job and regain the lost finance. They consulted with their friend who had experience of the gulf job. Ganesh and his wife got a decent job in Saudi Arabia. It was a job in a remote area of the Kingdom, but since they had their own circumstances, they adjusted themselves in a few months.
In this world there is no end to issues, no matter where a person lives. This soon started being applied to them too. A recently came new dentist in their workplace had Arab origin and the staff started giving him preferential treatment. The distribution of work started skewing, putting Ganesh in a difficult situation. His wife was cool as being a female, she was spared, or the person involved had no guts to disturb her and be caught in a situation that might have backfired.
Ganesh contacted his friend for solace. He understood his situation and the options available. He decided, as long as I am getting my salary, I have to stay here and refill my coffer. There was no second choice.
His wife and he stayed for five years in Saudi Arabia and then started thinking of coming back to India. They have earned sufficient, filled their coffer and most importantly regained lost self-esteem and self-worth. Their family life has again come back on a smooth track.
Before coming back to India, Ganesh refurbished his old clinic when he had visited India last time. It was ready to start the work. Ganesh started working in his own clinical practice the next day of arrival to India. His wife got her old tutoring job back in the same college she was teaching in. Within a year, they decided to open a second clinic. Soon it was booming by the hard-working ethics of his wife, who decided to go take the clinical practice as full-time work.
The couple decided to buy a house near their old home and were happy ever after. Ganesh remained obliged to his friends who supported him during his bad time.