Dr. Hall,

My dentist says he can't use an ovate pontic for my dental bridge because the ridge of gum is healed, and this technique is only used when there is a freshly extracted tooth. Is that true? Is there another technique that can make my tooth look like it is growing out of the gum so it is more natural?

-Brenda from Florida

Brenda,

The ovate pontic technique is primarily used when the ridge is fully healed, as in your situation. But it is common, when you present a technique to your dentist that he or she isn't too familiar with, for the dentist to deflect your request by saying that it won't work in your situation. I hear this all the time.

The photographs below show the ovate pontic technique. In the "before" photo, the tooth had been missing for years, and the ridge was fully healed. The gum tissue was surgically sculpted to prepare it for receiving the false tooth.

Here is a photograph of teeth prepared for bridgework, with the sculpted ovate pontic site.	Here are the same teeth, with the bridge in place. The tooth in the middle, the lateral incisor, is a false tooth and is an ovate pontic. This work was performed by Dr. Hall.

Your approach here is a common mistake people make. It is easy to think you can research a technique on the Internet and then tell your dentist about it and get him or her to use this technique. But this doesn't work-there's a steep learning curve for most of these techniques, and there has to be a passion for appearance-related issues that the dentist feels. These cosmetic dentistry techniques aren't hidden. Your dentist has probably heard about this technique but hasn't taken the trouble to become familiar with it enough to use it.

A dentist who really knows how to do the ovate pontic technique will want to use it for most anterior bridge cases. Only when the bone has shrunk drastically can this technique not be used. And even then, there are "ridge-plumping" techniques that can build up the ridge, if appearance is important enough to the patient.

-Dr. Hall

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