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MODIFIED NTP: Author's response
L E T T E R S
LETTERS ADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
J
MODIFIED NTP
The technique of using a natural tooth pontic, or NTP, as featured in Dr. James L. Kretzschmar’s “The Natural Tooth Pontic: A Temporary Solution for a Difficult Esthetic Situation” (November JADA) definitely has merit. However, the technique used by Dr. Kretzschmar needs to be modified for a more predictable outcome. As described in the article, the pontic should be left out of contact with healing tissue. This method is fine if you wish to end up with flattened papillae and unaesthetic tissue contours. The role of the provisional pontic in healing is not just to maintain space for the final tooth replacement, but also to sculpt tissue during healing to maintain and preserve inter-dental papillae as close to their pretreatment form as possible. Once lost (as will happen if this article’s technique is followed), it is doubtful that one would ever regain the papillae to their original contours with any degree of predictability. This phenomenon has been discussed in great detail by clinician lecturers such as Dr. Frank Speer and Dr. John Kois. 144
To increase the odds for a more predictable and esthetic outcome, one could use the NTP, but should add to and contour the cervical area to support the tissue during healing. Barry D. Hammond, D.M.D. Greer, S.C. Author’s response: Thanks to Dr. Hammond for his comments regarding the attempt to sculpt healing gingival tissue. Yes, the option of using an ovate pontic shape to support proximal papillae and facial soft tissue may help in achieving optimal esthetics. The patient’s overall health, oral hygiene and physical ability to keep the area clean also should be considered to minimize the possibility of a postsurgical complication. Taking all considerations into account, the clinician will be able to arrive at an appropriate plan for the patient’s treatment. James L. Kretzschmar, D.D.S. Pope Air Force Base, N.C. PROBLEM PATIENTS
I want to commend Dr. Gordon Christensen on his outstanding article, “Treating the Potential Problem Patient” (November JADA). Dr. Christensen pointed out many important things to be aware of when treating patients you consider to be a potential problem in the dental office. This is an excellent article for all dental students and recent graduates to read. Many think that once they have their dental degree and/or specialty degree and board certification in that specialty, they are able to treat patients who are unable to be treated in other offices. It is enlightening for younger practi-
tioners to see that someone of Dr. Christensen’s training and experience also faces problems of not being able to meet some patients’ expectations. Congratulations on another excellent and enlightening article. Glenn J. Wolfinger, D.M.D. Fort Washington, Pa. AGE AND CARIES
In their responses to Drs. Hays’ and Snaer’s November JADA letters to the editor criticizing their conclusions in the study related to early air abrasion treatment of suspect pits and fissures (“A Clinical Evaluation of Air-Abrasion Treatment of Questionable Carious Lesions: A 12-Month Report,” June JADA), Dr. James C. Hamilton and colleagues rely heavily on a rationalization that “56 percent … did not require treatment.” They responded that they would not seal the suspect pits and fissures in the older members since “age was negatively correlated with caries … .” These are both statistically true statements that I am sure every dental insurance actuarial accountant wrote down as soon as they read them. The following is also true: 44 percent of the sample teeth had decay into the dentin and a totally noninvasive procedure (sealants) can easily prevent pit and fissure decay in seniors, though it may be somewhat rarer than in 14-year-olds. In some cost/benefit analysis of dentistry where we are trying to maximize public health for a given amount of money, or where others would be denied care because an “unnecessary filling” was done for someone else, I would give their research
JADA, Vol. 133, February 2002 Copyright ©2002 American Dental Association. All rights reserved.
LETTERS ADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
J
MODIFIED NTP
The technique of using a natural tooth pontic, or NTP, as featured in Dr. James L. Kretzschmar’s “The Natural Tooth Pontic: A Temporary Solution for a Difficult Esthetic Situation” (November JADA) definitely has merit. However, the technique used by Dr. Kretzschmar needs to be modified for a more predictable outcome. As described in the article, the pontic should be left out of contact with healing tissue. This method is fine if you wish to end up with flattened papillae and unaesthetic tissue contours. The role of the provisional pontic in healing is not just to maintain space for the final tooth replacement, but also to sculpt tissue during healing to maintain and preserve inter-dental papillae as close to their pretreatment form as possible. Once lost (as will happen if this article’s technique is followed), it is doubtful that one would ever regain the papillae to their original contours with any degree of predictability. This phenomenon has been discussed in great detail by clinician lecturers such as Dr. Frank Speer and Dr. John Kois. 144
To increase the odds for a more predictable and esthetic outcome, one could use the NTP, but should add to and contour the cervical area to support the tissue during healing. Barry D. Hammond, D.M.D. Greer, S.C. Author’s response: Thanks to Dr. Hammond for his comments regarding the attempt to sculpt healing gingival tissue. Yes, the option of using an ovate pontic shape to support proximal papillae and facial soft tissue may help in achieving optimal esthetics. The patient’s overall health, oral hygiene and physical ability to keep the area clean also should be considered to minimize the possibility of a postsurgical complication. Taking all considerations into account, the clinician will be able to arrive at an appropriate plan for the patient’s treatment. James L. Kretzschmar, D.D.S. Pope Air Force Base, N.C. PROBLEM PATIENTS
I want to commend Dr. Gordon Christensen on his outstanding article, “Treating the Potential Problem Patient” (November JADA). Dr. Christensen pointed out many important things to be aware of when treating patients you consider to be a potential problem in the dental office. This is an excellent article for all dental students and recent graduates to read. Many think that once they have their dental degree and/or specialty degree and board certification in that specialty, they are able to treat patients who are unable to be treated in other offices. It is enlightening for younger practi-
tioners to see that someone of Dr. Christensen’s training and experience also faces problems of not being able to meet some patients’ expectations. Congratulations on another excellent and enlightening article. Glenn J. Wolfinger, D.M.D. Fort Washington, Pa. AGE AND CARIES
In their responses to Drs. Hays’ and Snaer’s November JADA letters to the editor criticizing their conclusions in the study related to early air abrasion treatment of suspect pits and fissures (“A Clinical Evaluation of Air-Abrasion Treatment of Questionable Carious Lesions: A 12-Month Report,” June JADA), Dr. James C. Hamilton and colleagues rely heavily on a rationalization that “56 percent … did not require treatment.” They responded that they would not seal the suspect pits and fissures in the older members since “age was negatively correlated with caries … .” These are both statistically true statements that I am sure every dental insurance actuarial accountant wrote down as soon as they read them. The following is also true: 44 percent of the sample teeth had decay into the dentin and a totally noninvasive procedure (sealants) can easily prevent pit and fissure decay in seniors, though it may be somewhat rarer than in 14-year-olds. In some cost/benefit analysis of dentistry where we are trying to maximize public health for a given amount of money, or where others would be denied care because an “unnecessary filling” was done for someone else, I would give their research
JADA, Vol. 133, February 2002 Copyright ©2002 American Dental Association. All rights reserved.