By Dr. Mars Lans with a case study by Dr. Richard Emanuel

    The Solopontic(TM) by Keller Laboratories, Inc., allows for the fabrication of potentially long-term provisional fixed prostheses. The Solopontic can be used in a variety of applications and, as in this case, combined with composite bonding procedures to achieve a result that can be most rewarding for patient and dentist alike. The inventors of the patented Monodont stainless steel components used in all Keller Solopontics have described three basic techniques:

    1) Direct-Direct Technique–Primarily used in emergency situations, this technique is totally chairside, using composite for the pontic material.
    2) Direct-Indirect Technique–Preparations are cut, impressions are sent to the lab for fabrication.
    3) Indirect-Indirect Technique–Proving to be the most widely used technique because of its cost-time efficiency; this method requires no preparations prior to impression-taking.

    This technique article describes the Indirect-Indirect method. All laboratory fabrication by Keller Labs, St. Louis, Mo.

Indirect-Indirect Technique
     An upper and lower impression are taken. If the impression can be poured up immediately, a full-arch or quadrant tray (as appropriate) with alginate will offer sufficient accuracy. If the laboratory will pour the impression, I suggest the use of a dimensionally stable material such as a vinyl polysiloxane.
    The appropriate shade is selected using a shade guide corresponding to the pontic material used (Bioform in most cases). It is strongly suggested that the clinician refer to whatever shade guide is being used by the laboratory.
    No preparations are cut at this time; therefore no temporization is necessary.

Laboratory Fabrication Steps
1) Model are poured and articulated.
2) Preparations are cut on the model. Anterior preps are merely conservative Class III going through the contact point of the proximal surface. A 37-inverted cone (or equivalent) bur can serve as a gauge.
3) Appropriate-size Monodont components are selected. In this case, both laterals will be fabricated using EF-70 Monodonts.
4) Acrylic pontics are relieved from the lingual as needed.
5) Acrylic pontics are bonded to 50-micron aluminum oxide-blasted components using Pro-Tech U-Bar acrylic material.
6) Completed, finished, and polished, Solopontics Bridges are ready for insertion.

Preparation guide and positioning stent
    The laboratory will construct a prep guide/positioning stent that will guide the clinician as to the placement of the preparations as well as the positioning of the pontic prior to light-curing the retentive composite. The prep guides function the same way that an implant surgical prep stent would function. It aids in the location of the penetration, in this case into the hard tissue of the abutment tooth. It is important to note that the function of the guide is not to act as a depth gauge; it is intended to be used to “spot” the location of the prep on the lingual or occlusal surface of the abutment teeth.
    After the prep has been spotted, the clinician will remove the stent and detail the prep with the requisite undercuts and dimensions. The same stent will be utilized later in the procedure to position the pontic prior to light-curing the retaining resin.

Dr. Richard Emanuel’s case study
St. Louis, Mo.
    Dr. Richard Emanuel of St. Louis, Mo., recently completed a case on an ideal Solopontic(TM) candidate. Dr. Emanuel’s patient is a young male (27 years old) with congenitally missing laterals. This patient was concerned with esthetics as well as economics.

    Photo 1 (lower left)–Patient with congenitally missing #7 and #10.
    Photo 2 (lower middle)–Patient with Solopontics #7 and #10.
    Photo 3 (lower right)–Dr. Emanuel further enhanced esthetics using a chairside composite to close the patient’s diastema.

Solopontic Protocol
First Visit
1) No tooth preparation
2) Take impression, including opposing impression, and a bite registration
3) Select shade.

Laboratory
1) Make models and fabricate Solopontic
2) Make prep/positioning guide.
3) Return Solopontic and prepped model with prep/positioning guide.

Second Visit
1) Place prep/positioning guide without Solopontic and mark rest placement with 37-inverted cone diamond burr.
2) Remove guide and complete a Class 3 undercut prep in the contact area.
3) Try in Solopontic.
4) Etch preparations. Apply a thin coat of primer/bonding agent on prep and on metal wings.
5) Apply initial layer of flowable composite into preparations.
6) Seat Solopontic using prep/positioning guide.
7) Clean up excess composite and light cure.
8) Remove positioning guide and back fill undercut preparations with hybrid or flowable composite and finish.

Solopontic’s Indications:
•  Immediate fixed prosthesis
•  Alternative to single-tooth flipper partial or unilateral “spider” partial.
•  Transitional prosthesis during complex treatment planning
•  Perio, ortho, or implant patients needing an esthetic, fixed transition prosthesis.
•  Patients with limited financial resources for traditional fixed or implant treatment.
•  Young patients needing conservative, non-aggressive treatment.