Achieving the optimal emergence profile: the role of soft tissue grafting and pontic site development

Hard and soft tissue remodelling after tooth extraction may result in a concave profile at the subsequent edentulous ridge. This defect may result in a sub-optimal aesthetic transition zone between the soft tissue and the pontic, which may appear to sit on the ridge, rather than emanating from within the ridge, as would a natural tooth. To optimise aesthetics, pontic site augmentation (PSA) (increasing the volume at the pontic site) and pontic site development (PSD) (remodelling the tissue at the pontic site) may provide a solution.

This article discusses the role of soft tissue grafting for PSA, alongside the techniques employed for PSD. Biomaterial substitutes may be used for soft tissue grafting; although autogenous tissue remains the gold standard. Patients may benefit from biomaterial substitutes (as no donor site is required) but evidence for long-term volumetric stability within this specific scenario is limited.

Studies suggest PSD may be initiated three months post-augmentation, with minimal changes in site volume following this time point; although again, clinical data are limited. PSD can be achieved via several techniques, depending on operator and patient preference, with the ultimate goal of tissue conditioning to accept a convex fit surface that facilitates hygiene practices. PSA and PSD play key roles in the creation of a natural emergence profile at edentulous sites, leading to optimal aesthetics and cleansability.