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. 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.
