CLASSIC ARTICLE

Current theories of crown contour, margin placement, and pontic design

Curtis M. Becker, DDS, MSD,a and Wayne B. Kaldahl, DDSb
University of Colorado, School of Dentistry, Denver, Colo, and University of Nebraska,
School of Dentistry, Lincoln, Neb

O ne of the prime goals of restorative therapy is to

establish a physiologic periodontal climate and facilitate
the maintenance of periodontal health. Crown contour,
margin placement, and pontic design all affect periodon-
tal health. This article reviews the current theories of all
three of these.

CROWN CONTOUR
The contours for full and partial coverage restora-
tions play a supportive role in establishing a favorable
periodontal climate. Three prominent theories of crown
contour have evolved: (1) ginvial protection, (2) muscle
actions, and (3) access for oral hygiene.
Gingival protection theory
The gingival protection theory advocates that con-
tours of cast restorations be designed to protect the mar-
ginal gingiva from mechanical injury (Fig. 1). The
concept of protecting the gingiva has been with den-
tistry for many years.1,2 A number of dental anatomy
textbooks,3,4 periodontal textbooks,5,6 and respected
clinicians1,7,8 advocate the concept of gingival protec-
tion with little or no supporting scientific evidence.
Statements in support of gingival protection appear to
be primarily empirical. Wheeler9 has stated, ‘‘The gin- Fig. 1. Double deflecting contours have been advocated by
giva is apt to be stripped or pushed apically through some authors, allegedly to protect the marginal gingiva from
lack of protection and consequent overstimulation.’’ mechanical injury.
The axiom of gingival protection has become so in-
grained in the dental literature and teaching that for
years this concept was seldom challenged. Some dentists The gingival protection theory has been defended
and laboratory personnel apparently have reasoned that, primarily on the basis of three elements: protection of
if a little gingival protection is good, then more is better. gingival margins, gingival stimulation, and self-cleans-
This theory and the increased use of full coverage veneer ing contours.10
crowns have produced an era of overcontoured restora- Protection of gingival margins. This concept im-
tions. Wheeler9 has remarked that, when molars have plies that undercontouring of the clinical crown will
curvatures in excess of normal, the gingiva will be over- cause deflection of masticated food onto the gingival
protected and will suffer from lack of proper stimulation. margin, forcing it into the sulcus, thus initiating gingivi-
Wheeler’s warning was based on ‘‘protection’’ of the tis.
gingiva. This concept may have originated from the observa-
tion that interproximal food impaction occasionally
a
Clinical Assistant Professor, Department of Restorative Dentistry, can initiate acute inflammation. However, numerous
University of Colorado, School of Dentistry. studies have demonstrated a cause-and-effect relation-
b
Assistant Professor, Department of Periodontics, University of
Nebraska, School of Dentistry.
ship between plaque and gingivitis,11-13 and in compar-
Reprinted with permission from J Prosthet Dent 1981;45:268-77. ison, the interrelationship of periodontal disease and
J Prosthet Dent 2005;93:107-15. food impaction appears slight. Many authors14-17 have

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THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 2. The temporary crown on this molar has been missing
for 8 weeks; in spite of the obvious lack of contour, there is no
evidence of marginal inflammation, food impaction, or
gingival stripping.
Fig. 4. Buccal and lingual contours of full and partial
coverage cast restorations should be kept flat to facilitate
plaque control and maintain gingival health.
reported situations where crowns or temporary fixed
partial dentures have been lost or removed for long pe-
riods of time with no apparent ill effects to the surround-
ing gingiva (Fig. 2). Schluger et al18 stated, in discussing
crown contours, ‘‘the so-called protective cervical bulge
that hypothetically protects the human gingival crevice
protects nothing but the microbial plaque.’’
Koivumaa and Wennstrom19 studied the histologic
effects of crown contour on human gingiva. They found
that there was an increase in inflammation adjacent to
bulbous artificial crowns but that properly contoured ar-
tificial crowns exhibited no such increase at the adjacent
gingiva.
Perel,20 in studying dogs, cut Class V preparations
0.5 mm above the buccogingival crest. He then over-
contoured some restorations and undercontoured other
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BECKER AND KALDAHL
Fig. 3. The evidence of plaque accumulation at the gingival
one third of this patient’s teeth emphasizes that self-cleansing
contours in this area are nonexistent, regardless of diet.
Fig. 5. The embrasure space with restorations such as these
maxillary crowns should be kept open to allow access to the
interproximal spaces for plaque control and for natural
architecture of the interdental papilla.
restorations. After 9 weeks, he found no clinical or his-
tologic changes with the undercontoured restorations;
but with the overcontoured restorations, he reported
evidence of inflammation and hyperplasia both clinically
and histologically. Thus, there appears to be no evidence
to support crown contours designed to ‘‘protect the
gingival margins.’’
Gingival stimulation. This concept reasons that, as
food is masticated, it will pass over the gingiva, stimulat-
ing it and causing increased keratinization of the epithe-
lium. The keratinized epithelium would be more
resistant to periodontal breakdown.
Several authors21-24 have shown that the gingival
margin is not in the path of masticated food. Even if
the food passing over the teeth were to increase keratini-
zation (there is little evidence to back this assumption),
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BECKER AND KALDAHL
Fig. 6. Contacts between restored teeth should be kept at the
incisal one third of the tooth to facilitate an accessible
embrasure space. The anatomy from the contact area to the
margin of the restoration should be flat or concave (never
convex).
this stimulation would only occur at the buccal and lin-
gual surfaces, leaving the interproximal tissues without
proper stimulation. It appears that, under normal cir-
cumstances, the mechanics of mastication has very little
effect on gingival health.
Self-cleansing contours. This concept asserts that,
as food passes over the tooth during mastication, the
tooth will be cleansed. While certain prominent buccal
and lingual surfaces of teeth do not accumulate plaque
even in neglected mouths, numerous authors21,22,24
have shown that mastication does not remove plaque
at the gingival margins of teeth. Neither does mastica-
tion have any effect on the progress of gingivitis.22
Thus, self-cleansing crown contours apparently are
nonexistent at the gingival margins of the teeth (Fig. 3).
Muscle action theory
Morris15,16 was one of the first to question the
rationale of the gingival protection theory. He and
others25-28 have suggested that overcontouring pre-
vents the normal cleansing action of the musculature
and allows food to stagnate in the overprotected
sulcus.
Lindhe and Wicen,22 Loe,11 and others29 have all
demonstrated that, in the absence of oral hygiene,
‘‘self-cleansing’’ mechanisms do nothing to prevent gin-
givitis. Even if there were some cleansing of the buccal
and lingual surfaces from muscle action, interpoximal
cleansing still would be impossible.
Some proponents of the gingival protection theory
also concur with the muscle action theory.5,6,14,27,28
These authors strive for an intermediate design of crown
contour which allows for both gingival protection
and muscular action.
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THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 7. Contacts (C) between natural teeth are buccal to the
central fossa (CF) except between molars. This allows space
for the relatively large lingual papilla (P).
Theory of access for oral hygiene
This theory is based on the concept that plaque is
the prime etiologic factor in caries30-32 and gingivi-
tis.11,29,33 Thus crown contour should facilitate plaque
removal, not hinder it.18 When crowns were overcon-
toured experimentally, 64.3% of the test sites demon-
strated an increase in periodontal inflammation. This
was attributed to decreased access for oral hygiene.34
The four guidelines to contouring crowns with
emphasis on access for oral hygiene will be described.
Buccal and lingual contours–flat, not fat!
(Fig. 4). Numerous authors17,18,21,25 have demon-
strated that plaque retention on the buccal and lingual
surfaces occurs primarily at the infrabulge of the tooth.
Reduction or elimination of the infrabulge would re-
duce plaque retention.18 Perel20 demonstrated that in
actuality undercontouring may promote gingival health.
Ramfjord,35 Yuodelis et al,17 and an increasing number
of other authors have come to the realization that over-
contouring is a greater periodontal hazard than under-
contouring.
The normal buccolingual contour of teeth without
caries is quite flat. Most authors who have studied nor-
mal tooth contours2-4,9,36,37 have reported that rarely
is the buccolingual width of these teeth more than 1
mm wider than the cementoenamel junction (CEJ).
Thus, a normal tooth at the buccocervical bulge is usu-
ally # 0.5 mm wider than the CEJ.
Open embrasures. If plaque is a primary etiologic
factor in gingivitis,18,33,38 then every effort should be
made to allow easy access to the interproximal area for
plaque control.18,35,39 Open embrasure spaces will allow
for this easy access (Fig. 5). An overcontoured embra-
sure will reduce the space intended for the gingival pa-
pilla. The result is a broadening of the col area,
causing pressure and irritation on the papilla. This also
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Fig. 8. Furcations should be ‘‘beveled’’ from the margin of the
restoration to the occlusal surface. This reduces plaque traps
created by the anatomy of the furcation region and facilitates
plaque control. A, Mandibular crown contour of buccal
furcation. B, Maxillary crown contours of lingual furcations.
inhibits effective oral hygiene.40,41 Several au-
thors35,36,42-46 have suggested or implied that an inter-
proximal space that is slightly larger than normal may
be desirable since it provides adequate room for the
gingival papilla and is a more accessible area to clean.
Some authors5,42,43,47 have reported the fear of cre-
ating an environment which promotes ‘‘lateral food
impaction’’ when open embrasures are employed.
Townsend48 has observed that, even with grossly
undercontoured, open embrasure spaces, lateral food
impaction rarely occurs as long as interproximal tooth
contacts are properly maintained. Several authors49-51
have demonstrated that the most effective method of in-
terproximal plaque control in gingival recession is the
use of an interproximal brush. When the interproximal
brush is used, the space between two adjacent proximal
surfaces must be wide enough to allow it to pass through
with relative ease.
Location of contact areas. Contacts should be high
(directed incisally) (Fig. 6) and buccal in relation to the
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BECKER AND KALDAHL
Fig. 9. A cast restoration which flutes into the furcation of
a periodontally involved molar (A) can effectively reduce the
triangular ‘‘plaque trap’’ region that results from restoring the
original anatomy of the crown (B).
central fossa (except between maxillary first and second
molars) (Fig. 7). Several authors3,36,52,53 have demon-
strated that the contact areas on natural teeth occur at
the incisal one third of the tooth. Many agree that natu-
ral teeth are straight or slightly concave interproximally
from the CEJ to the contact area.1,3,4,18 This tends to
open the embrasure, particularly if the contact area is
high (in the incisal direction). Many authors36,37,43,44,53
have pointed out that the contact area of all teeth, except
between the maxillary first and second molars, should be
buccal to the central fossa. This creates a large lingual
embrasure for optimum health of the lingual papilla.
Hazen and Osborne45 have warned of the consequences
of an ‘‘oversized’’ col resulting from broad (buccolin-
gual) contacts. The col is a nonkeratinized area which
is thought to be more susceptible to plaque. The broad
contact produces a larger col, thereby leading to in-
creased chance of inflammation. Ramfjord35 recom-
mends placement of contact areas as far occlusally as
possible to facilitate access for interproximal plaque con-
trol.
Furcations involvement. Furcations that have been
exposed owing to loss of periodontal attachment should
be ‘‘fluted’’ or ‘‘barreled out’’ (Fig. 8). The concept of
fluting into molar furcations is based on the desire to
eliminate ‘‘plaque traps’’ and facilitate plaque control.18
Yuodelis et al,17 in discussing molar furcations, warn
that the final restoration should not follow the anatomy
of the original clinical crown but should be an extension
of the contours of the periodontally exposed roots.
When this approach is properly executed, the triangular
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BECKER AND KALDAHL
Fig. 10. Supragingival margins generally provide a more
favorable environment to resist disease than subgingival
margins.
Fig. 12. A, Diagram of modified ridge-lap pontic design for posterior teeth. Note that the pontic does not contact the tissues
lingual to the crest of the ridge. B, The modified ridge-lap pontic (first molar). Note the open embrasures, minimal tissue contact,
and gingival health.
region that is created by the roots and the cervicular
bulge is eliminated (Fig. 9). This triangular region is
the most difficult area to maintain in a plaque-free
condition with conventional brushing techniques. We
have found that by recontouring the furcation to elimi-
nate the triangle, plaque control with normal brushing is
greatly facilitated (Fig. 8).
MARGIN PLACEMENT
The concept of subgingival margins is a natural out-
growth of G. V. Black’s54 ‘‘extension for prevention’’
and the ‘‘caries-free zone.’’ Locations for marginal
placement for cast restorations have included: (1) the
base of the gingival crevice55; (2) half the distance be-
tween the base of the gingival crevice and the gingival
margin56; (3) slightly below the gingival margin25,41;
(4) the crest of the gingival margin57; and (5) supragin-
givally.14,18,58,59 With each of these margin locations,
the authors have reported clinically healthy periodontal
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Fig. 11. Ridge-lap pontics can create gingival inflammation,
bleeding, and severe discomfort.
tissues when quality restorations were combined with ef-
fective plaque control.
As early as 1941, Orban60 proposed supragingival
margins for improved periodontal health. Orban60 and
other researchers61,62 discovered that the ‘‘caries-free’’
or ‘‘clean’’ subgingival zone, which had been observed
previously on extracted teeth, was nothing more than
the location of the epithelial attachment. This epithelial
attachment will not attach to the margin of a cast resto-
ration. Thus the concept of routine subgingival margins
was questioned as more scientific evidence appeared
(Fig. 10).
Plaque accumulation, inflammation, and gingivitis
are reported to occur more frequently in teeth with sub-
gingival crown margins than in those with supragingival
margins.18,57,59,63-69 Oral hygiene instructions do not
seem to alter this pattern.23,66,70
Few incidences of new caries associated with supra-
gingival margins have been reported because of im-
proved access for plaque control.69 Christensen71 has
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Fig. 13. A, Diagram of ridge-lap facing pontic design for anterior teeth. Note that the pontic does not contact the tissue lingual to
the crest of the ridge. B, The ridge-lap facing pontic (left lateral). Note the open embrasures, minimal tissue contact, and gingival
health.

Fig. 14. The cusp tip-to-cusp tip width of a posterior pontic

(P) should be the same width as the original missing tooth.

demonstrated that the visually accessible margin

(supragingival) can be, and is, fitted more accurately
than the visually inaccessible margin (subgingival).
Based on these and other findings,18,72-76 subgingi-
val margins should be avoided except for the following
specific situations: (1) esthetic demands, (2) caries re-
moval, (3) subgingival tooth fracture, (4) to cover exist-
ing subgingival restorations, (5) to gain needed crown
length, and (6) to provide a more favorable crown con-
tour (that is, furcation involvement).

PONTIC DESIGN
The design of pontics for fixed partial dentures has
been clouded by empirical judgment. The so-called
‘‘sanitary pontic’’ is not new to dentistry.5,77,78 The
‘‘bullet-shaped’’ pontic has been advocated by some au-
thors5,78,79 as a desirable design to reduce food accumu-
lation. Nearly all authors agree that the ‘‘ridge-lap’’
pontic is undesirable from the point of view of tissue
health (Fig. 11).
Fig. 15. A, The embrasure space between two adjacent
pontics can be closed to gain strength and reduce plaque
accumulation. B, Closing the embrasure between two
adjacent pontics does not affect esthetics. Note that the
embrasures are kept open next to the abutment teeth to
facilitate access for oral hygiene.
Numerous investigators7,51,80,81 have reported that
inflammation of the edentulous mucosa adjacent to
pontics is probably a response to plaque accumulation

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BECKER AND KALDAHL
Fig. 16. A, Modification (m) of tooth preparation to allow for
placement of attachment system within the normal contour of
the tooth. B, Castings with precision attachments for patient
in Fig. 15, a. Note the open embrasures, high contacts, flat-
not-fat contours, and the intracoronal attachments are within
the confines of the normal crown contour.
on the surface of the pontics. Many authors5,78,82-88
feel that glazed porcelain is the material of choice
for contact against the edentulous ridge. Other investi-
gators7,81,87-89 have shown that there is no clinical or
histologic difference in the response of the mucosa to
pontics properly constructed of cast gold, acrylic resin,
or glazed or unglazed porcelain.
Stein’s81 classic article on pontic design was largely
responsible for a change in philosophy from a ‘‘sanitary’’
or ‘‘bullet-shaped’’ design to what is now commonly
called a ‘‘modified ridge-lap’’ design. The modified
ridge-lap design in the posterior region (Fig. 12) and
the ridge-lap facing design in the anterior region
(Fig. 13) offer minimal tissue contact, acceptable cos-
metic value, proper cheek support, and accessibility for
adequate oral hygiene.14,18,44,81 It has now been estab-
lished that the design of the pontic may be the most im-
portant factor in preventing inflammatory
reactions,81,89 not the material used in the pontic.
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THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 17. The coping approach to reconstruction can be
designed to facilitate the access for oral hygiene guidelines.
A, Copings in place. B, Suprastructure cemented onto
copings. Note the open embrasures, flat buccolingual
contours, and fluted molar furcations.
In addition to properly designing the undersurface of
pontics, it is imperative to open embrasure spaces adja-
cent to abutments to allow room for interproximal tissue
and access for oral hygiene (Figs. 12 and 13, part
B).15,18,61,78,90,91 The occlusal surface should not be
narrowed arbitrarily18 since this may create a food im-
paction and/or plaque retention situation similar to
that of mal posed teeth (Fig. 14).5,81 The embrasure
space between two adjacent pontics usually is closed to
provide added strength, reduce food and plaque reten-
tion, and facilitate oral hygiene procedures under pontic
areas (Fig. 15).92
Basic guidelines for the access-for-oral-hygiene the-
ory of crown contour, margin placement, and pontic
design can be applied to nearly all fixed restorative pro-
cedures. These guidelines apply to full porcelain cover-
age restorations (Figs. 12, B, 14, and 15, B), precision
attachments (Fig. 16), and coping reconstructions
(Fig. 17). Occasionally tooth preparations must be
modified to allow for the added bulk needed for
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THE JOURNAL OF PROSTHETIC DENTISTRY
attachments, occlusal porcelain, and copings (Fig. 16,
A). If proper tooth reduction is achieved, physiologic
crown contours can be developed easily, regardless of
the prosthesis being used.
SUMMARY
Crown contours which promote favorable tissue re-
sponse follow these guidelines: (1) buccal and lingual
contours are flat; (2) embrasure spaces should be
open; (3) contacts should be high (incisal one third)
and buccal to the central fossa (except between first
and second molars); and (4) furcations should be
‘‘fluted’’ or ‘‘barreled out.’’ Margins should be supra-
gingival where possible. The pontic design of choice is
the modified ridge lap for posterior spaces and the
ridge-lap facing for anterior spaces.
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