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5.3 Accurate Tooth Preparation
Fig. 5.23 The preparation track of the bur (starting point)
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Fig. 5.25 The retainer of the sleeve
Fig. 5.24 The preparation track of the bur (terminus)
6. Design the retainer of the sleeve.
Add the retainer of the zirconia sleeve to complete the
design of the template (Fig.5.25).
7. Prepare the guide plane under the guidance of the
template.
Place the template on the dentition, and check whether
it is in place through the window opening on the template.
Place the bur into the sleeve from the occlusal side, and
place the sleeve with the bur into the track of the template
laterally. Then the guide plane is prepared along the preparation track. Keep the handpiece in close contact with
the template during the overall process (Fig.5.26).
Fig. 5.26 Preparing the guide plane under the guidance of the
template
90
5.4 The Digital Frameworks ofRPD
Design andProduction
The digital frameworks of RPD design use CAD software to
realize the virtual restoration step, which is very different
from the manual framework wax made in the past. It omits
the steps of lling the concave, copying the re-resistant
model, and making the bracket wax and saves the working
procedure and manpower.
In the digital mode, using CAD software for computer
operation, which not only does not have the dirty and messy
environment of the mobile stent in the past but also reduces
the human error in the production process, the stent design is
more accurate, and the design process and design results can
be easily used as medical-technical communication materials, which can effectively avoid the rework phenomenon
caused by poor communication.
The digital framework of RPD’s production process is
detailed in Chap. 4 (Figs.5.27, 5.28, 5.29, and 5.30).
5 DLD (Digital Line Design): Esthetic Analysis andDesign
Fig. 5.27 The digital framework of RPD design
Fig. 5.28 Fabrication of the digital framework of RPD
5.5 Personalized Porcelain Teeth andSimulation Denture Base Production
Fig. 5.29 Try-in of the
framework
91
Fig. 5.30 Bonding porcelain teeth
5.5 Personalized Porcelain Teeth
andSimulation Denture Base
Production
1. Opaque coating:
On the framework of the bonded porcelain teeth, the
contact surface between metal and resin is treated, and
the opaque porcelain is coated.
The rst layer, thin coating, plays a bonding role, and
the second layer covers the metal color (Fig.5.31).
In order to achieve good simulation results, personalized gingival colorimetry is very important.
You can use the existing gingival shade, or you can
match the color on the spot. The gum resin is placed on
the gingiva to compare the color on the spot, which shows
92
Fig. 5.31 Opaque coating
Fig. 5.32 Color matching for
internal colorimetry
5 DLD (Digital Line Design): Esthetic Analysis andDesign
that the color is a little light. Add an appropriate amount
of dye to the resin, then compare the color (this time the
color is close to the gingival color of the patient), and
determine the color matching scheme (Fig.5.32).
2. Coat the bonding layer on the opaque porcelain
(Fig.5.33).
3. In order to simulate the color of gingival blood vessels,
deeper underlying stains such as crimson and blue are
used at the membranous-gingival junction (Fig.5.34).
4. Layered stacking of gingival resin:
Different colors of gingival resin are used in different
positions of the gums to achieve a vivid simulation effect.
The following is a brief introduction to the process of
layering (Figs.5.35, 5.36, 5.37, 5.38, and 5.39):
Fig. 5.33 Coating the
bonding layer
5.5 Personalized Porcelain Teeth andSimulation Denture Base Production
Fig. 5.34 The bottom
staining
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Fig. 5.35 Gingival resin
Fig. 5.37 Making gingival stippling stippling
Fig. 5.36 Treatment of junctions
Fig. 5.38 Gingival stippling
Fig. 5.39 Polish smooth surface
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5 DLD (Digital Line Design): Esthetic Analysis andDesign
(a) The treatment of the connection between the frame-
work and the neck of porcelain teeth can make the
gingiva slightly cover the neck of the teeth. Use a
lighter or root-colored gingival resin.
(b) Fill the main area of the gingiva with resin, using a
predetermined color scheme.
(c) Make a stippling effect with a toothbrush.
(d) The free gingiva of the neck should be transparent,
and the gingival resin with high transparency should
be selected.
(e) Smooth the surface to ensure a good color mixture
between the layers.
(f) The stacking of the simulation denture base is com-
pleted by light curing, and then polish it.
5. Finished and ready to try in the RPD (Fig.5.40).
References
1. Beaumont AJ.An overview of esthetics with RPDs. J Quintessence
Int. 2002;33(10):747–55.
2. Aras MA, Chitre V. Direct retains: esthetics solutions in the smile
zone. J Indian Prosthod Soc. 2005;5(1):4–9.
3. Haiyang Y, Huang W.Classication design and clinical application
of beautiful clasp. West China J Stomatol. 2012;43–49(5):30.
Fig. 5.40 Trying in the RPD
Case Analysis ofEsthetic Clasp
6
Following the clinical pathway of esthetic clasp in this
book, prosthodontist can design RPD with esthetic clasp
for patients easily. Through 32 typical cases, this chapter
explains the clinical steps and skills of the esthetic clasp.
These real cases are certainly not the art performances,
but real records of the current clinical situation in China.
In our daily clinical work, we will encounter various
problems. For example, the periodontal conditions of
the elderly patients are generally not good, the patients’
awareness of self-health care is not strong, it is difcult
for patients to adhere to the correct brushing method,
and the basic treatment of dental pulp and periodontal is
not satisfactory. These problems deserve our attention.
Dentists should remember that although RPD is suitable for almost all the dentition defects, its efcacy is
limited. According to the complaints and the actual situation of patients, the purpose is to improve the esthetics of RPD as much as possible on the basis of a
reasonable design, rather than every case must pursue
the ultimate metal-free exposure. And long term, stable,
and effective are the highest clinical pursuit.
6.1 Case 1
When it comes to the restoration in esthetic area, prosthodontists should take into account the chewing, pronunciation, and other functions when designing. In RPD design,
how to use adjacent surface to retain is often ignored. In the
following case, we are going to introduce a proximalretentive e-clasp that we designed for anterior tooth:
1. Before restoration
He is a 48-year-old female patient, who is Kennedy III
for the upper jaw and Kennedy I for the lower jaw
(Figs.6.1 and 6.2).
2. RPD design and manufacturing
On A2 and A3, we designed adjacent surface hidden
clasps for anterior tooth, both of which have plate-shaped
retainer (Figs.6.3 and 6.4). The difference is the lingual
design—palate plate and lingual rest. Others are traditional design.
Fig. 6.1 Maxillary esthetic teeth: A1–A5, B1–B5
© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House Co. Ltd. 2023
H. Yu, Digital Removable Partial Denture Technology, https://doi.org/10.1007/978-981-19-7923-1_6
95
96
Fig. 6.2 Missing teeth:
A3–A5; B4, B6; C6–7; D5–7
6 Case Analysis ofEsthetic Clasp
Fig. 6.3 A2, B3—adjacent surface hidden clasp for anterior tooth
For the lower jaw, the patient’s smile line is low, so
there is minimal tooth exposure. Thus, we placed low T
clasps with mesial rest on D4 and C5 (Fig.6.5). We also
designed sublingual bar for major connector.
3. After restoration
The nal result is shown in Figs.6.6 and 6.7.
Fig. 6.4 Intraoral effect of A2, B3—adjacent surface hidden clasp for
anterior tooth
6.2 Case 2
Fig. 6.5 C5, D4-T clasp
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Fig. 6.7 Final effect
6.2 Case 2
1. Before restoration
Mrs. Zhou, 66 years old. Both her maxillary and man-
dibular teeth are Kennedy I type—bilateral free-end
edentia. The esthetic area teeth of this patient are A4–B4
and C3–D3, and C4 was I°loose. The point of this case is
the esthetic design of clasp put on the A4 and B4.
Conditions are shown in Figs.6.8, 6.9, and 6.10.
2. RPD design and manufacturing
On maxillary, A area and B area lost the same teeth. To
improve retention, we let rst premolar to be an abutment
besides the second premolar near the gap. We put a double T clasp on the two adjacent teeth (Figs.6.11, 6.12,
and 6.13).
C4 and C5 could have been designed according to the
maxillary, but considering that C4 was I°loose, we just
put a T clasp on C5 (Fig.6.14). On the opposite side, the
buccal space of the mesial abutment D6 was not enough
to put a T clasp, so we designed a traditional three-arm
clasp (Fig.6.15).
3. After restoration
The nal effect with denture is shown in Figs.6.16,
6.17, and 6.18. The patient was very satised.
Fig. 6.6 Intraoral effect
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Fig. 6.8 Free-end loss of
posterior teeth
Fig. 6.9 Dentition defect:
A6, A7, B6, B7, C6, C7, D7
6 Case Analysis ofEsthetic Clasp
Fig. 6.10 Esthetic teeth:
A4–B4, C3–D3