Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5199_Библиотеки_им_академика_М_И_Перельмана.pdf
6.2 Case 2
Fig. 6.11 A45, B45—double
T clasp
Fig. 6.12 Lingual surface
and one side of the double T
clasp
99
Fig. 6.13 Free end combined
with two teeth as abutment
100
Fig. 6.14 C5, T-type clasp;
D6, three-arm clasp
Fig. 6.15 Design of
mandible framework
6 Case Analysis ofEsthetic Clasp
Fig. 6.16 Intraoral
renderings of T-type clasps
6.3 Case 3
Fig. 6.17 The intraoral renderings
101
2. RPD design and manufacturing
In this case, we used the modication of T clasp. But
considering she is little old, to make it easy to take off, we
designed the clasp to be another shape (Fig.6.19). A part
of clasp arm is extended from the mesial end of the T
clasp and then got into the undercut in the distal surface
of the mesial adjacent tooth’s buccal axial ridge. It nally
ended on the buccal axial ridge, hidden by adjacent teeth
and lips (Fig.6.20). This exible design is called extended
T clasp.
3. After restoration
The nal effect with denture is shown in Figs.6.21 and
6.22.
Fig. 6.18 The nal effect with denture
6.3 Case 3
1. Before restoration
Mrs. Zhang, 76 years old. Her maxillary edentia have
lost A6, A7, B6, and B7 teeth. And similar to previous
patient, she has free-end edentia as well.
Fig. 6.19 Dentition defect A67, B67
102
Fig. 6.20 Extended T-type
clasp on A45 and B45
6 Case Analysis ofEsthetic Clasp
Fig. 6.21 The intraoral rendering
Fig. 6.22 The nal effect with denture
6.4 Case 4
1. Before restoration
A woman, 65 years old. In this case, we used buccal
short-arm clasp combined with T-type clasp to repair
bilateral free-end dentition defect.
Smile analysis: Median smile line, deep overbite, and
all the remaining teeth can be seen when smiling, while
mandibular anterior teeth are exposed only 1/3 of the
neck (Fig.6.23). Esthetic area teeth are A3–B3 and C5–
D4 (Fig. 6.24). Abutment teeth are in good health and
have proper undercuts (Fig.6.25).
2. RPD design and manufacturing
Maxillary framework design: Because the abutment
teeth on both sides of the gap are in good health, there is
a suitable undercut. Buccal short-arm clasps were
designed for both maxillary canine teeth (Fig.6.26).
Mandible framework design: The mandible teeth are
not exposed too much, so we used the original undercut
of the teeth and designed the T clasps on C5 and D4
(Fig.6.27).
3. After restoration
The nal effect with denture is shown in Figs.6.28
and 6.29.
In previous cases, we have presented patients with
Kennedy I single-ended free-end edentia and Kennedy II
double-ended free-end edentia. So in this case, we will
present Kennedy III non-free-end edentia. If only patients
keep their oral condition well, the retention and stability
of tooth- borne type RPD will be satisfying. The choice of
esthetic clasps is wise.
cd
6.4 Case 4
103
Fig. 6.23 Patient’s facial
analysis. (a) Full-face photo
(b) Front photo of the lower
third of the face (c) Left side
photo of the lower third of the
face. (d) Right side photo of
the lower third of the face
a b
Fig. 6.24 Smile analysis: tooth position in esthetic area—A3–B3,
C5–D4
Fig. 6.25 Dentition analysis: design esthetic clasps on A3, B3, C5, and D4
104
Fig. 6.26 Maxillary
framework design: buccal
short-arm clasps were
designed for both maxillary
canine teeth
6 Case Analysis ofEsthetic Clasp
Fig. 6.27 Mandible
framework design: T clasps
were designed for C5 and D4
6.5 Case 5
Fig. 6.28 The intraoral rendering
105
6.5 Case 5
1. Before restoration
A female patient is 61 years old. She lost A6 and B6 on
maxillary (Fig.6.30), and both ends had the second molar
left. The abutments were ne. Teeth in esthetic area are
A5–B5 and C4–D4.
2. RPD design and manufacturing
In this case, we put short buccally retained clasps on
the A5 and B5, and the clasp arms ended at buccal axial
ridge. We put traditional three-arm clasps on A7 and B7
the distal abutments of the gap. The back palate plate connected two sides of the RPD, making it symmetrical,
esthetic, small, and exquisite (Fig.6.31).
3. After restoration (Fig.6.32)
Fig. 6.29 The nal effect with denture
Fig. 6.30 Dentition defect:A6, B6
106
Fig. 6.31 The intraoral
renderings: A5, B5—short
buccally retained arm
6 Case Analysis ofEsthetic Clasp
cd
6.6 Case 6
Fig. 6.32 Final effect with denture
107
6.6 Case 6
Short Buccally Retained Clasp Design for Patient with
High Smile Line
1. Before restoration
Mrs. Wang, 59 years old.
Smile analysis: The patient’s smile line is high. When
she smiles, the gum exposure is seriously large (Fig.6.33).
B1 is a residual root, which has been nished with root
canal therapy. A2 is a residual crown and the patient
refuses to remove the tooth for repair. The overbite and
overjet of anterior teeth are deep. The esthetic teeth of the
patient is A5–B4 and C3–D3, and the overdenture is
made after grinding the B1. The remaining abutments
have suitable undercuts.
Dentition analysis: The patient has Kennedy III denti-
tion defect in the upper jaw and Kennedy II dentition
defect in the lower jaw. Missing tooth are 7 which will not
be repaired in A area; 1, 2, and 4in B area; 5–7in C area;
and 5–7in D area, and there is also a gap between 1 and
2in A area. With regard to the selection of abutments, due
to the serious caries of A2, the retention form is not good,
so the clasp is not designed on A2. We design e-clasps on
A4, B3, B5, C4, and D4 (Fig.6.34).
2. RPD analysis design and manufacturing
With regard to the selection of abutments, due to the
serious caries of A2, the retention form is not good, so the
Fig. 6.33 Facial analysis. (a)
Facial frontal view. (b) Lower
facial 1/3 frontal view. (c)
Lower facial 1/3 left lateral
view. (d) Lower facial 1/3
right lateral view
a b
108
6 Case Analysis ofEsthetic Clasp
clasp is not designed on A2. We design e-clasps on A4,
B3, B5, C4, and D4 (Fig.6.34).
Maxillary framework design: An embrasure clasp is
designed on A4, and a short buccally retained clasp is
designed on B3, which has good concealment effect. A
three-arm clasp is put on B5 to provide sufcient reten-
Fig. 6.34 Dentition analysis:
the e-clasps are put on A4,
B3, B5, C4, and D4. (It can
be seen that the oral hygiene
of the patient is poor, so it is
recommended to restore after
periodontal treatment.
However, the patient refuses
periodontal treatment due to
cost problems)
tion (Fig.6.35). Mandibular framework design: Two bar
clasps are, respectively, set on C4 and D4 to utilize the
labial undercut for retention (Fig.6.36).
3. After restoration
The nal effect with denture is shown in Figs.6.37,
6.38, 6.39, and 6.40. The patient is satised.
Fig. 6.35 Maxillary
framework design: set an
embrasure clasp on A4, a
short buccally retained clasp
on B3, and a three-arm clasp
on B5 to provide sufcient
retention