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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5199_Библиотеки_им_академика_М_И_Перельмана.pdf
6.14 Case 14
139
Fig. 6.95 Facial frontal view when smiling
Fig. 6.94 Facial frontal view with denture
6.14 Case 14
Double Lingual Bar in Digital Framework RPD Design
for Patient with Unilateral Free-End Edentia in the
Lower Jaw
1. Before restoration
A woman, 49 years old.
Smile analysis: The patient has a middle smile line and
deep overbite (Fig.6.95). The esthetic teeth are A4–B4
and C3–D4 (Fig.6.96).
Dentition analysis: Missing teeth on maxilla are A5–
A7. Due to the tight occlusion, there is no space for repair
(Fig.6.97). Missing teeth on mandible are D5–D7in D
area. And the anterior overbite and overjet are deep
(Fig.6.98). The patient nally chose e-clasp RPD for restoration, and we design e-clasps on D4, C6, and C7.
2. RPD analysis design and manufacturing
Mandibular framework design: Opposite embrasure
clasps are designed on C6 and C7, respectively, and a C
Fig. 6.96 Esthetic teeth: A4–B4, C3–D4
clasp is designed on D4. The double lingual bar is
designed on the lingual side of the anterior teeth, which is
conducive to the self-cleaning of the patient’s mouth
(Fig. 6.99). Trying in of the framework is shown in
Fig.6.100.
3. After restoration
The nal effect is shown in Figs.6.101 and 6.102.
140
Fig. 6.97 Missing teeth on
maxilla are A5–A7, and due
to the tight occlusion, there
was no space for repair
6 Case Analysis ofEsthetic Clasp
Fig. 6.98 Missing teeth on mandible are D5–D7. We design e-clasps
on D4, C6, and C7
Fig. 6.99 Mandibular framework design: opposite embrasure clasps
are designed on C6 and C7, respectively, and a C clasp is designed on D4
6.14 Case 14
141
Fig. 6.99 (continued)
Fig. 6.100 Trying in of the framework
142
6 Case Analysis ofEsthetic Clasp
Fig. 6.102 Frontal view with denture
Fig. 6.101 Intraoral view with denture
6.15 Case 15
E-Clasps in Digital Framework RPD Design Without
Tooth Preparation for Patient with Bilateral Maxillary
Free-End Edentia
1. Before restoration
A woman, 58 years old.
Smile analysis: The patient shows a short distance of
lower facial 1/3 in the frontal view (Fig. 6.103). And
according to Zhang’s smiling exposed zone before restoration, she has an average smiling line. The maxillary
esthetic teeth are A5–B5 (Fig.6.104).
Dentition analysis: The maxillary missing teeth are
A4–7 and B6–7. And there are apparent spaces among the
anterior teeth, tight occlusion of remaining teeth, severely
worn teeth, deep anterior overbite, and average anterior
overjet. Besides, the teeth are in a good, clean condition,
and the remaining teeth are not loose (Figs. 6.105 and
6.106).
6.15 Cas e 15
Fig. 6.103 Facial analysis.
Normal proportion of the
three courts and short height
of lower facial 1/3
Fig. 6.104 Smiling analysis;
the esthetic teeth are A5–B5.
Smiling exposed area has
tooth defect in A area
143
Fig. 6.105 Dentition
analysis
144
Fig. 6.106 Tight occlusion
in the frontal and lateral view
6 Case Analysis ofEsthetic Clasp
As a teacher, the patient has high requirements for
esthetics and pronunciation due to professional reasons,
and she is afraid of surgical implantation schemes. She
hopes that the restoration scheme is simple, minimally
invasive, and reversible and the effect evaluation after restoration can achieve a more natural appearance. After
examination, we nd that the position of the posterior
missing tooth on maxilla is relatively backward. So the
lips and the buccal axial ridge of the abutments could be
used to hide the cervical clasp. However, grinding is unacceptable for the incisors of anterior teeth, and the occlusal
surfaces of posterior teeth are severely worn, and the teeth
are hypersensitive. All in all, it is difcult to restore.
The lingual surfaces of maxillary anterior teeth, incisors of mandibular anterior teeth, and the occlusal surfaces of posterior teeth are severely worn, and there are
apparent spaces among A3–B4.
2. RPD analysis and manufacturing
The maxilla is Kennedy I dentition defect. A3, B3, and
B5 are chosen as abutments, and they are all in good con-
dition. However, not much teeth can be prepared because
of tight occlusion, and the opposite is natural teeth. In
order to obtain good support and stability, we design full
palate plate as major connector for the upper jaw, and put
short buccally retained clasps on A3 and B3. A minor
connector is designed closed to the natural gap between
B3 and B4 to reduce food impaction, and a three-arm
clasp with good retention is designed on B5. Because
tooth grinding is unacceptable, only one rest can be
designed on the distal side of B5 using the existing small
gap (Fig.6.107). After the metal framework is completed
(Fig.6.108), try it in the mouth (Fig.6.109), record the
occlusal relationship, and then try the wax pattern
(Fig.6.110).
3. After restoration
The nal repair effect is shown in Figs. 6.111 and
6.112. The patient is satised.
6.15 Cas e 15
Fig. 6.107 Bilateral free-end edentia in A
and B area; A3, B3—short buccally
retained clasps. The arm of clasp does not
cross the buccal axial rigid, and the clasp
tip is hidden in the buccal view. A minor
connector between B3 and B4 is thickened
as anti-impact device
145
Fig. 6.108 Laser printing
and polishing of the metal
framework
146
Fig. 6.109 Trying in of the
metal framework
Fig. 6.110 Occlusal
relationship recording and
trying in of the wax pattern
6 Case Analysis ofEsthetic Clasp
Fig. 6.111 Intraoral view
with denture
ab
cd
6.16 Cas e 16
Fig. 6.112 Comparison
before and after restoration.
(a) Lower facial 1/3 lateral
view before restoration. (b)
Lower facial 1/3 lateral view
after restoration. (c) Lower
facial 1/3 frontal view before
restoration. (d) Lower facial
1/3 frontal view after
restoration
147
6.16 Case 16
Due to the large number of missing teeth, the RPD are
mainly supported by the mucous membrane. Besides, the
E-Clasps in Digital Framework RPD Design for Patient
with Bilateral Free-End Edentia on Maxilla and
Mandible and Rare Remaining Teeth
1. Before restoration
Smile analysis: A woman, 70 years old. In the lower
facial 1/3 frontal view, the patient shows the loss of fattiness, apparent nasolabial groove, and mentolabial sulcus
(Fig. 6.113). Due to the loss of the maxillary anterior
teeth, only lower teeth can be seen when smiling
(Fig. 6.114). The aging face seriously affects her
appearance.
Dentition analysis: There are only A4 and B6 left in the
maxilla. And B6 is with mesial amalgam lling and defect
of distobuccal cusp and serious root exposure. However,
the patient is unwilling to pull the teeth. There are only
C3, D3, and D5in the lower jaw, and there is no contacted
teeth in the mouth. Residual roots A5, B3, and D4 have
been treated with root canal therapy, which the patient is
also unwilling to remove. There are apparent tooth extraction sockets of 4, 5, and 7in B area, and the last tooth
area of the main bearing area in B area is limited. So the
remaining abutments and covered area should be used to
disperse the occlusal stress as full as possible. In consideration of severe tooth root exposure in the upper jaw, a
lingual self-cleaning area beneath the clasp should be
allowed for oral cleaning.
2. RPD analysis design and manufacturing
For the upper jaw, we design a full palate plate, a RPT
clasp in A area, and a three-arm clasp on B4, leaving lingual self-cleaning area for all abutments (Fig.6.116). For
the lower jaw, we design a lingual plate, short buccally
retained clasps on both C3 and D3, a three-arm clasp on
D5, and three rests in the lower jaw to disperse stress
(Fig. 6.117). After the metal framework is completed
(Fig.6.118), try it in the mouth (Fig.6.119), then record
the occlusal relationship, and try the wax pattern in the
mouth (Fig.6.120).
3. After restoration
The nal repair effect is shown in Figs. 6.121 and
6.122. The patient is satised.
extraction has been completed for 9 months (Fig.6.115).
148
Fig. 6.113 Facial analysis.
Loss of fattiness in the lower
face 1/3, deep nasolabial
groove and mentolabial
sulcus. Typical aging face of
the elderly after teeth loss
Fig. 6.114 Smile analysis.
Most of the anterior teeth are
missing, and only two
remaining mandibular anterior
teeth can be seen when
smiling
6 Case Analysis ofEsthetic Clasp
Fig. 6.115 Dentition
analysis. Large number of
residual roots, large tooth
exposure, poor cleaning
Fig. 6.116 Maxillary
framework design. A4—RPT
clasp, B6—three-arm clasp,
The lingual side does not
cover gingiva, which is good
for cleaning