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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5199_Библиотеки_им_академика_М_И_Перельмана.pdf
6.18 Case 18
159
Fig. 6.139 Maxillary framework
design. (a) Labial and occlusal
view. (b) A4-short buccally
retained clasp
a
Fig. 6.140 Check for no
metal exposure with the
esthetic dental assistant
b
160
6 Case Analysis ofEsthetic Clasp
a
e
b
Fig. 6.141 (continued)
a
c
d
Fig. 6.141 Mandibular framework design. (a) Buccal view. (b)
Occlusal view. (c) D7, D8-united short-arm clasp. (d) D4-C clasp. (e)
C8-ring clasp
b
Fig. 6.142 Grinding and polishing after the framework forming. (a)
Maxillary framework completion. (b) Mandibular framework completion
6.18 Case 18
Fig. 6.143 The teeth arrangement and wax pattern
Fig. 6.144 Trying in of the
wax pattern
161
Fig. 6.145 Comparison
before and after restoration in
the facial frontal view
162
Fig. 6.146 Comparison
before and after restoration in
the facial lateral view
6.19 Case 19
E-Clasps Combined with Deformed Occlusal Rest in
Digital Framework RPD Design to Correct Spee Curve
1. Before repair
A woman, 60 years old. Maxillary and mandibular
dentition defects have been for more than 30 years.
Smile analysis: The patient’s face is symmetrical with
a relatively normal proportion, and the height of basifacial 1/3 is acceptable (Fig.6.147). The patient has a low
smile line, whose upper teeth cannot be exposed when
smiling. The esthetic teeth are C4–D3 with the visible
cervix of teeth (Fig.6.148).
Dentition analysis: The patient with Kennedy III den-
tition defect in the upper and lower jaw has deep overbite
(Fig.6.149). And there is no bounce or pain in the temporomandibular joints. Her oral hygiene is average.
2. RPD analysis design and manufacturing
We design a lingual bar as the maxillary major con-
nector to reduce globus sensation. Short buccally retained
clasp is placed on the abutments A5, B4, C4, and D2 to
reduce the clasp exposure when smiling. A combined
clasp is placed on B6 and B7 to ensure the retention of the
maxillary framework.
Because the remaining teeth of the lower jaw are worn,
the contour of the retaining teeth is utilized for clasp
design as full as possible. The undercut of C4 is concentrated on the lingual surface, so a three-arm clasp with
lingual retentive arm and buccal resistant arm is designed.
At the same time, taking advantage of the existing gap
between D2 and D3, a short buccally retained clasp is
placed on D2. A distal adjacent surface plate is placed on
6 Case Analysis ofEsthetic Clasp
Fig. 6.147 Facial analysis. Normal proportion of the three courts and
proper height of lower facial 1/3
D3 to enhance friction retention. Because the crown of
C7 is short, metal occlusal surface is designed on C7 to
restore a certain occlusal curve. The major connector
design of the mandible framework adopts a lingual plate
to ensure the stability of the framework (Fig.6.150); try
the wax pattern in the mouth after teeth arrangement
(Fig.6.151). When the patient is satised, complete the
restoration (Fig.6.152).
3. After restoration
The nal repair effect is shown in Fig.6.153. The clasp
exposure is minimal when the patient smiles. The maxillary articial teeth and denture base improve the facial protrusion. The patient’s face is younger than the condition
before restoration (Fig.6.154). She is quite contented.
6.19 Ca se 19
Fig. 6.148 Smile analysis.
This patient is low smile line.
Esthetic teeth are C4–D3
163
Fig. 6.149 Intraoral view
164
Fig. 6.150 Framework
design
6 Case Analysis ofEsthetic Clasp
Fig. 6.151 Trying in after teeth arrangement
6.19 Ca se 19
Fig. 6.152 Restoration
completion
165
Fig. 6.153 Intraoral view with denture
166
6 Case Analysis ofEsthetic Clasp
Fig. 6.154 Comparison
before and after restoration.
(a) Facial frontal view. (b)
Facial lateral view
a
b
6.20 Case 20
E-Clasps Combined with Metal Occlusal Surface in
Digital Framework RPD Design for Patient with
Dentition Defect and Insufcient Restoration Space
1. Before restoration
A male, 52 years old. Ten years ago, the patient under-
went maxillary and mandibular prosthesis. Due to the
partial fracture of the denture clasp, the denture was
unstable. Now, he requires restoration.
The patient has a scar on the left cheek, mouth- opening
limitation, and poor oral hygiene condition. The patient
has Kennedy III dentition defect on the maxilla and
Kennedy IV dentition defect on the mandible. There is a
residual root B4 and deep overbite. His occlusion is so
tight that the left mandibular teeth contact on the maxillary alveolar ridge. The position of the alveolar ridge in
the upper jaw is too close to the outside of paired jaw
teeth. If the occlusal function is ensured according to the
conventional teeth arrangement and occlusal design, the
position of the articial teeth will be too close to the lingual side, which affects the esthetics. Or if we arrange
teeth and improve esthetics in accordance with the contour of the upper jaw, this position will lose occlusal contact, which affects function and may cause elongation of
the paired jaw teeth. Therefore, in this case, the design of
dentures with both esthetics and function becomes difcult. In addition, a large amount of soft tartar deposits can
be seen in the patient’s mouth, which indicates his poor
oral hygiene (Figs.6.155 and 6.156).
2. RPD analysis design and manufacturing
In consideration of both esthetics and function of the
denture, we apply the design of double dentition for B4,
B5, and B6in the upper jaw: the inner metal occlusal sur-
6.20 Case 20
167
Fig. 6.155 Intraoral view
Fig. 6.156 Intraoral partial view
168
6 Case Analysis ofEsthetic Clasp
face to restore function and the outer plastic articial
tooth to improve esthetics. In the anterior region, a united
short-arm clasp is placed on A3 and A4, and a short buccally retained clasp is placed on B3. At the same time, a
three-arm clasp is placed on B7in the posterior region to
ensure the retention of the framework. A rest is set on B7,
and a lingual plate is used as the major connector to
ensure the entire stability. On C4 and C5, D4, and D5in
the lower jaw, united short-arm clasps are placed to
ensure retention (Fig. 6.157). After the framework is
Fig. 6.157 Framework
design
completed (Fig.6.158), try it in the mouth. The denture is
in good position, the clasps t the abutment, the retention
force is moderate, and there is no movement (Fig.6.159).
The restoration is nally completed (Fig.6.160).
3. After restoration
There is little clasp exposure, and denture is retentive
and stable without movement. This solution restore the
patient’s occlusal function while taking into account the
esthetics. Finally, the patient expresses satisfaction
(Fig.6.161).
Fig. 6.158 Framework
completion