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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5199_Библиотеки_им_академика_М_И_Перельмана.pdf
6.20 Case 20
Fig. 6.159 The framework
tried both on the model and in
the mouth is well positioned,
the clasps t the abutment, the
retention force is moderate,
and it is stable without
movement
Fig. 6.160 Final restoration
completion
169
170
6 Case Analysis ofEsthetic Clasp
Fig. 6.161 Intraoral view with denture
6.21 Case 21
E-Clasps in Digital Framework RPD Design for Patient
with Bilateral Maxillary Free-End Edentia and High
Laugh Line
1. Before restoration
A woman, 60 years old.
Facial analysis: The patient has a normal facial pat-
tern, symmetrical face, a normal height of the basifacial
1/3, and a high smile line. The esthetic teeth are A3–B3
(Fig.6.162).
Dentition analysis: The patient has Kennedy I denti-
tion defect on the maxilla and Kennedy III dentition
defect on the mandible. Her missing teeth are A4–A7,
B4–B7, C1–C2, C5–C7, D1, and D5–D7 (Fig. 6.163).
She has poor oral hygiene.
2. RPD analysis design and manufacturing
Maxillary dentition is bilateral free-end edentulous. C
clasps are placed on A3 and B3. Because the abutments
are located in the esthetic area, in addition to considering
the location of the undercut when designing the clasps,
we try to place the tip of the clasp on the gingival covert
location. Because there are many missing teeth and bilateral free-end loss, a full palate is designed as the major
connector to disperse the force (Fig. 6.164). There is
bilateral free-end edentia in the lower jaw. Combined
clasps are placed on C3–C4 and D3–D4. Mesial rests are
placed to reduce the lateral force on the abutment and
protect the abutment (Fig.6.165).
When the framework is tried in the mouth, it is retentive and stable without movement (Fig. 6.166). The
details of the framework are shown in Fig.6.167. Due to
free-end edentia in the upper and lower jaws, the vertical
height cannot be determined. The occlusal relationship is
recorded by a wax rim (Fig.6.168). After arranging the
teeth according to the occlusal relationship, the wax pattern is tried in the mouth (Fig.6.169).
3. After restoration
The nal effect with denture is shown in Fig.6.170.
The denture is stable with little clasp exposure when
smiling. The effect before restoration is shown in
Fig.6.171. The patient is satised.
6. 21 Case 21
Fig. 6.162 Facial analysis
Fig. 6.163 Intraoral view
171
172
Fig. 6.164 Maxillary
framework design
Fig. 6.165 Mandibular
framework design
6 Case Analysis ofEsthetic Clasp
6. 21 Case 21
173
Fig. 6.166 Trying in of the framework
Fig. 6.167 Framework details
174
Fig. 6.168 Recording occlusal relationship by a wax rim
6 Case Analysis ofEsthetic Clasp
Fig. 6.169 Trying in of the wax pattern
Fig. 6.170 Intraoral view with denture
6.22 Case 22
175
Fig. 6.171 Comparison
before and after restoration.
(a) Facial left lateral view. (b)
Facial right lateral view
a
b
6.22 Case 22
A man, 80 years old. In the past 1 year, the denture was conscious of poor retention, stability, and masticatory function.
1. Before restoration
The patient’s face is symmetrical. Due to the absence
of upper and lower dentition, the lower 1/3 of the face
becomes shorter, and a deeper nasolabial groove can be
seen (Fig.6.172). In the mouth, the alveolar ridge of the
mandible is low and at, and the posterior tooth area is
blade-shape (Fig.6.173). There are a lot of dental calculus, plaque, and pigmentation in the old denture; the denture does not t well, and the joint wear is serious. No
joint abnormality was found after joint consultation.
2. RPD analysis design and manufacturing
Because the patient requires to reduce the volume of
complete denture as much as possible to reduce the foreign body sensation, the metal base is used. First, make
the initial impression mold (Fig.6.174), then make individual tray (Fig.6.175) according to the initial model and
initial relationship, use individual tray to obtain the nal
impression mold and nal relationship (Fig.6.176), try to
arrange teeth according to the nal model and nal relationship (Fig.6.177), and complete the production of restoration after trial wearing denture (Fig.6.178).
3. After restoration
See Figs.6.179 and 6.180 for the nal repair effect.
Fig. 6.172 Full-face view
176
Fig. 6.173 Intraoral view
Fig. 6.174 The rst
impression
6 Case Analysis ofEsthetic Clasp
Fig. 6.175 Individual tray
Fig. 6.176 Obtaining nal impression and nal relation
6.22 Case 22
177
Fig. 6.177 Tooth arrangement
Fig. 6.178 Restoration
completion
178
ab
Fig. 6.179 The intraoral renderings
Fig. 6.180 Comparison
before and after restoration.
(a) Before restoration. (b)
After restoration
6 Case Analysis ofEsthetic Clasp
6.23 Case 23
dibular denture should be as stable as possible to avoid
prying. The old mandibular denture is shown in Fig.6.183.
1. Before restoration
A woman, 78 years old. Many years ago, all the teeth
in the upper jaw were removed due to loose. Now, the old
denture is loose, so it is required to make a new denture.
Because the upper teeth are missing, the face col-
lapses, the nasolabial groove is deep, and the lower teeth
can be seen when smiling (Fig.6.181), showing an aging
face. The upper jaw is edentulous, the arch is sharp and
round, the attachment position of frenum is high, the top
of palate is shallow, and the mandibular is Kennedy III
dentition defect. C4–C6 is absent in area C, and the
alveolar ridge in the edentulous area is in the shape of a
blade (Fig.6.182). Oral hygiene is poor. In the design of
mandibular support, it should be noted that because the
complete denture is used in the opposite jaw, the man-
2. RPD design and manufacturing
The upper jaw is edentulous, so single complete den-
ture is used. For the lower jaw, the combined clasp is
placed on D4D5, and the two arm clasp is placed on D7.
On the side of edentulous space, the three-arm clasp is
placed the distal abutment C7, and the C clasp is placed
on the mesial abutment C3. The C clasp design can reduce
the lateral force on the mesial abutment C3 while ensuring the retention force and preventing the denture from
oating. The double lingual bar major connector design
can disperse occlusal force, which has good stability, is
convenient for self-cleaning, and promotes gingival
health (Fig.6.184). The design details of mandible framework are shown in Fig.6.185. The retention of the denture is stable in wax pattern trial wearing (Fig.6.186).