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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5199_Библиотеки_им_академика_М_И_Перельмана.pdf
6.26 Case 25
189
Fig. 6.201 (continued)
3. After restoration
The nal result is shown in Figs.6.203 and 6.204.
The above cases adopt the comprehensive repair
method, which not only achieves the esthetic effect of
xed repair but also widens its scope of application,
reduces the attrition of natural teeth, and reduces the cost
of the whole repair. It is a multi-win repair method.
The intraoral prediction technique is an esthetic analy-
sis plan for the main medical history of esthetic xed restoration of anterior teeth. It is a new method of visualizing
tooth esthetic design with the help of computer before
creative operation. In the case of no need to grind and
prepare teeth, the treatment plan is designed by software,
which is not only intuitive but also noninvasive.
In the mouth, prediction technology can also be used
in comprehensive RPD analysis, design, and manufacturing. In the following cases, multiple factors such as xedremovable repair, intraoral prediction technology,
simulated resin base, and simulated porcelain teeth were
used.
190
6 Case Analysis ofEsthetic Clasp
Fig. 6.202 Porcelain crown making
6.25 Case 25
191
Fig. 6.203 The intraoral renderings
Fig. 6.204 Comparison before and after wearing denture
192
6.26 Case 26
A Case of Fixed-Removable Denture with E-Clasp
Digital Stent Based on the Simulated Production of
Multiple Anterior Teeth
A woman, 68 years old. The fullness of the lower facial 1/3
is normal (Fig.6.205). The absence of upper and lower anterior teeth has a great inuence on esthetics. Observing Cao’s
smiling exposed zone, it can be judged as a high smile line
(Fig.6.206).
1. Before restoration
Patient has higher requirements for esthetics and hopes
to achieve real and natural repair effect. The teeth in the
esthetic area are A5–B5 and C4–D4. The missing teeth on
maxilla are 1, 2, 3, 6, and 7in area A and 1in area B,
while the missing teeth on mandible are area C1–2 and
area D1–2. The remaining teeth are in good condition,
and the buccal inverted concave of area B6 is smaller
(Fig.6.207).
6 Case Analysis ofEsthetic Clasp
Fig. 6.205 Facial analysis
Fig. 6.206 Smile analysis
6.26 Case 26
193
Fig. 6.207 Intraoral condition
2. RPD design and manufacturing
Intraoral prediction technology: The rst step is soft-
ware design. In order to compare the effect, we make two
designs:
(a) Common design: Put C clasp of normal length on A5,
and place embrasure clasps on B4 and B5. Place the
circumferential clasp on A7.
(b) Esthetic design: Place the short buccally retentive
clasp on A5, and place the traditional clasp on area
B6. Because of the tight occlusion, we do not design
the rest of B6. The buccal inclination of B6 is obvious, and the position of clasp is higher (Fig.6.208).
The second step is to t the photos in the mouth with
the designed stent shape. Let’s look at the results of the
common design after tting. The clasps in areas A and B
are all at risk of exposure. Looking at the tting results of
the lower part, we can see that the clasps on B4 and B5
have been exposed, and the esthetic effect is not good. As
for the effect map of esthetic design facial tting, it can
be seen that there is no clasp exposed in the range of A5–
B5 and the normal shadow of the corner of the mouth
should cover the part of clasp that B6 is exposed to
(Fig.6.209). Compared with the two schemes, the effect
of esthetic design is better. After communicating with
patients, patients chose to use the second esthetic design.
The third step is personalized dental preview, similar to
DLD dental preview of xed repair. Here, the tooth shape
prediction can be realized with the tooth assistant software
(Fig.6.210). According to the patient’s satised esthetic
design tooth shape prediction, we make the esthetic wax
pattern. The wax pattern needs to copy the original design
parameters, and try wearing it in the mouth of the patient.
After trial wearing, it can be modied again according to
the actual situation. Finally, the wax pattern is used to
guide the nal repair system (Fig.6.211).
We design e-clasp + porcelain-fused metal framework
and simulate base for Miss Peng. At the position of the
missing tooth, a metal pre-prepared abutment part must
be designed to bond with the subsequent porcelain tooth.
The design points are as follows (Figs.6.212 and 6.213):
(a) Maxillary support design: most of the maxillary ante-
rior teeth are missing. AB11 (C clasp) clasp is
designed on A5, and three-arm clasp is designed on
A8 and B6
(b) Major connector to avoid the gum, so that the gum
can get sufcient food massage to ensure oral health.
(c) Labial retention bead design—to combine with the
maximum area of the simulation base. For gingival
tissue defect, it is suitable for patients with esthetic
effects.
194
6 Case Analysis ofEsthetic Clasp
a
b
Fig. 6.208 Bracket design: complete the two designed bracket forms
in the design software. Now, we can see the front view of the two
designs. The common design is easy to expose the metal because the
(d) The best position of the cervical line is consistent
with the esthetic wax pattern or more under the gum.
The simulate base can slightly cover the neck of the
teeth, and the esthetic effect is better.
(e) The design of shoulder is the same as that of abut-
ment to ensure the color of porcelain layer.
(f) The junction line of the trailing edge is ushed with
the cervical edge, which is equivalent to the effect of
metal reinforcing belt.
(g) Fit esthetic wax pattern in three-dimensional direc-
tions, labial surface, incisal surface, and lingual surface, and reserve appropriate thickness of porcelain
layer. It can be measured with the tool provided by
the software and adjusted accordingly.
According to the results of color comparison, the porcelain teeth are made, and the esthetic wax pattern turns
guide plate to guide the porcelain process (Fig.6.214).
abutment tooth is located in the front and the clasp is long (half-page
version). (a) Occlusal view of bracket design. (b) Front view of bracket
design
The patient is satised with the porcelain teeth made at
present. The clinical bonding can be carried out in or out
of the mouth. Figure 6.215 shows the bonding in the
mouth. Layered stacking of gum resin: different colors of
gum resin are used in different positions of the gum to
achieve vivid simulate effect (Fig.6.216). According to
the patient’s esthetic design tooth shape prediction, we
make the esthetic wax pattern. The esthetic wax pattern
need to copy the original design parameters, and try to
wear it in the patient’s mouth. After the trial wear, it can
be modied again according to the actual situation.
Finally, the wax pattern is used to guide the nal repair
system.
3. After restoration
The nal result is shown in Figs.6.217 and 6.218.
a
6.26 Case 26
Fig. 6.209 Oral photos and
shape tting of designed
bracket. (b) General Intraoral
prediction. (c) Esthetic
Intraoral prediction
195
b
c
196
Fig. 6.210 Personalized
tooth shape prediction
6 Case Analysis ofEsthetic Clasp
Fig. 6.211 The wax pattern
is tried on in the mouth, and
the shape is well coordinated
with the adjacent teeth.
Determine tooth shape
6.26 Case 26
Fig. 6.212 Design of
maxillary bracket
Fig. 6.213 Trial wearing of
bracket in mouth
197
198
Fig. 6.214 Trying to wear
the porcelain teeth on the
bracket
6 Case Analysis ofEsthetic Clasp
Fig. 6.215 Bonding of the porcelain teeth with the brackets in the
mouth
Fig. 6.216 Layered stacking of gum resin
Fig. 6.217 The intraoral renderings