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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5199_Библиотеки_им_академика_М_И_Перельмана.pdf
6.29 Case 29
Fig. 6.239 The weight of
PEEK bracket is 58% lighter
than that of CO-Cr alloy
bracket
209
6.29 Case 29
One Case of Dentition Defect Repaired with PEEK
Stent Combined with RPD
1. Before restoration
A woman, 66 years old. The upper jaw is Kennedy III
dentition defect, the remaining teeth in the upper jaw are
A3–B3, and only C3 is left in the lower jaw; C3 is once
loose. It can be seen that alveolar bone resorption is serious, especially that the mandibular alveolar bone is in
poor condition (Fig.6.240).
2. RPD design and manufacturing
For the patients with few remaining teeth, the main
support mode of removable denture is mucous membrane
support, and when using the remaining teeth for reten-
tion, it needs to use the base for retention, which requires
that the base has a certain range, and the edge of the base
is well sealed. Therefore, this case combines two techniques of esthetic clasp with absorbable denture to obtain
good retention and esthetic effect. First, make the primary
impression (Fig. 6.241), obtain the primary model
(Fig.6.242), make individual trays (Fig.6.243), make the
nal impression (Fig. 6.244), obtain the nal model
(Fig. 6.245), design the bracket on the nal model
(Fig.6.246), and make the wax pattern (Fig.6.247) after
the bracket is completed.
3. After restoration
After the repair, the facial pattern is good without
clasp exposure. The patient feels comfortable and satised (Figs.6.248 and 6.249).
210
Fig. 6.240 The remaining
teeth are few, and the
condition of the remaining
alveolar bone is poor
Fig. 6.241 Primary
impression
6 Case Analysis ofEsthetic Clasp
Fig. 6.242 Primary model
6.29 Case 29
Fig. 6.243 Making
individual trays
Fig. 6.244 Silicone rubber
for nal impression
211
Fig. 6.245 Final model
212
Fig. 6.246 Design of
maxillary bracket
Fig. 6.247 Bracket
completion and wax pattern
production
6 Case Analysis ofEsthetic Clasp
Fig. 6.248 The intraoral
renderings
Fig. 6.249 Full-face view
6.30 Case 30
213
6.30 Case 30
A Case of Upper and Lower Dentition Defect Repaired
by PEEK Stent RPD
1. Before restoration
The proportion of the patients’ face is normal, but it is
not symmetrical. The line between the pupil and the line
between the mouth corner are not parallel. According to
the main medical history before restoration, the smiling
Fig. 6.250 Lower 1/3 facial
view
exposed zone of Zhang is observed, which could be
judged as a low smile line, and the tooth position of the
esthetic area of the upper jaw is A3–B3 (Fig.6.250).
The upper jaw are Kennedy I dentition defection, and
the lower jaw are Kennedy III dentition defection. It can
be seen that there is a black triangle between A1 and B1.
The remaining teeth are not loose. The oral hygiene condition is general, and pigmentation can be seen on the
tooth surface (Fig.6.251).
Fig. 6.251 The intraoral renderings
214
6 Case Analysis ofEsthetic Clasp
2. RPD design and manufacturing
Because the patients are not willing to receive too
much attrition, we only prepare a small number of teeth
in the mandible and use the existing conditions of the
remaining teeth as much as possible to place the rest. The
palatal plate was extended to the lingual side of A3B3, so
as to achieve the purpose of both abutment teeth and
mucosa support. A one-arm clasp is placed on A4. In
order to make full use of tooth undercut to increase retention force, the clasp of B5 is extended to B4. The anterior
teeth avoid the gums to ensure self-cleaning effect. There
are Kennedy III mandibular defect. C4 and D5–D6 are
selected as abutment teeth. We place a one-arm clasp on
C4 and three-arm clasps on D5D6 to ensure the mandibular retention. Lingual plate is used for major connector
(Fig.6.252). After completing the bracket, arrange teeth
and try wax patterns on (Fig.6.253).
3. After restoration
The nal result is shown in Figs. 6.254, 6.255, and
6.256.
Fig. 6.252 Design of upper and lower jaw bracket
Fig. 6.253 After completing bracket, arrange teeth and try wax patterns on
6. 31 C as e 31
Fig. 6.254 The intraoral renderings
215
Fig. 6.255 Fitness and occlusion of denture are great
Fig. 6.256 Facial effects
6.31 Case 31
A Case Study on the Design of PEEK Stent and PEEK
Integrated Removable Partial Denture
1. Before restoration
A man, 86 years old. The facial asymmetry can be
seen in the frontal view, but the middle line of dentition is
in harmony with the middle line of the face. The esthetic
tooth position which can be seen in the smile view of the
face is 14–24in the upper jaw (Fig.6.257).
In the oral examination, the upper jaw is Kennedy II
dentition defect, and 25–27 are absent, 24 is residual root,
16 is I°loose, and 14 and 23 have wedge-shaped defects;
the lower jaw is Kennedy II dentition defect, 37, 45–47
are absent, 36, 42, and 44 are I°loose. The oral health
condition is poor, and there are many calculi (Fig.6.258).
2. RPD design and manufacturing
In this case, we have designed two schemes: one is
traditional design, and the other is a combination of articial teeth and stent to form integrated stent. Such stent
will not form weak points because of the need to design
216
Fig. 6.257 Facial analysis
6 Case Analysis ofEsthetic Clasp
Fig. 6.258 Intraoral condition
the nish line. At the same time, due to the low density of
PEEK, the weight of the whole stent is also very light.
(a) Scheme I
(i) Conventional stent design: In this case, both
upper and lower jaw major connectors were plate
design, combined with the traditional one-arm
clasp and three-arm clasp to sure the retention of
the whole stent (Figs.6.259, 6.260, 6.261, 6.262,
and 6.263).
(ii) Repair effect is in Fig.6.264.
(b) Scheme II
The design of rest and retainer in scheme I is not
changed, and the articial teeth and bracket are
designed as a whole. Because the missing teeth are
all posterior teeth, not in the esthetic area, so it will
not affect the esthetics. In the second visit, alginate
impression material was used to take impression, and
the plaster model is lled, then temporary base and
wax rim were made to obtain the occlusion relationship, and then the dental model scanner was used to
scan to obtain the digital dentition model and occlusion relationship of patients.
(i) Digital design of integrated bracket (Fig.6.265)
The dentition model and occlusion relationship of the patients were imported into the dental
design software for the restoration design. The
design of articial teeth is carried out after conrming the path of inserting and automatically
lling out the unwanted undercut. According to
the shape of the remaining teeth, the suitable
6. 31 C as e 31
Fig. 6.259 The CAD design
of PEEK bracket
217
Fig. 6.260 Maxillary bracket completion
articial teeth can be selected in the tooth shape
database; and the size, axial direction, and shape
of the teeth can be adjusted individually; and the
teeth can be arranged according to the principle
of alveolar crest.
After the tooth arrangement is completed, the
bracket is designed. The palatal plate/lingual
plate was chosen as the major connector to
enlarge the stress area of the mucosa and avoid
local pressure resulting in tenderness. The combined clasp was placed between 14 and 15, and
the one-arm clasp was placed on 17 and 23. The
combined clasp and the one-arm clasp were also
used for retention of the mandible bracket. The
clasp is semicircle, because PEEK elastic modulus is lower than that of metal clasp; in order to
ensure the retentive force of clasp, set the depth
of clasp tip into the undercut to 0.5 mm, the
radius of clasp is 1mm, the arm of snap ring is
1.3 mm, and the body of clasp is 1.5 mm. In
addition, the net minor connector in the traditional bracket design is removed, and the plate-
218
6 Case Analysis ofEsthetic Clasp
Fig. 6.261 Mandibular bracket complete
Fig. 6.262 It can be seen
that the bracket is suitable for
wearing
Fig. 6.263 Trying wax pattern on