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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5199_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Introduction
- •Preface
- •Acknowledgment
- •1.2.1 Esthetic Abutment
- •Contents
- •About the Editor
- •1.1.1 Elastic Resin
- •1.1.2 Tooth Color Resin
- •1.1.3 Transparent Resin
- •1.1.4 High-Elasticity Casting Alloy
- •1.2.3 Esthetic Retention Area
- •1.3.1 Mechanics Principles
- •References
- •2.2.1 Short Buccally Retained Clasp
- •2.2.2 C Clasp
- •2.2.3 L Clasp
- •2.2.5 T Clasp
- •2.2.6 Adjacent Surface Hidden Clasp
- •2.2.7 Twin-Flex Clasp
- •2.3.1 Short-Arm Embrasure Clasp
- •2.3.2 Plate-bar Clasp
- •2.3.3 Lingually Retained Clasp
- •2.3.4 RLS Clasp
- •2.3.5 Terec Hidden Clasp
- •2.3.6 Saddle-Lock Clasp
- •2.4 Comparison
- •References
- •3.1 The First Visit
- •3.1.1 Reception
- •3.1.2 Analysis Design
- •3.1.3 Fill Work Authorization
- •3.1.4 Make Custom Tray
- •3.1.5 Tooth Preparation
- •3.2 The Second Visit
- •3.2.2 Record Jaw Relation
- •3.2.4 Design Base
- •3.3 The Third Visit
- •3.3.3 Clinician’s Advice
- •References
- •4.1 Introduction
- •4.2 Digital Design Terminology
- •4.2.2 Digital Analysis
- •4.2.3 Computer-Aided Design (CAD)
- •4.2.5 Computer-Aided Manufacturing (CAM)
- •4.2.6 Post-processing
- •4.3 Digital Design Principles
- •4.4.1 RD Designer
- •5.1 Esthetic Analysis
- •5.2.1 E-Clasp Digital Design
- •5.2.2 DLD Facial Fitting
- •5.2.4 Making Wax-Up Appearance
- •5.3 Accurate Tooth Preparation
- •References
- •6.1 Case 1
- •6.2 Case 2
- •6.3 Case 3
- •6.4 Case 4
- •6.5 Case 5
- •6.6 Case 6
- •6.7 Case 7
- •6.8 Case 8
- •6.9 Case 9
- •6.10 Case 10
- •6.11 Case 11
- •6.12 Case 12
- •6.13 Case 13
- •6.14 Case 14
- •6.15 Case 15
- •6.16 Case 16
- •6.17 Case 17
- •6.18 Case 18
- •6.19 Case 19
- •6.20 Case 20
- •6.21 Case 21
- •6.22 Case 22
- •6.23 Case 23
- •6.24 Case 24
- •6.25 Case 25
- •6.26 Case 26
- •6.27 Case 27
- •6.28 Case 28
- •6.29 Case 29
- •6.30 Case 30
- •6.31 Case 31
- •6.32 Case 32
- •6.33 Case 33
- •References
- •7.1.1 Fill Work Authorization Form
- •7.1.2 Transfer Digital Image Data
- •7.1.3 Communicate Directly
- •Conclusion

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4 Digitalization inRPD
Fig. 4.36 Draw the expansion range
Fig. 4.37 Generate the preliminary shape and add the handle

4.3 Digital Design Principles
69
Fig. 4.38 Finish the design
the framework, mainly relies on the theoretical knowledge
and operation experience of doctors and technicians and
lacks the technical stability and objective standards, which is
apt to generate errors in the production process, resulting in
a series of problems such as the mist of the framework,
casting failure, and materials waste.
In the digital design, build the virtual structures of RPD
three-dimensionally such as meshwork patterns, major connectors, minor connectors, clasps, and the nish line through
CAD software, and print or mill the metal framework, or
wax or resin sacricial patterns by means of CAM
equipment.
1. Clinical analysis and design
The traditional design process of RPD consists of surveying, blocking out of undercuts, duplicating to form the
refractory cast, waxing up, and so on (Fig.4.39). Survey
the cast xed on the platform of the surveyor, and determine the path of insertion and undesirable undercuts that
then will be blocked out. The traditional framework is
made manually using prefabricated wax patterns for
clasps, connectors, palatal coverage, and so on. The size
of the clasp limited by wax patterns is relatively xed.
In the digital design workow, the rst step is to
acquire the digital arch information through intraoral or
extraoral scanners, and the second is to design the framework virtually by means of proprietary software, through
which the insertion path of the framework can be adjusted
and undercut areas of the abutment, presented by the
color strips on the right side, will change accordingly,
which can assist in the selection of the most suitable
insertion path that will be indicated by the blue arrow
(Fig. 4.40). After determining the path of insertion,
undercuts will be blocked out automatically using red
wax (Fig.4.41), and some wax in retentive areas, where
the tip of the retentive arm of the clasp contact with the
abutment (Fig.4.42), should be removed, leaving appropriate depth of the undercut.
2. Process of fabrication
Table 4.1 shows the clinical failure rate of the cast
framework, with a total of 30,618 dentures. Within 18
months, 89 of the 5076 pieces of pure titanium framework broke, with a failure rate of 1.75%. Among the
25,542 cobalt- chromium alloy framework, 146 pieces
broke, and the failure rate was 0.57%. The clasp is the
most common fracture location for both pure titanium
and Co-Cr frameworks.
Due to human errors and casting defects in traditional
framework fabrication, the quality of prostheses will be
affected to some extent. Some scholars have made statistics on the casting defects of cast Co-Cr frameworks
(Table 4.2). According to literature reports, among the
258 clasps of 90 cast Co-Cr frameworks, 111 clasps have
casting defects, accounting for 43% of the total. The

70
Fig. 4.39 Traditional design and fabrication procedures of cast frameworks
4 Digitalization inRPD
Fig. 4.40 Adjust the path of insertion
number and proportion of defects in each part of the clasp
are shown in the following table. It can be seen that the
casting defect rate of the occlusal rest is the highest,
reaching 24.18%.
Table 4.3 shows the number and prevalence of casting
defects. It can be seen that among the 90 frameworks, 12
of them have no casting defects, 26 of them have 1–2
casting defects, and 16 of them have extensive defects.
Compared with traditional frameworks, 3D printed
metal frameworks have obvious advantages:
(a) Net formability. There’re almost no wasted metal
powders, and unused materials can be recycled.
(b) Superior design and geometric exibility. Enable
producing a complex 3D design and geometries,
especially suitable for metal frameworks.
(c) No micropore, high density, and high precision.
(d) A variety of materials can be used for dental applica-
tions, such as Co-Cr alloy, titanium alloy, etc.
(e) Reduce the fabrication step of molding and shorten
the production time.

4.3 Digital Design Principles
71
Fig. 4.41 Block out undesirable undercuts
Fig. 4.42 Draw the virtual clasp three-dimensionally and the retentive tips are placed in the undercuts

72
Table 4.1 Clinical failure rate of cast frameworks after 18 months
Rates of situations in failure cases n(%)
Materials n Fracture failure rates n(%)
Ti 5076 89 (1.75%) 49 (55%) 16 (18%) 24 (27%)
Co-Cr alloy 25542 146 (0.57%) 88 (60%) 20 (14%) 38 (26%)
Clasp Minor connector Major connector
4 Digitalization inRPD
Table 4.2 The location and proportion of casting defects
No. of castings
Casting
Clasp units 258 111 43.00
Retentive arm 334 31 9.28
Reciprocal
arm
Occlusal rests 215 52 24.18
Minor
connector
Major
connector
studied
326 28 8.58
204 43 21.07
90 18 20.00
No. of castings
defects Percentage
(f) Maximum utilization of materials, energy, and cost.
Advantages of 3D printed wax or resin patterns
(Fig.4.43):
(a) The framework is also designed digitally, reducing
human errors associated with manual wax-ups.
(b) Low cost of the equipment and effectively combining
the advantages of the high accuracy of 3D printing
and the low cost of casting.
3. Time, efciency, and workow
The digitalization of frameworks is composed of CAD
and CAM process. The CAD process refers to collecting
digital data by 3D scanner and designing, and the CAM
process is to fabricate the framework by means of direct
printing of the metal or casting of the printed wax or resin
patterns (Fig.4.44).
The traditional procedure of the framework includes
steps of making impression, pouring into plaster cast,
waxing up, and casting. But in semi-digital and whole
digital workow, frameworks can be designed virtually
based on the digital model, which is acquired by scanning
the gypsum cast for Kennedy class I, II, and IV arches
and by intraoral scan for Kennedy class III arches, and
then be fabricated directly through selective laser melting
(SLM) or cast from 3D printed wax patterns (Fig.4.45).
To compare the average production time of traditional
and digital frameworks, 20 metal frameworks are selected
as samples, each of which is fabricated in three ways, the
traditional, the semi-digital, and the digital, and the cost
time of every step is recorded and summarized respectively by the same experienced technician. Results are
shown in the following table. The average fabrication
time of single framework is 4.12h, 10.56h, and 20.85h,
for the semi-digital process, traditional process, and digital process, respectively (Fig.4.46).
From the perspective of the average cost of a framework, we can see that the average cost of the framework
is 54.95 yuan for the semi-digital, 95.05 yuan for the digital, and 45.05 yuan for the traditional (Fig.4.47). Digital
frameworks cost about twice as much as the traditional,
while semi-digital frameworks cost only 22% more than
the traditional.
Thus, the advantages of digital RPD are as details:
(a) Repeatability: Conducive to the quality control of
prostheses and standardized management of the
clinic and laboratory.
(b) Predictability: Facilitating communication among
doctors, technicians, and patients.
(c) Resource integration: Facilitating the efcient appli-
cation of new technologies and equipment.

4.3 Digital Design Principles
Table 4.3 The number and prevalence of casting defects on cast frameworks
No. and status of specimens
No. of castings
studied
90 12 26 26 18 8 16
No castings
defect
One casting
defect
Two castings
defect
Three castings
defect
More than three castings
defect
(g) Equipment: The precision and accuracy of the exist-
ing equipment still need to be further improved, so as
to make more precise prostheses. There are still
shrinkage holes in the printed metal. In addition, the
printing time is long, and the printing rate needs to be
increased.
(h) Materials: There’re only two main kinds of digital
dental alloys for printed RPDs, Co-Cr alloy and Ti
alloy, needing to develop more kinds of metal
powders.
(i) Cost At present, most of the equipment and materials
are imported, and the cost of the whole digital process
is relatively high. It’s necessary to develop equipment
Fig. 4.43 3D printed resin patterns
and materials independently to reduce the cost of digital production and make it more widely used.
Digitalization in RPD refers to a series of digital
(d) Process integration: Facilitating the integration of
each link and avoiding errors in the information
transmission.
(e) Efciency improvement: Streamlining operations
(f) Environmentally friendly Computer-aided design and
computer-aided manufacturing (CAD/CAM) replac-
ing the traditional process of waxing up, investing,
and casting, greatly improving the working environ-
ment of technicians.
However, there are still problems to be solved in
digital RPD at present.
process, done through the computer, including the
evaluation of the patient’s anatomy physiology, the
design of the prosthesis, the impression of arches,
and the precise production of the prosthesis, making
the prosthesis a perfect work of art. With the continuous development of new materials and technologies,
the aim is to optimize the digital operation and to
reduce the cost, developing from powder spray to no
powder spray, from rough to precise, from complex
to intelligent, from slow to fast, from manual to automatic, from big to small, and from more to less.
73
Generalized castings
defect

74
Intraoral scan
g
3D printing
Workflow of cast frameworks
Digital workflow of esthetic frameworks
3D printed wax or resin
Impression
4 Digitalization inRPD
Milling
Model
3D scanner
Fig. 4.44 Digital workow of the framework
Fig. 4.45 Process
comparison of cast and digital
esthetic frameworks
CAD
Ta ke impressions
Make stone casts
Design clasps
Data
transmission
Kennedy class I , II and IV cases
Ta ke impressions
Make stone casts Intraoral scan
Esthetic analysis
Dentition analysis
Workstation
Design frameworks
Selective laser meltin
Kennedy class III cases
digitally
form the wax pattern of
frameworks
Cast frameworks
SLM
Digital esthetic frameworks
patterns and cast

h
Cost of a framework (yuan)
100
Semi-digital framework Digital framework Cast framework
4.3 Digital Design Principles
75
Design
0.76h
Design
0.76h
Process the model
4.16h
Print the
wax pattern
1.29h
Print the metal
7.10h
Invest &
cast
1.33h
Waxing
Up
0.66h
Finish &
polish
0.74h
Invest & cast
5.00h
Semi-digital worflow: 4.12h
Heat treatment
12.00h
Finish &
polish
0.74h
Fig. 4.46 Average production time of cast frameworks and digitalized frameworks
Fig. 4.47 Cost of a
framework fabricated by three
different techniques
75
Finish &
polish
0.99h
Digital workflow: 20.85
Traditional workflow: 10.56h
95. 05
50
54. 95
45. 05
25
0

76
4 Digitalization inRPD
4.4 Application ofRD Designer Software
inRPD
4.4.1 RD Designer
RD designer is a clinical decision support system software
for removable partial dentures in prosthetic dentistry. It can
be applied in clinical practice to assist doctors to complete
the design of frameworks of RPD according to the basic oral
conditions of patients and to provide a standard and feasible
delivery path of the plan. It is a supplement to the digital
process of RPDs. In addition, it can also be applied to the
analysis and design of virtual cases in teaching to enhance
the combination between teaching and clinical practices.
4.4.2 Working Principles ofRD Designer
Case-based reasoning (CBR) is an important reasoning
method in the eld of articial intelligence. It gives the
solving process and result of the new problem through the
retrieval and match of previous cases. Rule-based reasoning (RBR) system, also known as a production system,
connects rules in series through logical relations and draws
the required conclusions through logical derivation.
Combination of RBR and CBR, playing their respective
advantages, uses rules to guide case retrieval and to achieve
the goal that the cases should be as few as possible and as
relevant, similar or matching as possible to the target
cases.
RD designer applies the CBR-RBR hybrid model to the
design of RPD.Steps are as follows:
1. Obtaining the data of medical cases, carrying out preprocessing, and extracting the characteristics.
2. Performing CBR case retrieval on the test data.
3. For test cases with a high degree of similarity, it is
considered that the most similar medical records in the
case database are the same as the diagnosis results, so
the case can be directly output for the doctor’s diagnosis, and the reasoning results can also be output.
For the test cases with low similarity, the most similar
cases cannot be found, so the RBR module is used for
rule inference.
4. Recording the diagnostic effect of reasoning results, adding the valid results to the case database as new cases, and
updating the decision tree rules of RBR module.
4.4.3 Digital Workow ofRD Designer
1. Create a case. Select missing teeth according to the eden-
tulous areas of the patient (Fig.4.48).
2. Preliminary judgment. The software will judge the alter-
native plans preliminarily based on the situation of edentulous areas, for example, elastic dentures will be
suggested rstly when a few anterior teeth are lost.
3. Preliminary scheme. The software will recommend the
optimal plan and the alternatives according to the rules
(Fig.4.49).
Fig. 4.48 Software interface of creating a case

4.4 Application ofRD Designer Software inRPD
Fig. 4.49 Software interface of preliminary scheme
77
4. Secondary scheme. The software will adjust the primary
plan automatically according to the abutment situation of
looseness and tilt (Fig.4.50).
5. Customized adjustment. Clinicians are allowed to
replace clasps and connectors with alternatives according to the personalized situation of the patient
(Fig.4.51). The design of the framework will be completed primarily.
6. Analysis of load. The software will analyze the stress of
the designed framework while functioning according to
the law of fulcrum line and plane, providing certain reference for the rationality of the framework.
7. Guidance of tooth preparation. The preparation plan of
rest seats and guide planes will be generated according to
their locations by the software (Fig. 4.52). Finish the
design of RPD.
4.4.4 Future ofRD Designer
1. Optimizing the database through deep learning based on
of big data
2. Increasing the dimension and combining with the intraoral scan to display the esthetic result digitally and
immediately
3. Facilitating the linkup of RD designer and CAD/CAM
software and importing editable STL les to avoid errors
in transmission from 2D to 3D
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