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68
4 Digitalization inRPD
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 mist 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 sacricial 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 workow, 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 inRPD
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 inRPD
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, efciency, and workow 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 workow, 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 4.12h, 10.56h, and 20.85h, 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 efcient 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) Efciency 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 inRPD
Milling
Model
3D scanner
Fig. 4.44 Digital workow 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 inRPD
4.4 Application ofRD Designer Software
inRPD

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 ofRD Designer
Case-based reasoning (CBR) is an important reasoning method in the eld of articial 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 Workow ofRD 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 ofRD Designer Software inRPD
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 ofRD 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