Haiyang Yu

Digital Removable
Partial Denture
Technology
From Design Analysis to Practical Skills

123
Digital Removable Partial Denture Technology

[Link]/Dr_Mouayyad_AlbtousH
[Link]/Dr_Mouayyad_AlbtousH
Haiyang Yu

Digital Removable Partial

Denture Technology
From Design Analysis to Practical Skills

[Link]/Dr_Mouayyad_AlbtousH
Haiyang Yu
Department of Prosthodontics
West China Hospital of Stomatology
Chengdu
China

ISBN 978-981-19-7922-4    ISBN 978-981-19-7923-1 (eBook)

[Link]

© Springer Nature Singapore Pte Ltd. and People's Medical Publishing House Co. Ltd. 2023
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[Link]/Dr_Mouayyad_AlbtousH
Introduction

Dentures have been used to restore the beauty and function of missing teeth as early as 2500
BC. From ancient times to the present, the materials for replacing missing teeth have continued
to evolve, from wood, bone, animal teeth, dead human teeth to metals, ceramics, and high-­
performance polymers. Each alternative material may correspond to a type of repair method,
from simple simulation replacement to the pursuit of simulation bionics, and its technical con-
notation is often synchronized with the highest technological level of its contemporaries.
Among various forms, the modern Removable Partial Denture (RPD) was once an advanced
form of denture restoration. However, in the past 50 years, with the rapid development of fixed
restoration and implant restoration, as well as the increasing demand for functional recovery
of edentulous patients, RPD seems to be a little powerless, and professional and social atten-
tion is also declining. Whether RPD is still promising is the subject of this book.
It is not very early for RPD in the modern form to appear. In 1930 and 1937, cobalt-­
chromium alloys and dental acrylic resins were successively introduced into the dental field,
and the modern standardized RPD appeared for the first time in dental clinics. Compared with
earlier methods of restoration, the RPD at that time was extremely advanced. With decades of
development, especially the empowerment of digital technology in the past decade, RPD has
regained its youth. However, its overall market share has been declining.
In fact, RPD is minimally invasive and reversible, and the price is relatively low, espe-
cially when there are many missing teeth, it is the preferred repair method for patients
who are sensitive to disease burden and iatrogenic damage. This is the reason why it is
ordinary but lasting. How to retain its inherent advantages and reduce its disadvantages
is precisely the core of this book.
However, the “removable” feature, which is favored by some patients and doctors, limits the
functional reconstruction and recovery effect of RPD to a certain extent and also determines
the complexity and diversity of RPD structural design. Removable and wearable increases the
requirement for patients’ daily cleaning and also reduces the chewing function and comfort of
dentures. Also, in order to ensure sufficient retention, stability, and support under the premise
of repairing defects, the iterative RPD often needs to be composed of elastic clasps, rigid
framework, tooth-colored artificial teeth and gingiva-colored denture bases. Therefore, at pres-
ent, patients have mainly two dissatisfaction and problems after long-term use of RPD. One
problem is the lack of esthetics caused by the exposure of metal clasps. The other problem is
the inadequate accuracy of framework resulting in the ill fit and poor retention of the frame-
work. Therefore, after breaking through these two problems, the RPD can have better func-
tional recovery and comfort, and of course, there will be more indications and a better wearing
experience.
Therefore, the first chapter of this book “How to Improve the Esthetics of Removable Partial
Dentures” and the second chapter “Classification and Design of Esthetic Clasp” focus on the
first problem. These two problems have been driving the continuous exploration of repair
materials and processing techniques by professionals. Materials and techniques complement
each other and interact. The development of materials drives the progress of manufacturing
techniques, and at the same time, the maturity of technology also introduces new materials. In
addition, the introduction of new materials and new techniques also corresponds to the

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vi Introduction

u­ pgrading and changes of RPD design. Different denture upgrade designs have also improved
the function of dentures and have continuously produced better RPD repair effects.
In Chap. 1, “How to Improve the Esthetics of Removable Partial Dentures,” the authors
reviewed the first esthetic problem with exposed metal clasps. As early as 1981, McCartney
proposed a new design of the MGR clasp to improve the esthetics of metal clasp. Subsequently,
a variety of clasp concealment designs such as lingual retention clasp, Twin-Flex clasp, and
improved balance clasp were also proposed successively. In 1990, Budkiewicz proposed the
design concept of minimizing the retentive arm of the clasp, which is also the source of the
design of the short buccally retained clasp, the C clasp, the short-arm embrasure clasp, and
other clasps shared in Chap. 2 of the book. On the other hand, scholars have also tried to
replace metal clasps with thermoplastic resin materials with better esthetics. Early thermoplas-
tic resin materials are mainly acetal resin and polyamide and other materials. These materials
simulate the color of the gingiva well but are significantly less strong enough to be used as final
dentures. Polyaryletherketone (PAEK) family has good biosafety and stable physical and
chemical properties. With its development and wide application in the medical field, it has also
been introduced into the field of oral restoration, such as its family representative materials
Polyetheretherketone (PEEK), Polyetherketoneketone (PEKK) et al. On the basis of ensuring
the normal performance of the RPD function, the above methods of improving the overall
esthetic performance of the RPD by adopting a new clasp design or an esthetic repair material
are collectively referred to as esthetic clasp technology. At the beginning of 2021, the Chinese
Stomatological Association released the Esthetic Clasp Technology written by the author, indi-
cating that this set of ideas and methods has been recognized and supported by Chinese
counterparts.
The correct clinical pathway is also very important. This part of the content is described in
detail in Chap. 3 of this book, “Clinical Pathway of Digital Removable Partial Denture
Technology,” Chap. 6, “Case Analysis of Digital Removable Partial Denture Technology”, will
show the diagnosis and treatment process and the repair and reconstruction effect through 33
typical cases.
Digital technologies effectively solve the second difficulty. In the traditional RPD manufac-
turing process, the steps of the cast analysis, undercut block out, refractory cast reproduction,
wax-up making, and embedding casting are complicated and technically dependent, and errors
are easily accumulated layer by layer. The CNC milling technology of fixed repair is difficult
to realize the processing of the complex structure of RPD. Therefore, the continuous maturity
and development of three-dimensional printing technology have promoted the development
process of digital RPD restoration. In 2004, the method of indirect 3D printing resin wax com-
bined with the casting method to make metal frameworks appeared. In 2006, selective laser
melting (SLM) technology enabled direct 3D printing of metal frameworks. Optical scanning
technology and CAD/CAM technology transform manual operation into standardized device
operation, reduce human error and labor cost, shorten operation time, and at the same time,
data can be stored, and the restoration has better repeatability and accuracy. The research and
development of RPD expert systems such as RD-designer aim to provide standardized, diversi-
fied, and personalized framework design solutions to solve the difficult, messy, and compli-
cated problems of RPD design. That using the convenience and flexibility of digital technology
to improve the design and esthetics of dentures, and to solve difficult problems that cannot be
solved by traditional technology, is so-called digital removable partial denture technology. In
this book, Chap. 4 “Virtual Design and Numerical Control Manufacture of Digital Removable
Partial Denture Technology” and Chap. 5 “Special Designs and Production Skills of Digital
Removable Partial Denture Technology” expound the new capabilities and breakthroughs of
digital technology in RPD manufacturing. In Chap. 6, “Case Analysis of Digital Removable
Partial Denture Technology,” from routine cases, complex cases to rare cases, with 32 cases in
a step-by-step manner, a variety of RPD digital new manufacturing and new solutions are
shown. Solving professional problems by combining various latest technologies empowered

[Link]/Dr_Mouayyad_AlbtousH
Introduction vii

by the technology of the times is the only way for the development of the discipline, and it is
also the driving force for the rejuvenation of RPD. This feature also supports the author’s
proposition that integrated restoration is the realistic development path of prosthodontics.
The chapter arrangement of this book aims to explain the current application of various
digital technologies in RPD repair methods from the simple to the deep, from the part to the
whole, from clinical design, processing, and manufacturing to case analysis. By adopting inno-
vative clasps design and the application of digital new materials, the digital RPD technology
displayed will help to show the new connotation of integrated prosthetics in the future.
Then, in view of the current situation that clinician-patient-technician communication and
cooperation are often neglected during RPD restoration, the author also conducts detailed
patient discussions in Chap. 7 “Communication and Cooperation Between Clinicians and
Technicians in Digital Removable Partial Denture Technology.” I hope readers can do the daily
work that should be done well.
Lastly is the Conclusion. Different from traditional cognition, the author proposes that the
advantages of RPD are minimally invasive, reversible, and affordable, while the disadvantages
are low functional recovery, insufficient esthetics and comfort. It is emphasized that the popu-
lar implantation, esthetic restoration, and high-tech restoration techniques such as templates
are inseparable from the clinical design principles and principles contained in the classical
restoration methods such as traditional RPD and complete dentures, as well as the accumula-
tion of long-term clinical practical experience, which is the basic skill that should not be over-
looked. From the perspective of integrated restoration, it further emphasizes the academic
value of classic RPD and digital RPD, and the thinking and suggestions that the inheritance
quality of traditional restoration technology urgently needs to be improved.
The main content arrangement of this book is introduced here, please turn to the next page
and start a discussion and exchange with the author.

[Link]/Dr_Mouayyad_AlbtousH
[Link]/Dr_Mouayyad_AlbtousH
Preface

Successful prosthetic is to let us challenge with “Nature.”

Even though there are a variety of classic prosthetics for us to select, we have not overcome
“Nature” overall. The final result always gives priority to short-term satisfaction and mid-long-­
term replacement. There are both advantages and disadvantages in each classic prosthetic tech-
nology. There’s no best way but the difference of the needs of patients, profession of
prosthodontist, and medical market operation, which is one of the bases that I proposed com-
prehensive prosthetic is one of the leading directions in the future.
The removable denture, which has been snubbed for years and might continue to be left out
in the future，is actually a good option as noninvasive and reversible.
Removable prosthetic is mainly for “disabled people.” This kind of patients choose remov-
able prosthetic for four reasons. First, these patients in general have a large number of legacies
like periodontal and dentin problem that have not been solved. There’s no perfect case as por-
celain prosthetic from the clinical intraoral photos. Only if the function can be impaired, the
denture will be accepted. That means the requests of patients are not high. Second, the scheme
is minimally invasive and reversible. There’s room for compromise for both doctor and patient.
Third, the daily maintenance is easy. Fourth, removable denture is the cheapest. But the disad-
vantage is more obvious: uncomfortable and unesthetic.
It is difficult to increase comfort level. Denture can only be thinner and smaller, but it is
impossible to remove the saddle and big connector unless choosing other prosthetic method.
The exposure of clasp is the main reason to cause unesthetic. Is there invisible “esthetic” clasp
that can improve efficiency without an increase in cost?
The answer is yes. This is the original intention and goal of the book.
Since 2005, Fang Xiaoqin, Huang Wenjing, and Wang Man had been doing research about
the concept, retention principle, classification, and clinical application of esthetic clasp. We
have obtained two patents in this field. I also have many lectures in China. There’s an episode:
Before I present this topic on a meeting in 2009, a senior asked me after seeing the topic “Why
do you speak on this topic?” The implication is it is too simple. Actually, I agree with him. But
we have to admit that prosthodontist in China really needs it.
In the removable prosthetics dental technology published this year, I wrote an article called
“the fault by simplify,” listing the simplified and despised history of dental technology in
China. I have discussed the influence on the design and clinical application of removable par-
tial dentures and the main reason that causes difficulty in wearing whole casting denture and
suboptimal effect. It can be said that there’s no success and popularity of new prosthetic way
like implant if there’s no accurate acquaintance and application of classical removable pros-
thetic technology. Combined with the fact that more than 60% with licenses in our country do
not have a bachelor’s degree, the content of this book is more realistic.
Based on these understanding and preliminary work, combined with the content of general
doctors, I edited this book hoping to push popularity of invisible clasp in our country. This
book discusses the concept and principles, classification and design, clinical application and
examples of esthetic clasp in detail. There’s even work authorization (design card) with all
kinds of esthetic clasp (logos). It is very practical. The learning curve is short. This book is
suitable for all kinds of dental doctors, medical students, dental technicians, etc.

ix

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x Preface

This book gets support from BBD, Shenzhen Jia Hong Lab, KTJ Dental Lab, Dentsply
China, and many friends. Xin Chen and Na Zhang, secretary of this book, did a lot of work
including text editing, image screening, and logo designing. I express my thanks to her here.
Many thanks for the editing works from the Springer and People’s Medical Publishing
House.
Given the limited length and my limited acknowledge, I hope your advice for the inappro-
priate parts!

Chengdu, China Haiyang Yu

[Link]/Dr_Mouayyad_AlbtousH
Acknowledgment

Special thanks to Xin Chen, Yuqing Lu, Na Zhang, Bixin Wen, Chenyang Xie, Junjing Zhang,
Yuxin Lou, Ziyu Mei, Jiayi Yu, and Tinglu Fang for assistance in each chapter.

xi

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[Link]/Dr_Mouayyad_AlbtousH
Contents

1 
How to Improve the Esthetics of Clasps�������������������������������������������������������������������   1
1.1 Invisibility of Clasps Characterized by Modified Material���������������������������������   2
1.1.1 Elastic Resin��������������������������������������������������������������������������������������������   2
1.1.2 Tooth Color Resin �����������������������������������������������������������������������������������   3
1.1.3 Transparent Resin �����������������������������������������������������������������������������������   3
1.1.4 High-Elasticity Casting Alloy �����������������������������������������������������������������   3
1.2 Using Esthetic Retention Area to Change Clasp Design
and Reduce Exposure�������������������������������������������������������������������������������������������   4
1.2.1 Esthetic Abutment�����������������������������������������������������������������������������������   4
1.2.2 Esthetic Path of Insertion�������������������������������������������������������������������������   6
1.2.3 Esthetic Retention Area���������������������������������������������������������������������������   7
1.3 Mechanics Principles and Comparison of the Retention
of Esthetic Clasps�������������������������������������������������������������������������������������������������   9
1.3.1 Mechanics Principles�������������������������������������������������������������������������������   9
1.3.2 Comparison of Retention������������������������������������������������������������������������� 11
References��������������������������������������������������������������������������������������������������������������������� 12
2 
Classification and Design of Esthetic Clasp������������������������������������������������������������� 13
2.1 Concept of Esthetic Clasp����������������������������������������������������������������������������������� 13
2.2 Esthetic Clasp for Anterior Teeth������������������������������������������������������������������������� 13
2.2.1 Short Buccally Retained Clasp ��������������������������������������������������������������� 14
2.2.2 C Clasp����������������������������������������������������������������������������������������������������� 14
2.2.3 L Clasp����������������������������������������������������������������������������������������������������� 16
2.2.4 Modified RPI Clasp��������������������������������������������������������������������������������� 17
2.2.5 T Clasp����������������������������������������������������������������������������������������������������� 18
2.2.6 Adjacent Surface Hidden Clasp��������������������������������������������������������������� 19
2.2.7 Twin-Flex Clasp��������������������������������������������������������������������������������������� 21
2.3 E-Clasp for Posterior Teeth��������������������������������������������������������������������������������� 21
2.3.1 Short-Arm Embrasure Clasp������������������������������������������������������������������� 21
2.3.2 Plate-bar Clasp����������������������������������������������������������������������������������������� 21
2.3.3 Lingually Retained Clasp������������������������������������������������������������������������� 23
2.3.4 RLS Clasp ����������������������������������������������������������������������������������������������� 25
2.3.5 Terec Hidden Clasp��������������������������������������������������������������������������������� 25
2.3.6 Saddle-Lock Clasp����������������������������������������������������������������������������������� 26
2.4 Comparison ��������������������������������������������������������������������������������������������������������� 27
References��������������������������������������������������������������������������������������������������������������������� 29
3 
Clinical Pathway of Esthetic Clasp Technology������������������������������������������������������� 31
3.1 The First Visit������������������������������������������������������������������������������������������������������� 31
3.1.1 Reception������������������������������������������������������������������������������������������������� 31
3.1.2 Analysis Design��������������������������������������������������������������������������������������� 32
3.1.3 Fill Work Authorization��������������������������������������������������������������������������� 39
3.1.4 Make Custom Tray����������������������������������������������������������������������������������� 39

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xiv Contents

3.1.5 Tooth Preparation������������������������������������������������������������������������������������� 41

3.1.6 Impression and Working Model��������������������������������������������������������������� 42
3.2 The Second Visit ������������������������������������������������������������������������������������������������� 44
3.2.1 Try-In of the Framework������������������������������������������������������������������������� 44
3.2.2 Record Jaw Relation ������������������������������������������������������������������������������� 44
3.2.3 Design Artificial Tooth����������������������������������������������������������������������������� 45
3.2.4 Design Base��������������������������������������������������������������������������������������������� 46
3.3 The Third Visit����������������������������������������������������������������������������������������������������� 47
3.3.1 Adjust Position and Occlusion����������������������������������������������������������������� 47
3.3.2 Grind and Polish ������������������������������������������������������������������������������������� 47
3.3.3 Clinician’s Advice����������������������������������������������������������������������������������� 47
References��������������������������������������������������������������������������������������������������������������������� 48
4 Digitalization in RPD������������������������������������������������������������������������������������������������� 49
4.1 Introduction��������������������������������������������������������������������������������������������������������� 49
4.2 Digital Design Terminology��������������������������������������������������������������������������������� 50
4.2.1 Acquisition of Digital Data��������������������������������������������������������������������� 50
4.2.2 Digital Analysis��������������������������������������������������������������������������������������� 52
4.2.3 Computer-Aided Design (CAD) ������������������������������������������������������������� 53
4.2.4 Import and Arrangement ������������������������������������������������������������������������� 53
4.2.5 Computer-Aided Manufacturing (CAM)������������������������������������������������� 53
4.2.6 Post-processing ��������������������������������������������������������������������������������������� 56
4.3 Digital Design Principles������������������������������������������������������������������������������������� 56
4.3.1 Digital Process of RPD ��������������������������������������������������������������������������� 56
4.3.2 Comparison of Digital and Traditional Frameworks������������������������������� 67
4.4 Application of RD Designer Software in RPD ��������������������������������������������������� 76
4.4.1 RD Designer�������������������������������������������������������������������������������������������� 76
4.4.2 Working Principles of RD Designer ������������������������������������������������������� 76
4.4.3 Digital Workflow of RD Designer����������������������������������������������������������� 76
4.4.4 Future of RD Designer����������������������������������������������������������������������������� 77
5 DLD
 (Digital Line Design): Esthetic Analysis and Design ������������������������������������� 81
5.1 Esthetic Analysis������������������������������������������������������������������������������������������������� 81
5.2 Preliminary Design of the Digital Frameworks of RPD ������������������������������������� 83
5.2.1 E-Clasp Digital Design ��������������������������������������������������������������������������� 83
5.2.2 DLD Facial Fitting����������������������������������������������������������������������������������� 84
5.2.3 Personalized Tooth Shape and Color Design������������������������������������������� 84
5.2.4 Making Wax-Up Appearance������������������������������������������������������������������� 84
5.3 Accurate Tooth Preparation��������������������������������������������������������������������������������� 87
5.4 The Digital Frameworks of RPD Design and Production����������������������������������� 90
5.5 Personalized Porcelain Teeth and Simulation Denture Base Production������������� 91
References��������������������������������������������������������������������������������������������������������������������� 94
6 Case
 Analysis of Esthetic Clasp��������������������������������������������������������������������������������� 95
6.1 Case 1�������������������������������������������������������������������������������������������������������������������   95
6.2 Case 2�������������������������������������������������������������������������������������������������������������������   97
6.3 Case 3������������������������������������������������������������������������������������������������������������������� 101
6.4 Case 4������������������������������������������������������������������������������������������������������������������� 102
6.5 Case 5������������������������������������������������������������������������������������������������������������������� 105
6.6 Case 6������������������������������������������������������������������������������������������������������������������� 107
6.7 Case 7������������������������������������������������������������������������������������������������������������������� 110
6.8 Case 8������������������������������������������������������������������������������������������������������������������� 112
6.9 Case 9������������������������������������������������������������������������������������������������������������������� 118
6.10 Case 10����������������������������������������������������������������������������������������������������������������� 123

[Link]/Dr_Mouayyad_AlbtousH
Contents xv

6.11 Case 11����������������������������������������������������������������������������������������������������������������� 126

6.12 Case 12����������������������������������������������������������������������������������������������������������������� 128
6.13 Case 13����������������������������������������������������������������������������������������������������������������� 134
6.14 Case 14����������������������������������������������������������������������������������������������������������������� 139
6.15 Case 15����������������������������������������������������������������������������������������������������������������� 142
6.16 Case 16����������������������������������������������������������������������������������������������������������������� 147
6.17 Case 17����������������������������������������������������������������������������������������������������������������� 151
6.18 Case 18����������������������������������������������������������������������������������������������������������������� 157
6.19 Case 19����������������������������������������������������������������������������������������������������������������� 162
6.20 Case 20����������������������������������������������������������������������������������������������������������������� 166
6.21 Case 21����������������������������������������������������������������������������������������������������������������� 170
6.22 Case 22����������������������������������������������������������������������������������������������������������������� 175
6.23 Case 23����������������������������������������������������������������������������������������������������������������� 178
6.24 Case 24����������������������������������������������������������������������������������������������������������������� 182
6.25 Case 25����������������������������������������������������������������������������������������������������������������� 186
6.26 Case 26����������������������������������������������������������������������������������������������������������������� 192
6.27 Case 27����������������������������������������������������������������������������������������������������������������� 199
6.28 Case 28����������������������������������������������������������������������������������������������������������������� 205
6.29 Case 29����������������������������������������������������������������������������������������������������������������� 209
6.30 Case 30����������������������������������������������������������������������������������������������������������������� 213
6.31 Case 31����������������������������������������������������������������������������������������������������������������� 215
6.32 Case 32����������������������������������������������������������������������������������������������������������������� 220
6.33 Case 33����������������������������������������������������������������������������������������������������������������� 226
References��������������������������������������������������������������������������������������������������������������������� 229
7 
Communication and Cooperation Between Clinicians and Technicians��������������� 231
7.1 General Process of Clinician-Patient-­Technician Communication��������������������� 231
7.1.1 Fill Work Authorization Form����������������������������������������������������������������� 231
7.1.2 Transfer Digital Image Data ������������������������������������������������������������������� 236
7.1.3 Communicate Directly����������������������������������������������������������������������������� 236
7.2 The Necessity of Digitalization in Clinician-Patient-Technician
Communication and Cooperation ����������������������������������������������������������������������� 237
7.2.1 The Basic Meaning of Digital Clinician-­Patient-­Technician
Communication and Cooperation ����������������������������������������������������������� 238
7.2.2 The Necessity of Digitalization in Clinician-Patient-Technician
Communication and Cooperation ����������������������������������������������������������� 238
7.3 The Application of Digitalization in Clinician-Patient-Technician
Communication and Cooperation ����������������������������������������������������������������������� 239
7.4 The Prospect of Digitalization in Clinician-Patient-Technician
Communication and Cooperation ����������������������������������������������������������������������� 241
Conclusion��������������������������������������������������������������������������������������������������������������������������� 243

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[Link]/Dr_Mouayyad_AlbtousH
About the Editor

Haiyang Yu associate dean of West China School of

Stomatology in Sichuan University, chair professor, Principal
Investigator, and deputy director of State Key Laboratory of
Oral Diseases Research, General Secretary of the guiding
committee of higher dental education Chinese ministry edu-
cation, Coming President of Prosthodontics Committee of
Chinese Stomatological Association, well-known expert in
Chinese prosthodontics and dental technology and special-
izes in guided esthetic restoration and digital dental
[Link]. Yu put forward several clinical protocols
such as “the depth hole guided tooth preparation,” “real-time
measuring and checking protocol for correct implant site,”
and “RPD designer”. He has given lectures around the coun-
try, published a number of papers and received widespread
peer recognition as well as praises from patients. He has
been teaching for 20 years and hosted online course of
“Prosthodontics” of national essential resources, first
enrolled undergraduates and graduate students of dental
technology nationwide and obtained 2 National Teaching
Achievement Prize. He is mainly engaged in research of bio-
mechanics of implant as well as dental digital technology
and has hosted more than 30 national and provincial pro-
grams. He has been rewarded the Natural Science Award of
scientific and technological achievements in Colleges and
Universities by the Ministry of Education. He possesses 34
national invention patents and 12 of which have been in the
market. He drafted 6 national standards, edited and published
22 treatises, academic papers over 200. He created several
technical protocols, such as HX-6 minimal invasive depth
cutting and calibrating tungsten steel bur, e-clasp esthetic
framework, and measuring set of implanting site, which have
made important contributions to the development of digital
guided protocols in the field of Prosthodontics.

xvii

[Link]/Dr_Mouayyad_AlbtousH
 How to Improve the Esthetics of Clasps
1

epidemic investigation and oral epidemic investigation, for

From a wide view of the history of removable partial quite some time in the future, RPDs will still play an impor-
dentures (RPDs), clasp is a kind of retainer with long tant part among quinquagenarian and low-income groups in
history. Clasp-retained RPDs were always recognized most areas [2].
as one of the important solutions for dentition defect
But the display of metal clasps in the buccal and labial
because of its advantages, such as noninvasive, safe
or facial surface of abutments (especially the anterior teeth
and reversible, cheap, wide indications, and so on.
and premolar teeth) has badly influenced the esthetic
effect—people still looks old though with denture, and it
cannot satisfy patients with their esthetic requirements.
However, the poor esthetics is one of the most signifi- With life standard and requirement of esthetic improved,
cant disadvantages of traditional clasp-retained RPDs. more and more patients are unwilling to choose clasp-
Do we have any protocol or solution to overcome the retained RPDs. It has been the common goal of both pro-
“metal smiling” with low cost while keeping those fessionals and patients to improve the esthetics of RPDs
advantages? Make the RPDs a new life as a noninva- while keeping advantages of noninvasive, safe and revers-
sive and reversible cheap choice with compromised ible, cheap, and wide indications. Make the RPDs a new
esthetic outcome for more edentulous patients. Then life as a noninvasive and reversible cheap choice with
the first logistic question is how to improve the esthet- compromised esthetic outcome for more edentulous
ics of clasps. patients.
To remedy clasp’s esthetic disadvantage [3], in recent
decades, some kinds of new retainers have been used to
replace regular clasps [precision attachment, dental implants
with RPDs, etc. (Fig. 1.1)] for stable esthetic effect. However,
resulting from its difficult technological process, higher cost,
and limited indications and other factors, the popularization
of these new retainers is still restricted.
At present, the main direct retainers of RPDs are still
clasps, which still play an important part in prosthetics [4, 5].
So, is there a method that doesn’t need to increase the cost,
and is suitable for most patients and can easily improve the
esthetic effect?
Synthesizing former literature and the study of our West
RPDs have lots of advantages, such as noninvasive, safe China team, we think it can be realized from two aspects:
and reversible, wide indications, cheap, mature workman- One is to make the clasp invisible by using teeth color, gin-
ship, and simple but reliable technological process. Though giva color, or transparent materials. The other one is to
fixed denture has better esthetic effect, its indications are change the design of conventional clasps to make them dif-
strictly limited and cannot totally replace conventional ficult to display during function. Based on remaining the
RPDs [1]. In developing country like China, according to advantages of RPDs, we try our best to make patients smile
the fourth practical situation and the trend of population without display of metal (Fig. 1.2).

© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House Co. Ltd. 2023 1
H. Yu, Digital Removable Partial Denture Technology, [Link]

[Link]/Dr_Mouayyad_AlbtousH
2 1 How to Improve the Esthetics of Clasps

Fig. 1.1 New retention

pattern: implant, precision
attachment

1.1 Invisibility of Clasps Characterized by

Modified Material

There are two methods to make clasps invisible by modify-

ing materials or novel stealthy design of the clasp. First, by
choosing teeth color, gingiva color, or transparent resin to
replace metal, we can just change the color to fit with oral
tissue, but don’t change the shape and retention area. Second
for novel stealthy design of the clasp, we can use high elastic
casting alloy to make the clasp smaller and more invisible,
and we can utilize esthetic retention area to further improve
the invisibility of clasp and decline or even eliminate the dis-
play of metal.

1.1.1 Elastic Resin

Elastic resin is an essential material to produce invisible den-

ture; representative products are American Valplast elastic
resin. In 1953, American dentists began to use such polymers
to replace traditional metal clasp and base plate. Until now, it
has been used in clinic for nearly 70 years.
Except for artificial teeth, other parts of invisible denture
are all with high elasticity. Without regular clasps, the res-
inous base plate extends to be a clasp bracing the cervix of
the abutment, and the retention is entirely provided by the
Fig. 1.2 To make patients smile with less or without display of metal
elasticity of the base plate, so we also call this part base

[Link]/Dr_Mouayyad_AlbtousH
1.1 Invisibility of Clasps Characterized by Modified Material 3

work by itself and must be used with metal. Due to transpar-

ency, it can be used in esthetic area to replace the metal clasp
on labial and buccal side. However, it also has the common
disadvantage of resin and could not be used in free-end eden-
tulous cases. Therefore, the clinical application is limited.

1.1.4 High-Elasticity Casting Alloy

Because the long-time stability of resin’s mechanical prop-

erty is not good, casting metal framework is still the good
choice for the clasp of RPDs. But it has no transparency
itself, and it is difficult to change the color, so we can but
Fig. 1.3 Stealth elastic resin denture of teeth 12 reasonably take advantage of the esthetic retention area to
hide the metal and improve the design of clasps to make the
plate clasp. The color and luster of invisible denture are metal exposed less, such as shortening or narrowing the
similar to natural gingiva tissue, which has blood capillary clasp arm, hiding the clasp, etc.
with primary simulate effect and favorable transparency However, the decline of length or width means the
(Fig. 1.3). decline of clasp’s retention. To compensate for the reten-
However, with the resin’s unavoidable aging, many tion, we can put the clasp arm deeper into the undercut. But
problems could come, such as discoloring and the decline it requests enough elasticity and strength of the materials to
of elasticity [6]. The long-term effect of elastic resin den- make such clasps. In the metal used to make framework
ture is not good as the hot-setting traditional resin. So, it is currently, the satisfactory materials are only gold alloy and
always used to short-span temporary restoration and usu- vitallium.
ally not suitable for complete denture or long cross arch The elasticity of gold alloy is the best, but the hardness
denture. is low, the strength is insufficient, and it is expensive. By
contrast, the high elastic casting alloy, which is mainly
made of Co, Cr, and Mo [7], follows proprietary proportion
1.1.2 Tooth Color Resin of ingredients and purification process in the production.
So, comparing to common cobalt-chromium, it possesses
Tooth color resin is a kind of polymers synthesized mainly higher elasticity, ideal malleability, and Vickers hardness
by polyformaldehyde. To form clasp by hot setting, it is (Fig. 1.4).
harder than common base resin. The current market has The framework made of vitallium is less possible to
developed a variety of color options, and these can also be transform or break off, so the design is more flexible. The
used with dyeing resin to fit with several colors of remaining clasp arm can be slender, and the holder can be more deli-
teeth. It is suitable for RPDs, temporary restoration, peri- cate. Vitallium not only has great retention but also improves
odontal splint, etc. the esthetic of clasp. It is the most suitable material for
However, because of the limitation of resin’s physical designing and producing kinds of metal esthetic clasps
properties, it cannot replace metal to form the whole denture (Fig. 1.5). It also can be applied to traditional RPD
holder. It is fussy to get mechanical bond between metal frameworks.
holder and resin clasp in production. In addition, there is a There are some common vitallium brands, such as Vitallium
problem of aging and deformation of the resin; the long-term of American Dentsply and Wironit of Germany BEGO.
use will lead to poor retention of clasp. Casting clasp has some advantages that clasps made of
other materials can never surpass. The design of casting
esthetic clasp is more flexible and various. The development
1.1.3 Transparent Resin of RPDs is mainly supported by the technology of casting
framework. The development of materials and technology
The texture and working principles are the same with tooth has already been rather mature, so it is worthy to popularize
color resin. It also cannot be used to form the whole frame- casting esthetic clasps for clinical use.

[Link]/Dr_Mouayyad_AlbtousH
4 1 How to Improve the Esthetics of Clasps

Fig. 1.4 Gold alloy and

vitallium 1 2

Fig. 1.6 Smiling exposed zone

Fig. 1.5 Framework made of vitallium

(Fig. 1.7). It is usually related to age, gender, and other
individual factors.
1.2 Using Esthetic Retention Area High smile line: 75% proximal space gingiva, all the
to Change Clasp Design and Reduce marginal gingiva, and over 3 mm gingiva above dental
Exposure cervix can be seen. And what exceed the preceding scale
is gummy smile.
1.2.1 Esthetic Abutment Middle smile line: Middle smile line is considered as
the most ideal smile line, and its marginal gingiva is par-
1. Smiling exposed zone: The area our soft and hard tissue allel to the under margin of the upper lip, and the incisal
exposed when grinning, which mainly includes exposed margin of maxillary teeth touches the inner side of the
teeth and gingiva, and varies with different people lower lip. Researches indicate that young ladies’ smile
(Fig. 1.6). line is higher than men universally.
Smile can make people closer without language Low smile line: Only limited teeth are exposed.
despite of race, gender, and age. Besides, it is the window When young and middle-aged smile as usual, the
of our mind, an important factor to improve appearance dental cervix of the mandibular anterior teeth is hardly
charm and capital of social contact. exposed. So, we can put low clasps on the cervix of
The teeth crown exposure plays a critical role in our the mandibular anterior teeth to hide claps when
smile, which is mainly decided by the location of smile needed.
line, the width of rima oris, etc. Smile line is the fictitious Related researches show that the muscle tone of facial
line where the upper lip margin stretches when smiling muscle drops and gingiva tissue shrinks back with people

[Link]/Dr_Mouayyad_AlbtousH
1.2 Using Esthetic Retention Area to Change Clasp Design and Reduce Exposure 5

Fig. 1.7 The classification of

smile line 1

2 3

getting older. The elderly’s lip and facial muscle sag with
the decline of resilience, then the smile line of the lower
lip lowers (Fig. 1.8), and the exposure of anterior teeth
and gingiva of mandibular increases in the meantime.
Conversely, the exposure of mandibular anterior teeth and
gingiva of maxillary gets less.
2. Esthetic teeth: The teeth which are easy to expose when
smiling or talking (Fig. 1.9).
A great number of people expose their anterior teeth
and premolar, and a few of people can expose first molar
even the second molar.
3. Esthetic abutment: A nature tooth in the esthetic zone Fig. 1.8 The elderly’s smile line of the lower lip
chosen to be abutment
The choice of abutment plays a critical part in RPDs.
When it is distal extension or some anterior teeth get lost,
the nature tooth in the esthetic zone is always chosen to
be abutment (Fig. 1.10).
On condition that we need to set retainers on canine or
premolar, we had better put it on the premolar. When it is
necessary to use mandibular anterior teeth as abutment,
we can set clasp on the cervix of abutment to get esthetic
effects. On the premise that the design is reasonable, we
should choose the most esthetic teeth as possible as we
can. How to choose esthetic abutments will be stated in
the third chapter in detail.
Traditional clasps should brace the abutment as far as
Fig. 1.9 Esthetic teeth (A3–B5 in this figure)
possible to get retention, but the labial (or buccal) part of
mental clasp is easy to be exposed. The metal color that
doesn’t match with the oral tissue would severely influ- clasps on the appearance is more apparent, and tradi-
ence the entire esthetics. The esthetic teeth lie in the tional clasps cannot meet the esthetic requirement of
front of dental arch, so the negative influence of mental esthetic teeth.

[Link]/Dr_Mouayyad_AlbtousH
6 1 How to Improve the Esthetics of Clasps

Fig. 1.10 Esthetic abutment.

A3 and B3 are both esthetic
abutments. We designed an
indirect retainer on A3 and an
direct retainer on B3

1.2.2 Esthetic Path of Insertion of minor connector gets into undercut to get retention
while denture rotating, and finally the rest part of denture
1. Esthetic path of insertion: One of the path insertions is seated (Fig. 1.11).
which can eliminate or reduce the metal exposure on the Second-class path of rotary insertion: The center of
esthetic abutment and improve the esthetics of denture. rotation lies on the gingival extension part of minor con-
Usually, when surveying a model, determine the direc- nector, which works as rigid retainer. It has double path of
tion of path of insertion first and then draw the survey insertions. The first step is to let the center of rotary get
line. The model can be tilted to the angle that the clasp on seated along the vertical path of insertion. The second
the esthetic abutment is not easy to be exposed, and then step is to make occlusal rest and other parts of framework
the path of insertion can be determined according to the get seated along the rotary path of insertion (Fig. 1.12).
oral condition. Although the advantages of the rotary path of insertion
2. Rotary path of insertion: Denture revolves on lateral axis outstand, disadvantages still exist:
to get retainers seated in turn, which can effectively (a) The clinical operation is difficult, and it is not conve-
reduce the exposure of anterior teeth clasp. Rotary path of nient to take on or off, and it really takes time for
insertion is one type of esthetic path of insertion [8]. initial placement.
When applied, the front end of framework should be (b) The cancel of the clasp on anterior teeth makes some
designed to be rigid retainer, combined with one or sev- influence on stability, so we have to take some mea-
eral traditional clasps on the backend. Rigid retainer is sures, such as increasing the thickness and length of
composed of occlusal rest and minor connector, and the occlusal rest.
part of minor connector extending to the gingiva plays a Some clinicians may not fully grasped the theory of
main part in retention. rotary path of insertion, or it is hard to get support from
When you try denture on, rigid retainer gets seated at technicians, or there is no evidence to prove the long-term
first, and then the back clasps get seated in turn. Rotary success of rotary insertion so as to lack indispensable
paths of insertions are divided into two categories accord- confidence; the application of rotary insertion denture is
ing to the different rotation center: few.
First-class rotary path of insertion: The center of rota- 3. Esthetic survey line
tion is at the tail end of occlusal rest’s extension part, and When surveying a model, by adjusting the tilt angle of
rigid retainer lies on the gingival extension part of minor model, to get a survey line below which the undercut
connector. When tying the denture on, the center of rota- should all be in esthetic retention area, this survey line is
tion, O point, gets seated first, then the gingival extension called esthetic survey line (Fig. 1.13). We can predict the

[Link]/Dr_Mouayyad_AlbtousH
1.2 Using Esthetic Retention Area to Change Clasp Design and Reduce Exposure 7

Fig. 1.11 The first-class

rotary path of insertion to
eliminate anterior clasps

Fig. 1.12 The second-class

vertical-rotary path of
insertion to eliminate anterior
clasps

No matter what kind of the clasp is, the metal on abut-

ment’s lingual side is definitely hidden by abutment. But
the buccal part of clasp is relatively complicated to be hid-
den. The main factors influencing labial-buccal cover are
Esthetic
retention area the height of smile line and the width of rima oris. For
example, in the case, we have to set clasp on central inci-
sor, if patient’s smile line is high, the gingiva of anterior
teeth will all lie on exposed area in smile. So the mental
clasp on the labial side of abutment is hard to be hidden,
and clasp arm even can be seen totally. On the contrary, if
the smile line is low, clasp can be hidden by the lip, and the
area where is not hidden is exposed area of clasp (Fig. 1.14).
The main factor that influences the clasp’s cover from
adjacent teeth and abutment is the location of the abut-
Fig. 1.13 Esthetic survey line
ment selected in the dental arch. If we use the clasp arm
with the same length to brace the abutment in different
location of esthetic survey line in terms of esthetic reten- location, the closer to the facial center line and the front of
tion area and then decide the angle of esthetic path of the dental arch the tooth is, the more the labial-buccal
insertion. clasp arm is exposed. Taking the maxillary as example, if
the clasp is set on the second incisor, it may not get any
cover from adjacent teeth. If the clasp is set on the cuspid
1.2.3 Esthetic Retention Area at the corner of dental arch, the distal part of axis ridge
will be hidden by itself (Fig. 1.15). If it is set on the first
1. Clasp exposed area: The area that displays metal part of molar whose location is backer, not only its axis ridge will
clasps on abutment when opening mouth. be hidden by itself, but also its mesial part would be hid-
On account of anatomical features of abutment and den by next cuspid, and the exposed area of clasp is less.
oral tissues or the different angles of observing, the men- There is a special statement: Because of different
tal part of clasp would not be seen totally, only part of it observing angles such as frontal view and lateral view
can be seen, and the other parts are hidden by abutment, from 45°or 90°, the cover area formed by abutment and
adjacent teeth, or labial-buccal muscle. adjacent teeth would change. In addition, looking hori-

[Link]/Dr_Mouayyad_AlbtousH
8 1 How to Improve the Esthetics of Clasps

Fig. 1.14 The explosion and shelter of clasps (clasps are sheltered by the lip)

Fig. 1.15 The different shading effects from different observation angle. It was showed from the front view that the clasp on the distal area of
cuspid buccal axial ridge was sheltered by itself

zontally, looking down, and looking up would lead to the There is nonquantitative proper undercut on all nature
visual change of the cover area, too. In daily social life, teeth that is available for selection, and we can change the
we usually talk to others face to face, so frontal view and range and the location of undercut by adjusting the direc-
horizontal view are more valuable in clinical application. tion of path of insertion. If there is no appropriate under-
The esthetic clasp aims to reduce display of clasps as cut, we can get necessary undercut by tooth preparation.
much as possible, hide the metal part exposed of tradi- 3. Esthetic undercut area: All the undercuts on the esthetic
tional clasps on the buccal-labial side, and improve the abutment that have no effect on esthetics, including disto-
esthetics of RPDs. facial undercut, distal proximal undercut, lingual under-
2. Clasp retention area: It is the undercut on the abutment cut, and so on.
that provides retention [9]. The retention generated by the 4. Esthetic retention area: The part of tooth which is
clasp terminus extends into this area can ensure the nor- included both in the area below esthetic survey line and
mal function of denture. esthetic undercut area.
The retention of clasp mainly comes from the friction According to the statement above, balancing the
force between clasp arm and nature teeth [10]. The shape esthetics and the function, the scope of exposed area of
of nature teeth is convex, and the area under the most clasp in exposed area of smile should be reduced as much
salient points is undercut. Usually, the free end of clasp as possible to improve esthetics in social life and oral
arm clings to the undercut; when dislocated, the elastic function. In the meantime, the size of clasp retentive area
deformation of the clasp arm will happen to pass through selected should ensure that the retention produced by the
the salient point. And there is a pressure on abutment at the clasp reaches the minimum that the clinical application
same time, and then the friction force is occurred to prevent requires. This is the principle of esthetic clasp design,
clasp from dislocating. The retention must be strong which leads to a brand-new concept: esthetic retention
enough to ensure that denture can function normally. area (Fig. 1.16). This kind of undercut area is not exposed

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1.3 Mechanics Principles and Comparison of the Retention of Esthetic Clasps 9

Fig. 1.16 Esthetic retention

area

Clasp retention
Esthetic retention area
area

Smiling exposed
zone

due to the shelter from lips, cheeks, and adjacent teeth Insertion path Long axis
during normal functional activity.
As for framework removable dentures, retention is the
premise of function, and it mainly relies on the clasps, so Height of contour
it is impossible to completely eliminate clasps. Among all X
the undercuts of abutments, there are at least some cryptic X
undercuts we can use. The clasp tip can get into the X
esthetic retention area to get necessary retention and The depth of undercuts The slopes of undercuts
esthetics as well.
The existence of esthetic retention area can be said to Fig. 1.17 The depth and slopes of the undercut
be the important premise of designing and producing
esthetic clasps. ridge on the buccal surface of B4 and the lingual surface
of C5.
The depth of undercuts is the horizon distance from
1.3 Mechanics Principles and Comparison the analyzing rod of the surveyor to certain point on the
of the Retention of Esthetic Clasps undercut area. The deeper the undercut, the larger the
retention. The slopes of undercuts are the angles formed
1.3.1 Mechanics Principles by the tangent of certain point on the undercut area and
the major axis of the abutment (Fig. 1.17). The retention
1. Retention increases with the slopes increasing.
Retention refers to the RPDs would not dislodge dur- Commonly, the rulers measuring the undercut of clasp
ing oral function activities with RPDs in mouth. The have three different specifications: 0.25, 0.5, and 0.75 mm.
force resisting the dislocation on the occlusal direction or The depth that the clasp enters the undercut varies with the
the direction opposite to the path of insertion is called materials. The larger the elasticity of the materials, the
retention. Retention mainly includes the friction force smaller the force needed to make the clasp deformed or
between the retainers and abutments, the adsorption force moved. So to improve the retention, we should put the
between the base plates and mucous membranes, and the clasp into the undercuts deeper. The wrought wire gets
atmospheric pressure. In terms of the supporting type of into undercuts by 0.5~0.75 mm. The gold alloy is 0.5 mm,
RPDs, the proportion of these three kinds of retention is and the cobalt-chromium alloy is 0.25~0.5 mm.
different. Clasp tips should be elastic, and clasp arms should get
The retention of retainers is mainly influenced by three fac- into the undercut by half to one third. This principle is
tors: undercuts, materials, and the shape of clasps [11, 12]. essential. If the clasp is not elastic, patients cannot put the
Undercuts can be described by three elements: loca- RPDs on. RPDs have the function of retention, only if the
tion, depth, and slopes. force that the retention arm of the clasp generates is larger
First of all, we decide the location of undercuts accord- than the force needed when removing RPDs from the
ing to the tooth contour, for example, the buccal axial abutment, when crossing abutment’s height of contour.

[Link]/Dr_Mouayyad_AlbtousH
10 1 How to Improve the Esthetics of Clasps

Fig. 1.18 Bracing at least

180° (the left is three-point
discontinuous contact)

≥180°

But the retention should not be too strong to make wear-

ing and removing difficult and even damage the abut-
ment. We should try to decline the retention if only it can
resist the dislocation force.
2. Bracing
Clasps must brace the maximal circumference of the
Labor-saving lever with distal rest
abutment at least 180° from the undercut area to non-­
undercut area of the axial surface. It can be a continuous
contact or discontinuous contact (point contact) and at
least in contact with three areas of tooth surface
(Fig. 1.18). On the one hand, that can prevent clasp from
separating from teeth when pressed. On the other hand,
that can prevent abutment from moving under eternal
force. Effort lever with distal rest
3. Stability
Fig. 1.19 The different leverage effects occurred on different clasp
The abutment should try to avoid bearing gradient locations
force, and the clasp is able to decline the movement of
abutment. Especially for the abutment near the free-end
gap, we had better make it equip stress interruption effect 6. Passivity
by adjusting the design and structure of frameworks. We Except for when functioning with RPDs and seating
can achieve that through using the mesial occlusal rest to and removing the RPDs, there should not be any com-
change the balance point (Fig. 1.19). pressive stress between the retention arm and the abut-
4. Supporting ment. All in all, when the clasp is put on the abutment,
Occlusal rests should be designed to prevent the RPDs it should be passive, still and with no compressive
from sinking. stress.
5. Resisting 7. Balance
The resisting arm is the rigid part on the opposite tooth Clasps should be dispersed on two sides of dental arch,
surface to the retention arm. Its function is to balance the so they can restrict each other. The retention of two sides
lateral force caused by the retention arm when it crosses of dental arch should be even to get balance.
the maximal circumference in the process of dislocation. If there is no guiding plane to control the direction of
Then it compels the retention arm to be deformed to pro- path of insertion, the retention arm should be symmetri-
tect the abutment (Fig. 1.20). In general, every retention cally designed. In other words, the retention arm on both
arm needs a resisting arm to interact with each other. sides of dental arch should all be put on the buccal side
Furthermore, the resisting arm also can be replaced by or the lingual side. As for the bilateral abutment of
lingual plate or high base plate, which has the same resis- Kennedy III type, the retention arm can be designed
tance effect. heterochiral.

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1.3 Mechanics Principles and Comparison of the Retention of Esthetic Clasps 11

Fig. 1.20 Resisting

Fig. 1.21 We designed

clasps using CAD/CAM and
then use Instron tensile
elongation measuring device
to test the retention force

1.3.2 Comparison of Retention cal shoulder clasp, modified RPI clasp, RLS clasp, saddle-­
lock clasp, plate-rod clasp, lingual retention L clasp, C clasp,
Until now, reports about esthetic clasp design are almost L clasp, and Terec hidden clasp. And the control group was
descriptive and lack of scientific evidence. The fundamen- traditional three-arm clasps. The undercut depth was
tal function of clasps is retention, but clasp arms of most 0.25 mm, and we carried out tensile dislocation force test on
esthetic clasps are shorter than regular design ones. The Instron tensile elongation measuring device (Fig. 1.21).
cut of length would cause the decline of contact area and According to the results (Fig. 1.22), it could be consid-
the increase of metal deformation resilience force, but ered that the retention force of all ten kinds of esthetic clasps
what influence it has on the retention of esthetic clasps on was smaller than traditional three-arm clasps, but all can
Earth? Would it satisfy the retention requirement in clini- meet the demand of clinical use. The retention of modified
cal use? These questions decide the application value of RPI clasps, C clasps, lingual retention L clasps, and saddle-­
clasps, so it is necessary to carry out the retention test to lock clasps was almost the same, and the retention effects
esthetic clasps. were better than other esthetic clasps. The RSL clasp showed
The material, used to produce samples of carrying out the the lowest retention. Terec hidden clasp and saddle-lock
retention test of esthetic clasps, is the most suitable material clasp were the most invisible ones, and the retention also sat-
for esthetic clasps—high-elasticity vitallium. We took isfied the clinical requirement, so both are worthy to be
­natural premolars with standard size as abutments and then popularized.
designed and produced ten kinds of esthetic clasps, such as The detailed design of various esthetic clasps will be
buccal short retention arm clasp, lingual retention short buc- introduced in the next chapter.

[Link]/Dr_Mouayyad_AlbtousH
12 1 How to Improve the Esthetics of Clasps

Fig. 1.22 The comparisons

of average retention forces
between ten kinds of esthetic
clasps and traditional
three-arm clasps

6. Fitton JS. The physical properties of a polyacetal denture resin. J

Clin Mater. 1994;17(3):125.
References 7. Bridgeman JT, Marker VA, Hummel SK. Comparison of Ti and
Co-Cr RPD claps. J Prosthet Dent. 1997;78(2):187–93.
1. Alan BC, Glen PM, David TB, et al. McCracken removable par- 8. Krol AJ, Finzen FC. Rotational path removable partial dentures: part
tial prosthodontics. Zhang FQ, translated, 11 ed. Beijing: People’s 1. Replacement of posterior teeth. Int J Prosthodont. 1988;1:17–27.
Military Medical Publishing House; 2007. 9. Hebel KS, Graser GN, Featherstone JD. Abrasion of enamel and
2. Chao Y. Stomatology. Beijing: People’s Health Publishing House; composite resin by removable partial denture clasps. J Prosthet
2006. Dent. 1984;52(3):389–97.
3. Beaumont AJ. An overview of esthetics with RPDs. J Quintessence 10. Sato Y, Abe Y, Yuasa Y, et al. Effect of friction coefficient on Akers
Int. 2002;33(10):747–55. clasp retention. J Prosthet Dent. 1997;78(1):22–7.
4. Rodney D. Stewart’s clinical removable partial prosthodontics. 11. Prothero JH. Prosthetic dentistry. 2nd ed. Chicago: Medico-Dental;
Batavia: Quintessence; 2008. 1916. p. 332.
5. Alan B. McCracken’s removable partial prosthodontics. St. Louis: 12. Jepson NJA. Removable partial dentures. Wang J, translated.
Elsevier Science Health Science div; 2004. Beijing: People’s Military Medical Publishing House;2006.

[Link]/Dr_Mouayyad_AlbtousH
 Classification and Design of Esthetic
Clasp 2

2.1 Concept of Esthetic Clasp

Esthetic clasp (e-clasp) is the generic terms of new
classified design clasps which improve the overall
Esthetic clasp, the generic term of new classified design
esthetic appearance of removable partial denture on
clasps which use esthetic retention area of the abutment
the basis of balancing both esthetics and normal func-
teeth to retain or are made of esthetic restoration materials
tion of the denture. It could be one of the traditional
[1–3], can improve the overall esthetics of denture on the
clasps or brand-new designed one. According to the
basis of ensuring the normal function performance of
teeth where the clasp is set, it can be classified into
RPDs.
anterior e-clasp and posterior e-clasp, while it also can
E-clasp is a new classification of clasps in terms of
be classified into buccally retained clasp, proximally
overall esthetics of denture, including some traditional
retained clasp, and lingually retained clasp according
clasps and newly designed clasps [2, 4]. At present, it is
to the retention site on the abutment teeth.
mainly made of highly elastic Co-Cr-Mo metal [5] or
tooth color, gingival color, or colorless nonmetallic com-
posite materials. The metal esthetic clasps are usually
placed on the teeth on the esthetic teeth, and the retention
Taking the abutment teeth as classification standard, comes from the hidden esthetic retention area of abut-
this chapter will state the designs, characteristics, and ments. Metal esthetic clasp can make patients smile with
indications of e-clasp in detail. less or without display of metal during function, which is
more common in clinic. On the other hand, nonmetallic
composite materials have a stealth effect because their
colors are similar to that of teeth and gingiva but possess
lower mechanical and antifatigue properties, and so they
buccally
retained
Short buccally
retained clasp C clasp L clasp Modified RPI clasp are often used in temporary or transitional restoration of
RPDs [6].

T clasp Short-arm embrasure clasp Plate clasp Saddle-lock clasp

2.2 Esthetic Clasp for Anterior Teeth

proximally
retained

Adjacent surface hidden clasp

for anterior tooth
Twin-Flex clasp Terec hidden clasp For anterior teeth in esthetic zone, including incisors and
canines, it is difficult to determine the esthetic retentive area
lingually and design e-clasp due to their special features like no occlusal
retained
Lingually retained short
buccal arm clasp
Lingually retained L clasp Lingually retained J clasp RLS clasp surface, small lingual retention area, and the exposure of buc-
cal retention area, which has a great impact on esthetics [7].

© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House Co. Ltd. 2023 13
H. Yu, Digital Removable Partial Denture Technology, [Link]

[Link]/Dr_Mouayyad_AlbtousH
14 2 Classification and Design of Esthetic Clasp

Therefore, the following seven kinds of anterior e-clasps 3. Indication

mainly take advantage of distofacial undercut and distal proxi- This kind of e-clasp is applied to both anterior and
mal undercut to obtain retention and decrease or even elimi- posterior teeth with appropriate undercuts. It is also
nate the display of metal, which can be applied for posterior required that there must be distal and mesial abutments
teeth as well. on both sides of edentulous space meanwhile. However,
it is not suitable for distal extension abutment.

2.2.1 Short Buccally Retained Clasp

2.2.2 C Clasp
Modified from the traditional circumferential clasp that con-
sists of occlusal rest, retentive arm, and reciprocal arm, the C clasp is modified from the traditional ring clasp, whose
short buccally retained clasp shortens the length of the reten- clasp arm encircles the lingual, buccal, and proximal sur-
tive arm and lies on the distal side of the buccal axial ridge face of abutment. Due to the excessive contact with abut-
rather than across it, to minimize the display of metal clasp. ment, the self-cleaning of traditional ring clasp is poor. So,
the modification of C clasp improves both esthetics and
1. Structure self-cleaning [2].
Short buccally retained clasp consists of short buc-
cally retained clasp arm, lingual reciprocation, distal 1. Structure
guiding plate, and distal rest (Fig. 2.1). C clasp consists of shortened retentive arm, minor
2. Characteristic connector, and mesial occlusal rest (Figs. 2.4, 2.5, and
The short buccally retained clasp arm is placed on the 2.6). The retentive arm originates from the mesial rest
distal side of the buccal axial ridge rather than across it. and encircles the lingual surface of abutment and then
In this way, reduced encirclement makes facial and buc- terminates at the proximo-facial line angle. If there is no
cal clasp arm hidden in the mouth. The distal guiding contact between the adjacent tooth and the abutment to
plate can also provide supplementary retention for the reciprocate, a reciprocal plate can be set connecting with
denture (Figs. 2.2 and 2.3). the mesial rest.
2. Characteristic
← distal Because the clasp terminus is closed to the denture
mesial →
artificial teeth and the rest is positioned on the mesial side
of the abutment, the lock structure can effectively prevent
1 1
the saddle from tilting when dislodging force is applied.
And when masticatory loading is applied, both saddle
2
2 and retentive arm sink, reducing the pressure on the abut-
4 4
ment and decreasing or removing the torsion.
3. Indication
3 3 Wide application scope of C clasp, especially for dis-
tal extension cases. However, for abutment whose non-­
1. short buccally retained clasp arm 2. distal rest undercut area is too closed to the occlusal surface or
3. lingual reciprocation 4. distal guiding plate
anterior teeth with insufficient lingual encirclement area,
Fig. 2.1 Short buccally retained clasp (lingual view of the anterior
its arm is likely to affect occlusion. Thus, another modifi-
type, occlusal view of the posterior type) cation clasp, L clasp, is derived.

[Link]/Dr_Mouayyad_AlbtousH
2.2 Esthetic Clasp for Anterior Teeth 15

Fig. 2.2 Short buccally retained clasp (wax pattern type, cast metal type)

Fig. 2.3 Short buccally

retained clasp (intraoral
effect)

Fig. 2.4 C clasp (lingual view of the anterior distal mesial

type, occlusal view of the posterior type)

1 1

3
3

2 2

1. retentive arm 2. minor connector 3. mesial rest

[Link]/Dr_Mouayyad_AlbtousH
16 2 Classification and Design of Esthetic Clasp

Fig. 2.5 C clasp (CAD

drawing: buccal, occlusal,
lingual view)

Fig. 2.6 C clasp (intraoral

effect)

distal mesial
2.2.3 L Clasp

L clasp is a further modification of C clasp [2]. Its retentive

arm is separated from the occlusal rest and is connected with
the minor connector so as to improve self-cleaning of the
3 3
abutment by reducing metal covering on the lingual surface
and prevent the forming of abnormally high occlusal points. 1 1
It is also applicable for distal extension cases. For the sepa-
rated retentive arm that looks like “L” when viewed from the
2 2
proximal direction, it is called L clasp.
L-type clasp is applicable for both anterior and posterior
teeth, but it should be in accordance with the actual condi- [Link] arm [Link] connector [Link] rest
tions to avoid metal exposure.
Fig. 2.7 L clasp (lingual view of the anterior type, occlusal surface of
the posterior type)
1. Structure
L clasp consists of retentive arm, minor connector, and
occlusal rest (Fig. 2.7). 3. Indication
2. Characteristic Similar extensive application scope as C clasp, espe-
The main structure is formed by independent L-shaped cially for distal extension removable partial dentures. On
retentive arm and mesial rest (Figs. 2.8 and 2.9). the condition that lingual non-undercut of abutment gets
When there are edentulous spaces at the mesial and too close to occlusal side and influences occlusion or
distal sides of the abutment with no adjacent teeth for abutment is low and flat, C clasp isn’t applicable, and
reciprocation, a mesial reciprocal plate, which the mesial then we can choose L clasp.
rest could connect with, should be added to separate the When L clasp is applied to incisor or canine, clasp arm
rest from the retentive arm. does not look like L-shaped because abutment arm is lim-

[Link]/Dr_Mouayyad_AlbtousH
2.2 Esthetic Clasp for Anterior Teeth 17

Fig. 2.8 L clasp (CAD

drawing: lingual, occlusal,
distal side of the buccal
surface)

Fig. 2.9 L clasp (lingual

view, proximal view and
intraoral effect of cast metal)

L clasp for
anterior teeth distal mesial

1
1

2 2
3
3

Fig. 2.10 L clasp is applicable for distal extension edentulism 1.I-bar [Link] guiding plate [Link] rest

Fig. 2.11 Modified RPI clasp (buccal view of the anterior type, buccal
ited and its retention and stability are slightly decreased view of the posterior type)
additionally. Hence, using both L clasp and other clasps
of distal abutment is advised (Fig. 2.10).
The modified RPI clasp is designed to apply to a variety
of situations. It is still composed of I-bar, distal guiding
2.2.4 Modified RPI Clasp plate, and mesial rest, but the I-bar is positioned on the distal
side of the buccal axial ridge instead of the mesial side to be
Traditional RPI clasp is a classic infrabulge clasp and also con- less visible and can prevent the distal extension saddle from
sidered as e-clasp [1, 3]. The I-bar of RPI clasp is positioned on tilting to occlusal side.
the gingival third undercut area of the buccal or labial surface
of the abutment, and only a small surface area is contacted, so 1. Structure
just a little esthetic impact is caused. However, the I-bar is also The modified RPI clasp consists of I-bar, distal guid-
likely to display if the patient gets a high smile line. ing plate, and mesial rest (Fig. 2.11).

[Link]/Dr_Mouayyad_AlbtousH
18 2 Classification and Design of Esthetic Clasp

Fig. 2.12 Modified RPI

clasp CAD drawings (buccal
and lingual view)

2. Characteristic
The I-bar is positioned on the distal side of the buccal distal mesial
axial ridge and engages the distofacial undercut, which
makes it more invisible (Fig. 2.12).
3. Indication 1
1
It is suitable for the last distal abutment whose survey
2
line is close to the gingival third. It is contraindicated
2 3
when severe buccal or lingual tilts of abutment teeth,
severe tissue undercuts, or shallow buccal or labial vesti- 3
bules exist.
The I-bar of this modified RPI clasp is positioned on
the distal side of the buccal axial ridge to help prevent the
distal extension saddle from tilting to occlusion side. 1.T-bar [Link] guiding plate [Link] rest
When denture is under masticatory process, the distal
Fig. 2.13 T clasp (buccal view of the anterior type, buccal view of the
extension saddle sinks and rotates around the mesial rest, posterior type)
and the direction that distal I-clasp moves is ­perpendicular
to gingival side. Then the I-bar gets out of touch with
abutment, reducing or avoiding the torsion applied to 3. Indication
abutment and protecting abutment ultimately. It is suitable for the last distal abutment and is contra-
indicated when buccal or labial vestibules are too shallow
or the survey line is too closed to the occlusion surface for
2.2.5 T Clasp there would be a large interspace between T-bar and oral
tissue that may cause food impaction and a higher risk of
T clasp is also infrabulge clasp [1, 2] similar to I-clasp with display of metal.
almost the same structure and indication. But its retentive The five kinds of clasp described above are all modi-
arm changes to T-shaped extending from approach arm, fied from traditional clasps. Their esthetics are improved
causing a better retention by covering more tooth surface. by reducing the contact area of metal on the labial or buc-
cal surface. However, if the patient gets a high smile line
1. Structure and the clasps cannot be hidden by either lips or adjacent
T clasp consists of T-bar, distal guiding plate, and teeth, esthetic effect would be unacceptable. Thus, it is
mesial rest (Figs. 2.13, 2.14, and 2.15). also essential to make the full use of proximal undercuts
2. Characteristic in e-clasp design. The following section is going to
Its concealment is favorable, and two clasp terminus describe two types of proximally retained e-clasp: adja-
of the T-bar can be adjusted according to the actual cent surface hidden clasp for anterior tooth and Twin-­
situations. Flex clasp.

[Link]/Dr_Mouayyad_AlbtousH
2.2 Esthetic Clasp for Anterior Teeth 19

Fig. 2.14 T clasp (buccal,

distal, and lingual view)

Fig. 2.15 Intraoral effect of

T clasp

2.2.6 Adjacent Surface Hidden Clasp surface and does not extend into the buccal area
(Fig. 2.16).
Adjacent surface hidden clasp for the anterior tooth accom- 2. Characteristic
plishes retention by engaging the proximal undercut. Its It accomplishes retention by engaging the proximal
crescent-shaped retentive arm originates from the distal side undercut and has platelike retentive arm (Figs. 2.17 and
of palate plate, then extends into the undercut, and termi- 2.18).
nates at the proximo-buccal line angle without buccal metal 3. Indication
exposure, so it is esthetically pleasing. It is suitable for incisors or canines with enough proxi-
mal undercut for patients with high requirement of
1. Structure appearance. It has to be used in conjunction with other
It consists of retentive clasp and palate plate. The clasps on distal abutment due to insufficient retention. It
crescent-­shaped retentive clasp is located on the proximal is contraindicated in distal extension cases.

[Link]/Dr_Mouayyad_AlbtousH
20 2 Classification and Design of Esthetic Clasp

Fig. 2.16 Adjacent surface mesial distal ligual bucaal

hidden clasp for anterior tooth
(lingual and distal view)
1 1

2
2

lingual distal

[Link] plate [Link] clasp

Fig. 2.17 Adjacent surface

hidden clasp for anterior tooth
(wax pattern and intraoral
effect)

Fig. 2.18 Adjacent surface

hidden clasp for the anterior
tooth (effect on model and
intraoral effect)

[Link]/Dr_Mouayyad_AlbtousH
2.3 E-Clasp for Posterior Teeth 21

mesial distal ligual bucaal distal mesial

1 1 1
2
2

3 2
4

lingual distal
occlusal

1. connector 2. proximal wire clasp 3. arm channel

Fig. 2.19 Twin-Flex clasp (lingual and distal view)

2
2.2.7 Twin-Flex Clasp

Twin-Flex clasp, designed by Ticonium (USA), is a kind of

e-clasp with special structure [8, 9]. There is a precast chan- 1
nel on the tissue surface of the metal major connector for the
connector of clasp arm to pass through. It is very suitable for
anterior teeth due to no buccal display of metal. buccal

1. short retentive arms 2. lingual reciprocation

1. Structures 3. combined clasp body 3. combined rest
Twin-Flex clasp consists of proximal wire clasp, minor
Fig. 2.20 Short-arm embrasure clasp (occlusal and buccal view)
connector, and arm channel (Fig. 2.19).
2. Characteristics
The elastic retainer made of wire does not generate as 1. Structure
much torsion to abutment, and its retention force can be Short-arm embrasure clasp consists of short retentive
adjusted. Moreover, there is little display of metal for no arms, lingual reciprocation, combined clasp body, and
buccal clasp. combined rest (Fig. 2.20).
3. Indication 2. Characteristics
Twin-Flex clasp is not suitable for deep undercut The shape of the retentive arms looks similar to embra-
because the retentive arm is comparatively short and less sure hook, but the difference is that there are clasp tips
elastic [10]. It can be applied only when the depth of the emerging and entering the undercuts. The two short arms
undercut is less than 0.25 mm. In addition, it is also suit- which end at buccal-proximal line angle of the two adja-
able for the posterior teeth with insufficient buccal or lin- cent abutments can provide retention while hiding in the
gual undercuts and has to be used in combination with embrasure, which enhances esthetics dramatically
other clasps. Twin-Flex clasp can be fabricated by whole-­ (Figs. 2.21 and 2.22).
casted or the laser-welded method [9]. 3. Indication
It is applied to abutments of distal extension edentu-
lism, which are short and solid, or there is space between
2.3 E-Clasp for Posterior Teeth them.

2.3.1 Short-Arm Embrasure Clasp

2.3.2 Plate-bar Clasp
Short-arm embrasure clasp is modified from the traditional
embrasure clasp. Its buccal retentive arms are shortened, and L clasp does harm to the abutments when applied to indepen-
the clasp terminus lies at bucco-proximal line angle of the dent posterior abutments without adjacent teeth to reciproca-
two adjacent abutments so as to be hidden in the embrasure. tion. Besides, the L retentive arm on the distal surface would
This is our design. be pressed down when overloaded, causing abutment rotat-

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22 2 Classification and Design of Esthetic Clasp

Fig. 2.21 Short retentive

clasp arms (occlusal view)

Fig. 2.22 Short-arm

embrasure clasp (effect on
model and intraoral effect)

ing and influencing the occlusal function. To solve this prob-

lem, plate clasp is designed to adapt to the occlusal features
of posterior teeth based on the L clasp. This is also our 1
design.
4 3

1. Structure 3 1
2
Plate clasp consists of short retentive arm, rod-shaped
connector, distal guiding plate, and mesial rest
(Fig. 2.23). 2
2. Characteristic
The rod-shaped connector projects from the major occlusal distal
connector, connecting with the distal guiding plate,
from which the short retentive arm extends. Similar to [Link] retentive arm [Link]-shaped connector
[Link] guiding plate [Link] rest
L clasp, mesial rest is separated from clasp arm
(Fig. 2.24).
Fig. 2.23 Plate-bar clasp (occlusal and proximal view)
The distal plate maintains plane contact with the guide
surface along its path of insertion or removal, which can
protect the abutment, aid retention, and prevent food 3. Indication
impaction between abutment and denture. To ensure the It is applied to premolars and molars and is applicable
elasticity of the retentive arm, the plate does not connect for distal extension cases. A guide surface should be
with the saddle. prepared.

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2.3 E-Clasp for Posterior Teeth 23

Fig. 2.24 CAD drawings of

plate-bar clasp (occlusal,
lingual, distal side of the
buccal surface)

2.3.3 Lingually Retained Clasp

For anterior teeth, their buccal and proximal surfaces are 2

usually taken into consideration of esthetic design due to the
insufficiency of lingual retentive area. However, for posterior
teeth with sufficient height, lingually retained e-clasp is an 3
option [11]. There are three types of lingually retained clasp
including lingually retained short buccal arm clasp, lingually 1

retained L clasp, and lingually retained J clasp.

1. Lingually retained short buccal arm clasp occlusal

Lingually retained short buccal arm clasp looks simi-
lar to the short buccally retained clasp. The difference is 1. lingually retained arm 2. short buccal reciprocation 3. distal rest.

that the retentive arm of the former lays on the lingual

Fig. 2.25 Lingually retained short buccal arm clasp
surface, with its short reciprocation on the buccal surface,
while the short retentive arm of the later is located on the
buccal surface with its reciprocation on the lingual sur- (a) Structure
face. Whatever, the buccal exposed clasp has to be short- Lingually retained L clasp consists of occlusal
ened while keeping involvement of more than half of the rest, tiny reciprocal palate, lingual retentive arm, and
circumference of the tooth. occlusal connector (Fig. 2.28).
(a) Structure (b) Characteristic
Lingually retained short buccal arm clasp consists The reciprocal arm is removed, and a tiny palate
of lingually retained arm, short buccal reciprocation, that extends to the buccal surface forms reciprocal
and distal rest (Fig. 2.25). plate instead. Its retentive arm is L-shaped from the
(b) Characteristic lingual view.
The short buccal reciprocation is positioned on the (c) Indication
distal side of the buccal axial ridge of the abutment This clasp can be used on the abutment opposite to
and near the occlusal surface since it is over the con- the space in unilateral distal extension cases. The
tour (Figs. 2.26 and 2.27). self-cleaning of gingival papilla is weakened because
(c) Indication of the large contact area between the lingual retentive
It is often used on premolars which lie on both arm and the abutment surface.
sides of the edentulous space and is commonly used 3. Lingually retained J clasp
with other types of clasps or used as indirect retainer. Because of the bad self-cleaning of L-type clasp, the
2. Lingually retained L clasp lingual retentive arm of J-type clasp has changed from
There are other two kinds of lingually retained clasp, surface contact to point contact to ensure the normal self-­
whose reciprocation is the short plate that extends to the cleaning of gingival papilla.
buccal surface and connected with the occlusal connector (a) Structure
across the occlusal surface of the two abutments instead Lingually retained J clasp consists of occlusal
of clasp arms. They are named lingually retained L clasp rest, tiny reciprocating plate, lingual retentive arm
and lingually retained J clasp according their shape. (J-type), and minor connector (Fig. 2.29).

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24 2 Classification and Design of Esthetic Clasp

Fig. 2.26 CAD drawings of

lingually retained short buccal
arm clasp (occlusal, lingual,
buccal)

occlusal

Fig. 2.27 Lingually retained short buccal arm clasp (effect on model)
3

2 4

1 lingual

3 [Link] rest [Link] reciprocal palate

[Link] retentive arm [Link] connector
occlusal
Fig. 2.29 Lingually retained J clasp (occlusal and lingual view)

(b) Characteristic
J-type retentive arm instead of L-type. Surface
3 contact instead of point contact.
(c) Indication
Similar to L clasp, lingually retained J clasp is
also applicable for abutment on the opposite arch to
4
the space in unilateral edentulous cases. However, it
requires careful consideration because of the certain
lingual loss of the retention.

[Link] rest [Link] reciprocal palate

[Link] retentive arm [Link] connector

Fig. 2.28 Lingually retained L clasp (occlusal and lingual view)

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2.3 E-Clasp for Posterior Teeth 25

2.3.4 RLS Clasp patient to pay special attention to oral hygiene in case of
plaque deposits on the lingual surface of abutment.
RLS clasp (rest L-bar stabilize clasp) is another type of lin-
gually retained e-clasp. Due to its similar structure to RPI
clasp except that the I-bar is placed at the lingual undercut of 2.3.5 Terec Hidden Clasp
the abutment, it is called “reverse RPI” and “lingual RPI” as
well. Terec hidden clasp, invented by TEREC dental lab, can be
regarded as a separated lingually retained three-arm clasp.
1. Structure To obtain retention from the proximal undercut, its retentive
RLS clasp consists of lingual I-bar, distal stabilizer, arm has to be separated from the reciprocation and the minor
and mesial rest (Fig. 2.30). connector with sufficient length to ensure elasticity as well
2. Characteristic as retention.
RLS clasp can be regarded as “reverse RPI” with
mesial rest, distal stabilizer similar to guiding palate 1. Structure
that interacts with the retainer for stability, and retentive Terec hidden clasp consists of proximal retentive arm,
I-bar designed on the lingual surface. It is visually satis- lingual reciprocation, minor connector, and occlusal rest
fied without display of metal on the buccal surface (Fig. 2.32).
(Fig. 2.31). 2. Characteristic
3. Indication The proximal retentive arm starts from the major
It is applicable for distal extension cases on premolars connector, then extends beneath the lingual reciproca-
or molars with appropriate lingual undercut. Alert your tion, and finally hides in the proximal undercut. The
minor connector is only connected with the rest and the
reciprocation without contact with the proximal reten-
tive arm.
There is seldom buccal display of metal since only
3
proximal undercut is used for retention, which makes
it visually satisfied. There are also disadvantages
2 including its complex structure that is difficult for fab-
1 rication, insufficient undercut, and low elasticity of
cast clasp that may cause permanent deformation
(Fig. 2.33).
3. Indication
Appropriate undercut at proximal surface that is near
the edentulous space is necessary because of the complex
lingual proximal structure. It is applicable for distal extension
[Link] l-bar [Link] stabilizer [Link] rest. cases considering its stress-interrupting design that sepa-
rates retainer and reciprocation (Fig. 2.34).
Fig. 2.30 RLS clasp (lingual view)

Fig. 2.31 CAD drawings of

RLS clasp (buccal, occlusal,
and lingual view)

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26 2 Classification and Design of Esthetic Clasp

Fig. 2.32 Terec hidden clasp

(proximal view)

proximal

[Link] retentive arm [Link] reciprocation

[Link] connector [Link] rest.

Fig. 2.33 Terec hidden clasp

on model (lingual and
proximal view)

2.3.6 Saddle-Lock Clasp

Terec Hidden The saddle-lock clasp is an e-clasp system designed for the
Clasp elasticity of the retentive arm and named after its inventor
saddle-lock dental lab [12].
There are two types—A type for distal extension saddle
and B type for bounded saddle. Though their indications are
different, the similarity is that both of them have an arm
channel for the retainer to pass, which means that the guiding
plate and the retentive arm are separated though they do con-
tact to each other. And the main difference is if the rest is
connected to the plate.

1. Type A Saddle-Lock Clasp

(a) Structure
Elastic retentive arm, reciprocal plate (when there
are spaces on both sides of abutment and no adjacent
Fig. 2.34 Terec hidden clasp applied to distal extension edentulism tooth to provide reciprocation), guiding plate, mesial
rest (Fig. 2.35).

[Link]/Dr_Mouayyad_AlbtousH
2.4 Comparison 27

1 1

4
3 2
2
1
3

occlusal
distal occlusal
[Link] retentive arm [Link] plate [Link] rest
[Link] retentive arm [Link] plate
[Link] plate [Link] rest
Fig. 2.36 Type B saddle-lock clasp (I) (occlusal view)
Fig. 2.35 Type A saddle-lock clasp (distal and occlusal view)

(b) Characteristic 1
The retentive arm starts from the major connec-
tor, passes through the channel in the plate, and 2
ends at the distobuccal line angle or proximal-buc- 1
cal line angle. There is no contact between the 3
retainer and the plate, so the arm has a tensile elastic
range. The mesial rest moves toward the gingival to
decrease its torque to protect the abutment while
masticating.
(c) Indication occlusal
It is applicable for last abutment of distal exten-
[Link] retentive arm [Link] plate [Link] rest
sion. To ensure sufficient space for the retainer and
the plate, appropriate height of the abutment is
Fig. 2.37 Type B saddle-lock clasp (II) (occlusal view)
needed (4–5 mm from marginal ridge to gingival
papilla is desirable).
If the distal abutment of bounded saddle is diag- For distal abutment, type II is suggested. Its reciproca-
nosed loose and is risky to be lost, A-type saddle-lock tion is obtained from the lingual arm encircling around
clasp is suggested. the distal surface of the abutment (Fig. 2.37).
2. Type B Saddle-Lock Clasp
B-type saddle-lock clasp is applicable for bounded
saddle, and it has two types—type I and type II. 2.4 Comparison
When there is remaining teeth on the mesial side of the
abutment that provide reciprocation, the mesial rest can It is easy to be confused when the prosthodontists clinically
be removed and directly connected to the distal plate. use several kinds of e-clasp similar in shape, and for better
This is type I (Fig. 2.36), and it can be placed on the understanding, the comparison of the characteristic is shown
mesial abutment beside the edentulous space. as take-home messages in Fig. 2.38.

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28 2 Classification and Design of Esthetic Clasp

Saddle-Lock clasp
L-Type clasp Plate-bar clasp (type A)

Clasp arm circling around the The distal retainer is connected Prodmal stabilizer contacts with
promal surface, no plate or to the plate, and its retentive retainer without connection and
minor connector. its retentive area locates on the buccal its retentive area locates on the
area locates on the buccal surface as well there us buccal surface as well. There is
surface. Applicable for short requirement of the height of requirement of the height of
aborment abutment teeth abutment teeth

Short buccally Lingually retained

retained clasp short buccal arm clasp

Its retentive area locates on the

distal-buccal surface. its short Its retentive area locates on
retentive arm is on the buccal the lingual surface. Its short
surface, while the reciprocation reciprocal arm is on the buccal
is on the lingual. surface.

Fig. 2.38 Similar-looking e-clasps

[Link]/Dr_Mouayyad_AlbtousH
References 29

References 6. Tannous F, Steiner M, Shahin R. Retentive forces and fatigue

resistance of thermoplastic resin clasps. J Dental Mater.
2012;28(3):273–8.
1. Chu CH, Chow TW. Esthetic designs of removable partial dentures.
7. Oh WS, Basho S. Esthetic removable partial denture design in
Gen Dent. 2003;51(4):322–4.
replacing maxillary antetior teeth. J Gen Dent. 2010;58(6):252–6.
2. Donovan TE, Cho GC. Esthetic considerations with removable par-
8. Perezous LF. The twin-flex clasp: An esthetic removable partial
tial dentures. J Calif Dent Assoc. 2003;31(7):551–7.
denture approach. J Prosthod. 2003;12(4):325.
3. Cibirka RM, Lefebvre C, Goldstein RE. Esthetic removable partial
9. Mansueto MA, Phoenis RD. The Twin-flex removable par-
dentures. In: Goldstein RE, editor. Esthetics in dentistry, vol. 2. 2nd
tial denture: design, fabrication, and clinical usage. J Prosthod.
ed. Hamilton: B.C. Deker; 2002. p. 669–702.
1998;7(4):268–72.
4. Beaumont AJ. An overview of esthetics with RPDs. J Quintessence
10. Santana-Penín U, Mora MJ. An esthetically attractive twin-flex clasp
Int. 2002;33(10):747–55.
for removable partial dentures. J Prosthet Dent. 1998;80(3):367–70.
5. Vallittu PK, Kokkonen M. Deflection fatigue of a cobalt-­chromium,
11. Brudvik JS, Palacios R. Lingual retention and the elimination of
titanium and gold alloy cast denture clasp. J Prosthet Dent.
the visible clasp arm. J Esthet and Restor Dent. 2007;19(5):247–54.
1995;74(4):412–9.
12. Cherkas L, Jaslow E. Saddle lock hidden clasp partial dentures. J
Compend Cotin Educ Dent. 1991;12(10):746–75.

[Link]/Dr_Mouayyad_AlbtousH
[Link]/Dr_Mouayyad_AlbtousH
 3
Clinical Pathway of Esthetic Clasp
Technology

The clinical pathway of esthetic clasp technology is 3.1 The First Visit
very important for clinicians to design esthetic clasp
on RPDs conveniently. The process can be carried out 3.1.1 Reception
successfully as long as clinicians follow it.
1. Record essential information and complaints. When
edentulous patients first come to your dental office, they
should be welcomed friendly and led to a dental chair.
The purpose of this chapter is to help clinicians to Then clinicians are supposed to ask and record the essen-
complete the clinical process of esthetic clasp technol- tial information of the patients, including name, gender,
ogy and provide patients a perfect or compromised age, and contact way [1].
esthetic RPD denture Obtain the authentic details, for example, whether the
patient has systemic or contagious disease, such as hepa-
titis B, AIDS, etc. Patients with heart disease, hyperten-
sion, and other systemic diseases need real-time
monitoring and special clinical skills.
Record patient’s chief complaint (Fig. 3.1), and exam
oral condition preliminarily.
2. Oral examination. The content of oral examination
including:
(a) Missing teeth: Record the position of the missing
teeth by site recording method.
(b) Loose teeth: Check and record the mobility of
remaining teeth.
I°loose: The mobility in the buccolingual direc-
tion is within 1 mm, and in other directions, there’s
no moving.
II° loose: There are two types. One is the mobility
in buccolingual direction between 1 and 2 mm,
and the other is that the tooth in two directions
(buccolingual and mesiodistal) has mobility.
III° loose: There are also two types. One is the
teeth with buccolingual direction mobility of more
than 2 mm. The other is that the tooth is movable
in three directions (buccal lingual, mesial,
vertical)
(c) Teeth: Check whether there is movement, inclination,
and elongation in remaining teeth. Whether there is
occlusal interference. First, make sure if orthodontic

© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House Co. Ltd. 2023 31
H. Yu, Digital Removable Partial Denture Technology, [Link]

[Link]/Dr_Mouayyad_AlbtousH
32 3 Clinical Pathway of Esthetic Clasp Technology

Facial analysis Smile analysis Dentition analysis

Defect type
Frontal view Frontal and lower third
Abutment teeth
Frontal lower third Lateral and lower third
Model survey
Lateral lower third Dynamic smile
Clasp

Fig. 3.2 Three major parts of analysis and design process

3.1.2 Analysis Design

After the reception, clinicians can begin the second step flow
analysis design. This procedure includes analysis and design
based on patients’ facial features, smile, and dentition
Fig. 3.1 Reception and record basic information and complaint
(Fig. 3.2). Analysis and design play a decisive role in the
final esthetic effect of a removable denture.

treatment is necessary. If there’s too much grinding 1. Facial analysis: The first step of analysis is facial analy-
capacity for severely elongated and inclined teeth, sis, which means observing facial features at rest posi-
clinicians can do root canal therapy first. Then regain tion, estimating, and information recording.
the natural occlusal curve by a full crown prosthesis. (a) Frontal view
(d) Dentin: Check the defection and caries on remaining (i) The height of the lower third of the face
teeth—whether there’s wedge-shaped defection or According to the rule of thirds, make a line
percussed pain. Check whether there’s probing or along with the patient’s glabella and subnasal,
percussion. Clinicians can estimate with the dental which separates the face into three equal parts
radiograph. horizontally: the upper third (hair line to gla-
(e) Dental periphery: Check the condition of the peri- bella), the medium third (glabella to subnasal),
odontium, including bacterial plaque, dental calcu- and the lower third (subnasal to gnathion)
lus, periodontosis, gingiva, and gingival recession. If (Fig. 3.3). When the patient loses too many teeth,
there’s too much bacterial plaque or bad oral condi- the height of lower third face would be short.
tion, clinicians should do periodontal scaling treat- This can be used to confirm the height of the
ment before prosthetic treatment. lower third face.
(f) Mucous: Check whether the color of mucous is nor- (ii) Position and form of facial reference points and
mal. Estimate if the patient has a mucous disease. lines
(g) Other oral treatments: Ask patients if they have Nasolabial groove: Nasolabial groove con-
received other oral treatment before, and check the sists of a nasal groove (lateral nasal depression)
effect, for example, if the tooth extraction wound is and labiofacial groove (diagonal depression
healed and fixed denture is well preserved. If the patient between the upper lip and genal region)
accepted root canal therapy, clinicians should estimate (Fig. 3.4). Patients with deep nasolabial grooves
the periapical condition by dental radiograph. might give others an aging impression.
Before restoration, the oral condition should meet Angulus oris: Observe the coordinate position
the following requirements: of angulus oris in the face horizontally.
(i) Necessary surgical procedure is finished Rima oris: It is the horizontal fissure between
(remove residual root and III°loose tooth). upper and lower lips. Observe the feature of rima
(ii) No defective denture. oris at rest position (concave, horizontal, convex)
(iii) No pulposis; The defect tooth has been repaired. before prosthetic treatment.
(iv) Periodontal disease has been treated perfectly. (b) Frontal lower third
Dental calculus and tartar have been removed The vertical range of the frontal lower face is from
completely. the nasal tip to gnathion. Its significance is to help
(v) No mucous disease. The condition of oral observe the proportion of the upper lip and lower lip.
mucous is good. According to the lower third proportion, the rate of
(vi) Optimal designed necessary orthodontic treat- the distance between subnasal and rima oris and the
ment is finished (correct over inclination tooth). distance between rima oris and gnathion should close

[Link]/Dr_Mouayyad_AlbtousH
3.1 The First Visit 33

Subnasal
Hair line

Rimaoris

Glabella

Gnathion

Subnasal
Fig. 3.5 Frontal lower third face (short tri-stop)

Gnathion

Philtrum
Fig. 3.3 Frontal view (long tri-stop)

Nasolabial groove Nasolabial groove Labiomental groove

Fig. 3.6 Lateral lower third face in 45° (philtrum, labiomental groove)

Labiomental groove: Observe whether the

horizontal depression between the lower lip and
Fig. 3.4 Nasolabial groove and rima oris the mental region is sunken (Fig. 3.6).
(ii) Lateral lower third face in 90°
Lateral tri-stop: Draw lines from the center of
1:2 (Fig. 3.5). The insufficient height of lower 1/3 tragus to the midpoint of hair line, glabella, nasal
face may be caused when the two parts are all too tip, and pogonion, which form three angles. It
short. fits in with estheticism when the difference is
(c) Lateral lower third less than 10°.
The vertical range of frontal lower face is the Ricketts esthetic line: The lower lip should set
same with frontal lower third face, including nasal tip on the line from patient’s nasal tip and pogonion
and gnathion. And the angle includes 45°and 90°: (Fig. 3.7).
(i) Lateral lower third face in 45° Nasolabial angle: The normal angle between
Philtrum: Observe whether philtrum and phil- the nasal columella and the upper lip is 90°–
trum ridge (the parallel skin ridges along with 100°, which helps estimate fullness of the upper
philtrum) is depression inward, droop, or asym- lip should be restored.
metry. If the fatness of philtrum is insufficient, Nasomental: Clinicians can restore patient’s
clinicians can restore facial profile by proper vertical height of lower 1/3 face by estimating
thickness base plate (Fig. 3.6). the optimum nasomental. Draw two lines from

[Link]/Dr_Mouayyad_AlbtousH
34 3 Clinical Pathway of Esthetic Clasp Technology

(a) Frontal lower third

Observe the smile exposing area before prosthetic
treatment. Choose the smile line type. Then analyze
the explosion of tooth tissue and soft tissue. Record
the esthetic teeth. At last, choose the esthetic abut-
ment according to the gap position.
(b) Lateral lower 1/3 face
Lateral lower 1/3 face in 45°and 90° is auxiliary
reference of front feature. Observe the exposure of
esthetic abutment laterally by estimating the esthetic
regional teeth when the patient smiles. Besides,
observe the facial sufficient signs when the patient
smiles (Figs. 3.9 and 3.10).
(c) Dynamic smile analysis
Fig. 3.7 Lateral lower third face in 90° (esthetic line ) After finishing analyzing the static oral exposing
area, clinicians can observe the exposure condition
when patient opens and closes the mouth naturally
and speaks and smiles by communicating with them.
Through this procedure, clinicians can choose the
abutment and the type of esthetic clasp.
Because of the variability of dynamic smile, we
can record it dynamically by camera, to obtain abun-
dant and accurate information. Hold the camera in
the same horizontal plane with patient’s lower 1/3
face. Both frontal and lateral views should be
recorded. Let patient read a paragraph of words or
have a conversation, to record the dynamic image of
lips meanwhile. It helps clinicians and technicians to
select the optimum denture, the position, the type of
clasp, and the color of the base by watching the
video.
Video recording is an important case data. It is
also the reference for next prosthetic treatment. From
now on, the second part of the analysis-smile analy-
sis is complete. The main processes are presented in
Fig. 3.11:
3. Dentition analysis
The third part of analysis and design is dentition analy-
sis, which means analyzing patient’s study cast, because
different types of dentition defects are corresponding to
different design rules. First, determine the type of dentition
defect. Then confirm abutments by analyzing esthetic abut-
Fig. 3.8 Static smile analysis (frontal lower 1/3 face) ment and study cast. The esthetic retention area in abut-
ment can be confirmed by model surveying. At last select
optimum esthetic clasp according to esthetic retention.
the nasal tip to nasion and gnathion, which inter- Select a proper tray to get a model for patient. It can
sect and form nasomental, whose normal range not only help clinicians to analyze dentition and make
is 120°–132°. custom tray but also be preserved as record model. It
2. Smile analysis serves multiple purposes.
When the facial analysis is finished, the next step is to (a) Types of dentition and design rules
analyze smile [2]. Observe smile exposed area, estimate Dentition defect includes missing one tooth to
teeth in esthetic zone, and provide a reference to selecting remaining one tooth. There are many classification
esthetic abutment (Fig. 3.8). methods. We can’t introduce them in details one by

[Link]/Dr_Mouayyad_AlbtousH
3.1 The First Visit 35

Fig. 3.9 Static smile analysis (lateral lower face in 45°)

Fig. 3.10 Static smile analysis (lateral lower face in 90°)

planned. When mucosal support is used, an

Smile line Smiling exposure space
attempt should be made to reduce the load act-
ing on the tissue [3]. This may be achieved by
extending the fitting surface of the denture as
widely as possible and by reducing the num-
Esthetic abutment Esthetic teeth ber or the width of the teeth on the denture.
When there’re many remaining teeth and
the oral condition is good, combined sup-
Fig. 3.11 Key point of smile analysis
port can be considered mucosal and teeth
support. The design of teeth and mucosa-
one. Now, we introduce Kennedy dentition defect supported RPD is the most complex.
classification [1]. The main design points are as Improper design can lead to abutment
follows: loose, mucous tenderness, and alveolar
(i) Kennedy classes I and II distal extension: bone absorbing. When designing this kind
Where tooth support is considered inade- of RPD, clinicians should pay attention to
quate, additional mucosal support should be three “reduces”:

[Link]/Dr_Mouayyad_AlbtousH
36 3 Clinical Pathway of Esthetic Clasp Technology

retain clasp (anterior proximal plate clasp,

Twin-Flex clasp). The proximal retain clasp
must be used with other clasps because it can’t
meet the requirement of retention. The tradi-
tional clasp can be placed in the unesthetic area.
If there are not many missing teeth, the plate
will be only placed on the abutment beside the
edentulous space. If not, in order to avoid the
subsidence of the denture, rest should be placed
Mesial occlusal rest two abutments along with
on the abutment.
edentulous space (b) Selecting abutment
(i) Select the abutment adjacent to the edentulous
Fig. 3.12 Reduce the denture sinking space preferentially. Improve retention and sta-
bility and reduce denture structure.
Reduce sinking: The rest at the mesial (ii) When the patient has fewer teeth (less than
abutment of edentulous space should be four), clinicians should try to make as full use
designed at mesial as far as possible to con- of every abutment as possible. When there’s a
firm lever effort. Clinicians can also combine large number of remaining teeth in good condi-
retainer in two abutments in the mesial side tion, the number of abutment has to be less than
of edentulous space to improve retention 4. An overcomplex framework structure is not
(Fig. 3.12). The distal extension edentulous conducive for patient to wear and clean. What’s
space should be impressed under pressure. more, because of the increase of lateral force, it
The fitting surface should be relined in time may cause periodontal trauma.
when the denture is used a period of time. (iii) The distribution of abutment should meet the
Reduce revolving: Set indirect retainer in requirement of three-point distribution as far as
the opposite of fulcrum. It should be away possible. The center of the plane formed by
from distal extension base as far as possible. direct retainers should be located in the center
Enlarge base properly to make the bases on of the denture, which helps to achieve ideal
both sides of arch restrict each other. stability.
Reduce swing: Big connecter with rigid (iv) On the basis of reasonable design, try to use
connection can resist swing. Reduce the wrapped clasp at nonesthetic area.
width of the teeth and the height of cusps. Set (v) Try to choose the abutments with large peri-
proximal plate on the distal surface of abut- odontal members, such as canine and first pre-
ment at the proximal edentulous space. molar. The abutments should be in good
(ii) Kennedy class III nondistal extension: periodontal condition. If the patient has dental
There are teeth both at the head and the back calculus or periodontal disease, it is suggested
of the edentulous space in Kennedy class III that the treatment should be done after peri-
defect, which indicates the type of the denture is odontal treatment. The long axis direction of
tooth support [4]. This kind of support method abutment should be vertical with the bite force.
can provide great retention, support, and stabili- Increase periodontal potential. Reduce excess
zation. There’s one point to pay attention to: we load on abutments.
can choose the invisible denture only when the (vi) Try to choose the abutments with complete
gap is small. We should avoid designing unilat- crown, good retention form, and a certain depth
eral denture—there’s denture only on one side of concave and concave slope. The wrap of
of the dental arch to avoid the coronal rotation clasp to caries tooth can influence its self-­
of the denture. cleaning effect and accelerate the decay pro-
(iii) Kennedy class IV anterior defect: cess. So treatment must be done first for this
Kennedy class IV dentition means the losing kind of abutment. In the case of defective abut-
of anterior teeth. An esthetic abutment is gener- ment, the shape of the retainer should be
ally located in the esthetic area [5]. From an restored by inlay or filling.
esthetic point of view, the design of the buccal (vii) Teeth with endodontic disease must be treated
clasp should be avoided in the edentulous side with root canal therapy before loading. The
abutment, as well as the design of proximal hard tissue of devital teeth has low strength, and

[Link]/Dr_Mouayyad_AlbtousH
3.1 The First Visit 37

the stress of the retainer may lead to fracture. equally, which means it shouldn’t be very deep
Therefore, the application of post core and on some abutment and very shallow on others.
crown prosthesis is necessary to strengthen the In addition, the guide plane can provide par-
devital teeth. Dentin hypersensitivity tooth tial retention by rubbing with the tooth. The
shouldn’t be selected as abutment if it is still guide plane should be parallel to the insertion
sensitive to external stimulation after path and each other.
desensitization. Interference: Tooth and soft tissue may be
(c) Model surveying formed so as to physically obstruct the RPD
Determinate the insertion path of removable par- along an otherwise appropriate path of inser-
tial denture, and control the factors affecting the tion. The common interference area includes the
selection of insertion path by surveyor called model dentin lingual tilted area (Fig. 3.14). The effect
surveying [1] (Fig. 3.13). Surveying is the key step in of positioning can be eliminated by modifica-
designing removable denture. The main purpose of tion in general. However, if there is much grind-
model surveying in esthetic clasp technology is to ing, it should be restored by a full crown
determine the esthetic retention area. prosthesis, or change the location of denture
The surveyor essentially comprises a vertical rod units.
that is held perpendicular to a horizontal platform Esthetic: For the loss of anterior teeth, if the
which can be adjusted on the 3D direction. The rod undercut of the tooth adjacent to edentulous
can be moved horizontally, up and down. It repre- space is too deep, clinicians can adjust the inser-
sents the path along which the denture is inserted and tion path to reduce nonesthetic gap (Fig. 3.15).
removed. The path of insertion can be altered by After facial analysis and smile analysis, cli-
changing the tilt of the model on the horizontal plane. nicians should know the position of esthetic
By positioning this vertical rob against the teeth and retention area fairly well. For example, in order
soft tissue area on the model, their morphology can not to expose the metal, the only adjacent sur-
be examined. face can be used in A2. Only a little bit of the
(i) Positioning esthetic insertion path distal-buccal axis ridge can be shadowed to rely
There are three main factors that affect the
esthetic insertion path: retention area, interfer-
ence area, and esthetics [6].
Retention area: The existence of undercut
provides the retention force. The area of under-
cut in every abutment should be distributed

Fig. 3.14 Lingual abutment

insertion pathway esthetic insertion pathway

Fig. 3.13 Model surveying Fig. 3.15 Esthetic insertion pathway to reduce anterior gap

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38 3 Clinical Pathway of Esthetic Clasp Technology

on dentin in A3. The dental convex can be cov- tic parts like clasp tip can extend under the sur-
ered by the lip completely in A4. According to vey line. If the path of insertion and removal are
these judgments, survey esthetic abutment, not in the same direction, the terminus of the
position esthetic insertion path, and check the clasp should enter the common undercut area
depth and slope of retention area. (Fig. 3.16).
Esthetic insertion path focuses more on (iii) Confirming esthetic retention area
esthetic factors. Meanwhile, other factors must Confirm esthetic retention area by esthetic
also meet the requirement of clinical practice. survey line. Commonly, the clinical esthetic
(ii) Drawing esthetic survey line retention area includes distofacial undercut, cer-
Once the path of insertion has been decided vical third, and proximal undercut [5]
upon, the final design of the prosthesis can be (Fig. 3.17).
completed. The contour line formed by joining (d) Choosing esthetic clasp
points of maximum bulbosity on the teeth or According to the tooth surface in esthetic reten-
soft tissue is termed the “survey line.” There are tion, choose an esthetic clasp [7] (Fig. 3.18). Then on
many kinds of survey lines on one model. The the basis of esthetic abutment (anterior, molar), con-
choosing of survey lines depends on physician’s firm the type of the esthetic clasp at last.
experience and the emphasis of denture design. From now on, the dentition analysis is finished
All the inelastic parts of the denture should completely. Let’s review the main processes
be located above the survey line. Only the elas- (Fig. 3.19).

Fig. 3.16 Right figure: The

only elastic tip of clasp can Elastic part common undercut area
expend under the survey line.
Left fig.: The tip of clasp surveying line of insertion
enters common undercut area
Inelastic
Surveying line of displacement
part

Fig. 3.17 Commonly

esthetic retention area

distal surface of cervical 1/3 proximal surface

buccal axis ridge

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3.1 The First Visit 39

Fig. 3.18 Esthetic clasp

classification according to the
location of retention area

buccally Short buccally

C clasp L clasp Modified RPI clasp
retained clasp
retained

Short-arm
T clasp embrasure clasp Plate-bar clasp Saddle-lock clasp

proximally
retained
Adjacent surface hidden clasp Twin-Flex clasp Terec hidden clasp
for anterior tooth

lingually
retained
Lingually retained short Lingually retained L clasp Lingually retained J clasp RLS clasp
buccal arm clasp

The type of dentition defect Smile exposed area order to get a complete and accurate impression, it’s nec-
essary to make custom trays for most patients. This part
will introduce how to make custom tray quickly with self-
Esthetic abutment Esthetic area teeth curing resin.

Fig. 3.19 Flow chart of dentition analysis Draw Lines Draw the boundary of tray on the study cast
with a soft pencil. Be careful to leave the mucous at a dis-
tance to give out the channel for overflow of impression
3.1.3 Fill Work Authorization material.

After selecting the esthetic clasp, the work authorization

should be filled at once, which helps to check the prepared Fill the Undercut and Buffer Soak the model in water for
tooth. The following figure is the design of 15 kinds of 1 min. Heat the wax knife to fill the undercut area at the
esthetic clasp design diagrammatic sketch (Fig. 3.20). They model. The sharp ridges on the alveolar ridge can be buffered
are simple, legible, and unique. The main purpose is to trans- by 0.5 mm wax.
fer information between physicians and technicians. The
detailed process of filling work authorization and <esthetic
clasp prosthesis technology work authorization> provided Wax Coating Heat two layers of red wax slices soft cover-
only in this book will be introduced in the fifth chapter. ing the model. The part with remaining teeth is thick (about
4–5 mm). Mucosal pat is thin (about 2–5 mm). The impres-
sion material is not easy to lose in this way. Be careful not to
3.1.4 Make Custom Tray cover the pencil line.

Because there are differences among individuals, trays in

consulting room may not be suitable for all patients [5]. Coat Separating Agent The separating agent is applied to
The individual differences of patients include the mor- the model on where self-curing resin may flow over. There must
phology and size of the dental arch, arrangement of denti- be enough separating agents on the surface of the wax layer.
tion, and condition of the frenum and other soft tissues. In Otherwise, it will be difficult for the next polishing to work.

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40 3 Clinical Pathway of Esthetic Clasp Technology

Fig. 3.20 Diagrammatic Icons of Anterior esthetic clasp

sketch of anterior esthetic
clasp

Short buccally retained clasp C clasp L clasp Modified RPI clasp

T clasp Plate-bar clasp Twin-flex clasp

Icons of Posterior esthetic clasp

Short-arm embrasure Plate-bar clasp Lingually retained short buccal arm clasp
clasp

Lingually retained L clasp Lingually retained J clasp RLS clasp

TEREC hidden clasp Saddle-lock clasp

Prepare Self-curing Resin Material Self-curing dental Cover and Cut The resin slice is covered on the surface of
resin consists of dental base acrylic resin liquid and powder. the wax layer. Press the resin making it fit the wax. Trim off
According to the instruction of manufacturers to take the the excess material following the boundary.
powder in a certain amount, drop the liquid into the container
until the powder is completely immersed. It can be taken out
to shape when it is in the dough stage. Make Handle Form the excess material into needful shape.
Dip the connection with dental resin liquid. Then place it on
the tray. Be careful that the handle can’t hamper the lip
Tips movement.
Remove the resin with a little amount of water under
the tap. Washing while rubbing can keep the dough
from sticking to hands. Burnish and Polish Wait for 20–30 min until the resin
cures completely. Separate the tray and model carefully.
Remove excess wax and separating agent. Grind off the
small lips with emery wheel. Leave soft tissue like frenum.
Press Slices Press the resin with hand or smooth stick. At last, polish the surface with cotton wheel to avoid scratch-
Thickness is preferably less than 2 mm. ing patient’s mucous.

[Link]/Dr_Mouayyad_AlbtousH
3.1 The First Visit 41

Try-In The last job is to put the tray into the patient’s mouth The thickness of rest seat should be deeper than 1 mm to
to check if there’s enough space for impression material and ensure rigidity of selected material’s recommendations.
whether it effects the movement of soft tissue. Clinician can make patient bite a softened wax to check the
thickness. The bottom of rest seat should be inclined to the
center of a tooth, which forms an angle less than 90° with the
3.1.5 Tooth Preparation proximal surface (Fig. 3.21). The purpose of this way is to
ensure positive seating. Denture wouldn’t slide along the
Clinicians can start to prepare teeth after finishing a custom direction of abutment.
tray. The purpose of tooth preparation is to provide reliable
support, retention, and stability [1]. Cingulum Rest The ideal position for cingulum seating
should be apical to the area of contact with opposing teeth
Rest Seat Preparation Rest is an important part to provide (Fig. 3.22 left).
support in RPD. Rest should seat at the occlusal tooth sur- Start at the edge ridge of abutment, and stop at the incisal
face to transmit axial loads to abutment and avoid hurting surface of cingulum with round diamond bur. Observed from
supporting tissue. lingual surface, it is like semilunar (Fig. 3.22 middle). It
should be widened properly in edge ridge. The margin should
The rest seat in the abutment provides rest space to ensure be rounded.
the thickness of the mental. The position of the rest seat What’s more, there’s also lingual rest, seating at cingulum
means a lot for bite force to transfer accurately. located on the cingulum near the gingival, which along the
cingulum as U shape (Fig. 3.22 right). It requires a certain
Occlusal Rest It looks like a rounded triangle. It’s widest at height of abutment. This kind of rest not only can transfer
the marginal ridge and tapers down into the adjacent fossa occlusal force but also can be a resistant arm to improve the
[5]. The tip points to the center. Its width is 1/3–1/2 of edge stability of the denture.
ridge. Its length is 1/3–1/4 of tooth distal diameter. The mar- Carry out embrasure widening. The abutment teeth should
gin of rest seat should be round. It also should transit natu- be taken into account when the space is enough for a metal
rally to the edge ridge. Avoid a sharp line angle. framework. For example, the clasp shoulder and small con-

Fig. 3.21 Occlusal rest seat

< 90°

Seat at central 1/3 of edge ridge the angle between bottom and
The length is about 1/3-1/4 of proximal surface less than 90
tooth distal diameter.

Fig. 3.22 Tongue rest

Connection area gingivally cingulum incisally cingulum gingivally

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42 3 Clinical Pathway of Esthetic Clasp Technology

nector may affect occlusion (Fig. 3.23). Apply thin cone car The anterior guide surface should be in proximal tongue
to mill off a small amount of enamel. The line angle should surface, but not affect the labially axiomesiodistal surface.
be round. Prepare teeth axial surfaces. The propose of preparing
Prepare guide space. Guide plates are most frequently teeth axial surfaces is to lower survey line and improve clasp
prepared on the proximal surfaces of abutment teeth adja- placement. Declining and dislocated teeth make the position
cent to the edentulous space, which guide the direction of of the survey line improper. If the clasp can’t enclasp the
denture wearing in and out. They also need to be parallel ideal retention area, it would affect the denture to be in place.
with the pathway of insertion and displacement. The struc- Firstly, we should refer to the survey line on the study
ture contacting guide surfaces called adjacent panel in cast. Apply cylindrical diamond bur positioned alongside the
RPD. Because the guide surfaces and adjacent panels have enamel surface to be prepared. Tip slightly to form a new
friction when they contact, so guide surfaces can also pro- angle. Remove the enamel to form a new height. Pay atten-
vide some retention effect. Key points to prepare include the tion to protect the teeth. The surface should be polished or
following: mineralization and desensitization treatment. If the tilt angle
Apply a cylindrical bur to prepare along with the abut- is too large resulting in a large amount of tooth modification,
ment teeth. A guide surface should be prepared by even the ideal solution is to make a crown for abutment teeth.
reduction of the surface of the tooth maintaining its contour
and not as a flat surface (Fig. 3.24).
A proximal guide surface should be 2–4 mm high and 3.1.6 Impression and Working Model
about as wide as the distance between the buccal and lingual
cusp. 1. Impression. We present alginate, the most commonly
used in the clinic, as an example to introduce the key
point. Firstly, we introduce two different impressions:
anatomic impression and functional impression [5].
(a) Anatomic impression: It records the soft and hard tis-
sue in static. It is suitable for tooth support and
mucosa support denture. Anatomic impression
records oral anatomy in one go.
(b) Functional impression: It records the surface feature
when alveolar ridge bears occlusal force, which can
protect soft and hard tissue better. It is suitable for tooth
and mucosa support dentures. It is commonly used in
Kennedy classes I and II free-end dentition. When free-
end dentition bears occlusal force, denture in the
Carry out embrasure widening mucosa and abutment is in different sinking degrees. A
denture made according to anatomic impression will
Fig. 3.23 Carry out embrasure widening to obligate enough space for make abutment teeth withstand large torsional force.
metal framework So, it needs to make a functional impression.
Apply selective tissue placement impression to
make a functional impression. A denture can get sup-
port in the primary bearing area (mucosa in free-end
alveolar ridge) by controlling the flowability of
impression material.
Reduce buffering capacity in primary bearing area
of custom tray (e.g., lay a wax slice in fitting surface
wrong right or other unflow material) to increase tension.
Buffering by wax and increasing overflow hole
Along the tooth shape to grind prepare axial surface
can control the flowability of impression material,
uniformly which can help form different displacement capacity.
In that way, it can record the organization
Fig. 3.24 Guide surface should fit the shape of abutment teeth functionally.

[Link]/Dr_Mouayyad_AlbtousH
3.1 The First Visit 43

Operation steps and outcome

(a) Check tray: Put the custom tray into patient’s mouth
to check the size and whether the edge and handle
hinder lips’ movement.
(b) Adjust chair: In order to avoid patient nausea and
vomiting, the clinician should raise chair to make
patient’s dentition occlusal plane parallel to the hori-
zon. The patient should rinse the mouth to remove
the food residue and other objects.
(c) Liquid and powder blending: Measure powder and
liquid according to product instruction. Put them to
rubber cap. Mix quickly along one direction with a
plaster spatula. When it becomes smooth and pasty,
put it on the tray.
(d) Impression: As for some areas, that impression
material can’t be reached, like deep undercut and Fig. 3.25 Water cleaning
buccally gap. Clinicians can use impression material
with finger to coat these areas. Pull one side of angu-
lus oris with dental reflector. Put the tray into the
mouth in lateral rotation. Make the custom tray in
place from back to front. Before impression material
is hard, it should be done in a muscle functional
setting.
(e) Check impression: When the impression solidifies
completely, put the tray out. Compare the dentition in
the mouth to check whether the dentition and muco-
sal transition are complete. Small bubblet can be
filled by newly mixed impression material. If there’s
big bubblet, clinician needs to get patient’s impres-
sion once more. Impression should be perfused with
gyp at once.
2. Working model
(a) Clean and disinfect.
Fig. 3.26 Sterilizing cabinet
The residual saliva in impression surface will
infect the accuracy of gyp model. And it may transfer
bacteria. So it must be cleaned before perfused (iii) Make base. The thickness of it shouldn’t be less
(Fig. 3.25). Besides, it should be disinfected by ultra- than 16 mm.
violet or ozone (Fig. 3.26). The silastic model should (iv) Set the model in static about 20 min to make it
be disinfected by immersion way. solidify preliminarily. It will be hardest 2 h later.
(b) Perfuse model. At that time, the model can be pulled out from
(i) Measure gyp powder and water according to impression.
product instruction. Sprinkle the powder into (v) As for working model for removable denture,
water. Mix them about 30 s until it becomes the record of mucosal transition is very impor-
smooth and flowing paste. Never add water or tant. The boundary of model should expend to
powder halfway. It will be better with a vacuum this area.
mixer. From now on, all work at the first visit has
(ii) Put the rubber cap on oscillator to shake. To been done.
make bubbles go out. Then perfuse gyp from the The workload is the biggest at the first visit.
top of impression. Shake it, and pull gyp con- The most important part is analyzing and
stantly until it flows to everywhere of the designing. According to the steps regularly, cli-
impression. nicians can finish it well organized.

[Link]/Dr_Mouayyad_AlbtousH
44 3 Clinical Pathway of Esthetic Clasp Technology

3.2 The Second Visit

3.2.1 Try-In of the Framework

The objective of this stage is to ensure that the framework fits

accurately and does not interfere with the occlusion of the
natural teeth. Prepare for the next stage-getting bite record.

1. Put it in place. Try in the framework according to the

insertion pathway designed at first visit (Fig. 3.27). If it
can’t be wear successfully, induce block area by articulat-
ing paper, and wear off them by green sharpening stone.
Wear off in minor when adjusting block area, espe-
cially retention area under guide line, like the tip of clasp.
Fig. 3.27 Framework in place
Avoid too much adjustment in case of insufficient reten-
tion. In the adjustment process, the bracket should be
continuously immersed in cold water to avoid overheat-
ing and metal oxidizing.
2. Adjust occlusion. The parts in framework influencing
occlusal height are generally rest and the arm of clasp cross
occlusal surface. Indicate the bite points with occluding
paper. Adjust central occlusion first and then protrusive and
lateral. If there’re frameworks in maxillary and mandible,
adjust one by one (Fig. 3.28). At last, check them all.
Measure the thickness of metal with caliper when wearing
a framework to avoid too thin to break partially.
3. Check after all the wearing process; check whether the
framework fits the abutment teeth or not, including the pit
of rest, the arm of clasp, tip of clasp, minor connector,
anterior lingual panel, and others. The parts adjusted
should be polished.
Fig. 3.28 Adjust occlusion

3.2.2 Record Jaw Relation

1. Few missing teeth. When a missing tooth is less and

maxilla-­mandibular relationship is clear, clinicians just
need to confirm it on the models.
The other condition is that even though there are a few
missing teeth, vertical distance can be determined, but a
unique occlusal relationship can’t be found. Now, clini-
cians can use bite record material like wax or impression
material to make patient bite at a central position.
2. Several teeth missing. When many teeth missing, like
end-free edentulous, the vertical distance can’t be deter-
mined. Then clinicians need to record occlusal relation-
ship with wax occlusal rim.
(a) Wetting the surface of working model. Put the frame-
work try-in well in place. Observe the gap between Fig. 3.29 Fill the fitting surface with wax
the framework and model.
(b) Drip wax to the network part at the end of framework
with heated wax spatula. Make the flowing wax fill right place (no risen and reverse). When there’s no
the fitting surface of framework (Fig. 3.29). Ensure to obvious gap, clinicians can put it off from the model
never make wax effect the framework sitting in the to fix the interspace. Put it back to the model.

[Link]/Dr_Mouayyad_AlbtousH
3.2 The Second Visit 45

(c) Heat red wax soft and fold it in 8–10 mm. The length
is the same as the edentulous space. The height is
about 12–14 mm (Fig. 3.30). Heat the bottle of the
wax occlusal rim, and adhere it into the framework
(Fig. 3.31). After adhering them, when the wax is still
soft, put it into patient’s mouth to check whether the
height and width are proper (Fig. 3.32) and whether
the end of framework influences occlusion. The inap-
propriate places should be amended as soon as
possible.
(d) If the wax hardens, heat the big wax knife to make
the occlusal surface of the wax rim soft. Then put it
into patient’s mouth to bite in a central position.
(e) Put it out to cold water to cold and clean it. Then put
it back to the mouth to check the occlusion again. Fig. 3.32 Record occlusal relationship
Avoid wax deformation because of cooling.
(f) Most factories and hospitals in China use simple
articulators. Other complex semi-adjustable and fully
adjustable articulators are in great difference. We
won’t discuss specifically in this book.

Fig. 3.33 Colorimetric

3.2.3 Design Artificial Tooth

Fig. 3.30 Make wax occlusal rim

The three elements of artificial tooth design include color,

shape, and arrangement. Technician can determine the shape
and arrangement of teeth according to the remaining teeth on
the model. But the color information can only be recorded by
clinician and passed to technician.
When there’s no artificial tooth in esthetic area, the artifi-
cial teeth design should put function in the first place—only
if they were consistent with adjacent teeth and opposite
teeth. But the esthetic requirements of the anterior denture
are much higher. As fixed prosthetic, artificial teeth need
colorimetric. The standard of colorimetric and the transfer of
information can reference fixed prosthetics (Fig. 3.33).
When there are more anterior missing, and there’s no
enough information, clinician can not only design it based on
the remaining teeth but also consider the natural color
Fig. 3.31 Rax occlusal rim adhered in framework edentulous space changes, the color of the skin, personal preferences, aging,

[Link]/Dr_Mouayyad_AlbtousH
46 3 Clinical Pathway of Esthetic Clasp Technology

the transparency of tooth decreases, the saturation increases

and the pigmentation becoming yellow.
With the development of material technology, artificial
teeth can also simulate the different levels wrapped around
like natural teeth. Color and texture are more realistic. To
achieve a better esthetic effect, the technician can also carry
out surface resin dyeing on artificial teeth, like veneering
porcelain in fixed prosthetic to increase the simulation of
resin teeth (Figs. 3.34, 3.35, and 3.36).

Fig. 3.36 The comparison of esthetic and normal artificial teeth

Fig. 3.34 Simulation material

Fig. 3.37 Comparison of esthetic and normal base

3.2.4 Design Base

The design of the base includes two elements: color and

form. Similar to artificial teeth, technician can simulate gin-
gival margin and root form by referencing adjacent gingival
tissue on working model. But the color of the base can only
be recorded and transferred by clinician.

1. Red-white esthetic effect. Two completely different

objects tied together will give people a visual impact. At
the same time, they can highlight their characteristics. A
strong contrast between red gingival and white teeth can
deliver a message of health and vitality. That is what we
call “red-white aesthetic effect.” The color relationship
between gingival and teeth is not simple red-white con-
trast, but a color progression, hierarchy of light, and dark.
2. Blood effect. Despite the coordination of color and sur-
Fig. 3.35 Groove simulating rounding soft tissue, the best choice for an esthetic base is
simulate resin, which has a certain bionic effect with
resin fiber similar to red blood (Fig. 3.37).

[Link]/Dr_Mouayyad_AlbtousH
3.3 The Third Visit 47

3.3 The Third Visit

If clinicians carry out everything according to the operating

process strictly, it will be easier to wear the denture at last.

3.3.1 Adjust Position and Occlusion

1. Before wearing the denture, the clinician should check

whether there’s a sharp boundary or bump.
2. Modified resin base mainly. Check if the patient has ten-
derness. Coat methylrosanilinium in the alveolar ridge.
Put the denture in place. Then put it out to modify color-
ing area slightly. Still follow the principle of “less amount
Fig. 3.38 Modify denture
many times.”
3. Check whether the denture has set in a place completely,
including the fitness between clasp and abutment teeth
and fitness between base and mucous.
4. Modify the overlong boundary of the base (Fig. 3.38).
5. Adjust occlusion with articulating paper. If they’re all
dentures in maxillary and mandibular, clinician should
modify them one by one. The sequence is tooth support,
mixed support, and mucous support.

3.3.2 Grind and Polish

The denture must be polished by a cotton wheel after grind-

ing (Fig. 3.39). Clean the signet of articulating paper.

Fig. 3.39 Wear and polish

3.3.3 Clinician’s Advice

Practice speaking first after wearing dentures. Overcome for- After eating, put off the denture to flush with a soft tooth-
eign sensation generally. Start eating liquid food like por- brush. Everywhere should be brushed. Remove denture
ridge when speaking fluently. When there’s no problem before going to bed at night. Never wear it when you sleep
eating liquid food, begin to eat solid food. Never bite hard but soak it in cold water or denture cleaning tablets.
stuff. Removable denture can’t compare with natural denti- Never modify the denture by yourself. Go to the doctors
tion. The restoration of occlusal efficiency is limited. Be as long as you feel uncomfortable. Go back for review every
patient. half year (Fig. 3.40).

Make everything as simple as possible, but not

simpler.
Albert Einstein

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48 3 Clinical Pathway of Esthetic Clasp Technology

Fig. 3.40 The clinical The clinical pathway of Esthetic clasp prosthetic
pathway of esthetic clasp
prosthetic
The first visit The second visit The third visit

Reception try-in framework modify

Analyses and design occlusal record wear and polish

Fill work authorization design articular teeth doctor’s advice

Individual tray design saddle

Tooth prepare

Impression and work model

4. Rodney D. Stewart’s clinical removable partial prosthodontics.

References Batavia: Quintessence; 2008.
5. Alan B. McCracken’s removable partial prosthodontics. St. Louis:
Elsevier Science Health Science div; 2004.
1. Alan BC, Glen PM, David TB, et al. McCracken removable par-
6. Beaumont AJ. An overview of esthetics with RPDs. J Quintessence
tial prosthodontics. Zhang FQ, translated, 11 ed. Beijing: People’s
Int. 2002;33(10):747–55.
Military Medical Publishing House;2007.
7. Yu HY. Rehabilitation design of aesthetic removable denture. Chin
2. Aras MA, Chitre V. Direct retains: esthetics solutions in the smile
J Pract Depart Stomatol. 2012;5(2):72–4.
zone. J Indian Prosthod Soc. 2005;5(1):4–9.
3. Shi B. Practical series of clinical stomatology//removable denture
restoration. Wuhan: Hubei Science and Technology Press; 2003.

[Link]/Dr_Mouayyad_AlbtousH
 Digitalization in RPD
4

and risk management of the process and to the standardiza-

In the past, the restoration was fabricated entirely by tion and unification of clinic and laboratory. Therefore, the
hand, and the work of clinicians and technicians was application of digital technology in dental prosthodontics is
sharply divided, while the success and esthetic of the not limited to the digital information collection and CAD/
restoration depended on the technician’s skill and expe- CAM of the definitive restoration, but throughout the whole
rience. The overall quality of restoration varies because process of oral prosthesis; it should also include preoperative
of great technical dependence and the lack of commu- simulation analysis software, for example, Digital Line-­
nication between clinicians and technicians. With the plane Design (DLD) of West China Hospital of Stomatology,
rapid development of digital technology, the integration Digital Smile Design (DSD), 3Shape Smile Design, and so
of CAD/CAM (computer-aided design/computer-aided on, and digital recording and transmission of the design.
manufacturing) technology with medicine and stoma- The application of digital technology in RPD can be
tology has greatly changed the production process of roughly divided into three processes: design, transmission,
dental prostheses. At present, with the powerful func- and realization. The process of design includes the personal-
tion of CAD software, every link of the restoration ized RPD design developed by clinicians according to the
design can be visualized by computer, and the design of situation of patients and designed by the RPD decision sys-
complex and varied removable partial frameworks can tem. The process of transmission includes that the clinical
be entirely completed on the computer. design is transmitted from the clinician to the technician
through dental laboratory work authorization or working
chart, and the two-dimensional clinical design is transmitted
to a three-dimensional gypsum cast and refractory model; it
also includes that the physical design is transmitted to the
digital design utilizing digital scan and design software (i.e.,
the process of CAD). The process of realization includes
elaborate and accurate tooth preparation under the micro-
scope in the clinic and transformation from virtual design to
physical object (i.e., the process of CAM) in the laboratory.
Digital technology can be applied to design, transmission,
and realization of RPD. For patient-requiring RPD, the clini-
cal RPD decision system (RD Designer) will provide
optional plans according to their conditions, which will be
4.1 Introduction transmitted to the laboratory after optimization of clinicians,
where two types of transformation will accomplish before
Digital dental prosthodontics, referring to the process that delivery, from physical cast to digital data and then from vir-
clinicians and technicians participate in, to collect, analyze, tual design to final restoration.
and transmit the oral and facial digital information and to With the development of technology as well as the sup-
design and fabricate the restoration with the help of digital port of national policies, the application of digital technol-
facilities and software, has good repeatability of operation ogy in stomatology is wider than ever before, not only in the
and predictability of result, beneficial to quality supervision field of dental fixed denture where digital technology has

© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House Co. Ltd. 2023 49
H. Yu, Digital Removable Partial Denture Technology, [Link]

[Link]/Dr_Mouayyad_AlbtousH
50 4 Digitalization in RPD

Fig. 4.1 virtual simulation teaching laboratory

achieved remarkable results but also in the field of RPD; ing their innovative thinking, and fully arousing their enthu-
digitalization in RPD adopts a series of fast and efficient siasm and interest in learning.
digital processes including the digital acquisition of oral and West China College/Hospital in Stomatology, Sichuan
facial information, digital design, and digital production, University, has set up a virtual simulation experimental
improving the quality of RPD effectively and the efficiency teaching center on the basis of the digital 3D virtual oral
of the clinicians and technicians and reducing the cost time anatomy practice platform, the digital virtual training system
and frequency of the patients’ visit. The digitized data is con- of oral skills, and the oral medical simulation robots
venient for storage, exchange, and transmission, avoiding (Fig. 4.1), providing students with advanced digital equip-
physical space occupation and material waste. It is conve- ment for their study and research. It is believed that, in the
nient for patients to check the previous information in the future, more and more new materials and equipment will be
later visit and convenient for clinicians and technicians to put into clinical practice and teaching to promote the con-
carry out the repeatable production in the later period. tinuous development of digital technology.
Nonetheless, there are some deficiencies at present such as
the high cost of software and equipment, lack of intuition,
and perception of the process of design and production com- 4.2 Digital Design Terminology
pared with the conventional.
Digital technology has been widely applied in clinical 4.2.1 Acquisition of Digital Data
practice, as well as in education. At present, the application
of RPD in education is mainly in the teaching of the school Acquire necessary position, and shape information of the
and the instruction of the laboratory. In order to adapt to the maxillofacial region, dentition, and bite registration based on
development of digital technology, colleges and laboratories the principle of image and photoelectric information by
have set up courses to introduce digital technology in den- means of the digital processing system. It is an important
tistry and have equipped with the digital scanning system, prerequisite for fabricating the good prostheses to obtain
digital design software, digital production equipment, etc. accurate scan data.
Based on the fundamental theory of RPD, teachers explain There are lots of errors during the traditional process of
how to operate the software and equipment and then assist in impression taking and cast pouring, such as incomplete and
operation practice, letting the students have a deeper under- blurry impression, bubbles in impression, shrinkage of
standing of the digital process and operation. Students learn impression materials, impression deformation, cast deforma-
to design by themselves to solve different problems by means tion, bubbles on the surface of the cast, wear of the cast,
of 3Shape or EXOCAD software, to guarantee a combina- errors generating when duplicating cast several times, and
tion between theory and practice. Digitalization makes damage of cast or death. Some irreversible operations in the
teaching vivid, practical, shared, and open, modifying and laboratory may result in loss of oral information.
enriching the teaching content, keeping pace with the times, The acquisition of a digital model can be divided into
improving students’ ability of autonomous learning, expand- direct method and indirect method: direct method refers to

[Link]/Dr_Mouayyad_AlbtousH
4.2 Digital Design Terminology 51

oral scan and maxillofacial scan while indirect method to ability, and high scanning accuracy but with low scanning
digital scan of cast and impression. speed; representative products are iTero (Cadent, Israel),
3D Progress (MHT, Italy), and TRIOS (3Shape, Denmark).
Direct Method 2. Triangulation of light, including linear laser scanning
Combined with optical and electronic technology and com- technology, structure light scanning technology, three-­
puter image recognition and processing technology, the dimensional photographic technique, and so on, is char-
acquired optical signals are converted into electronic signals acterized by fast scanning but needs humidity isolation
that can be recognized by the computer through the corre- and spraying powder according to the requirement of
sponding scanning equipment, and the physical objects are equipment; representative products are CEREC Bluecam
converted into virtual information. Thus, a 3D digital model (Sirona, Germany) and its improved version Omnicam,
is acquired (Figs. 4.2 and 4.3). Bluescan (A.T RON3D, Austria), IOS FastScan (IOS,
At present, the main operating principles of intraoral USA), MIA3D (Densys3D, Israel), and DirectScan
scanning are as follows: (HINT-ELS, Germany).
3. The active wave front sampling technology is represented
1. Confocal microscopy adopts the mode of scanning layer by Lava COS (3M, USA) and the latest True Definition
by layer, with high data clarity, good detail reproduction Scanner.

Some intraoral scanners (e.g., 3M Lava COS) need to

spray powders on the teeth before scanning to increase the
number of reference points for system recognition, but it’s
important to note that it will lead to abnormal scan morphol-
ogy of some sites due to uneven distribution of powders, and
patient’s discomfort makes it difficult to keep a stable head
position, which may negatively affect the precision of and
reduce the reliability of the scan data. TRIOS (3Shape,
Denmark), widely used clinically, whose accuracy is 5 μm,
can reflect the color and shape characteristics of soft and
hard tissue.

Introduction to Some Common Intraoral Scanner

1. CEREC system
Based on triangulation of light, whose basic principle
is that a beam of light that is sent to the surface of the
tooth and reflected back to the charge-coupled device for
imaging, due to the uneven light reflection on the surface,
Fig. 4.2 Intraoral scan
would affect the accuracy of information collection, a
kind of opaque powder was sprayed on the surface of the
teeth to improve the quality of information collection.
Files containing collected information are transmitted
through CEREC Connect in a proprietary format to
CEREC MC and CEREC in Lab, terminals supported by
Sirona, meaning that CEREC is a closed system.
2. TRIOS system
Based on confocal microscopy and ultrafast optical
sectioning technique combined with a special optical path
oscillation system, the system can automatically recog-
nize the change of the object’s focus plane and keep the
relative position between the scanner and the scanned
object fixed. The acquisition speed is up to 3000 images
per second, reducing the scan error. TRIOS outputs 3D
graphics which becomes a digital impression with the
method of image collection and combination construc-
Fig. 4.3 Facial scan tion. TRIOS is an open system, namely, files can be

[Link]/Dr_Mouayyad_AlbtousH
52 4 Digitalization in RPD

exported in an STL format, compatible with other CAD/ 5. Acquisition of texture.

CAM system. 3Shape also provides mobile terminals, 6. Support varieties of output formats.
allowing the digital impression to be displayed on mobile
phones or tablets to patients, doctors, and technicians, The accuracy of oral scan and face scan, used to acquire
and also provides true color scanning, so it is very conve- patients’ information, is affected by the following factors:
nient for communication among the doctors, patients, and
technicians. 1. Scanning equipment factors: scan accuracy, scan speed,
3. Lava COS system match degree, etc.
Developed by 3M company, based on active wave 2. Operator technical factors: operation angle, operating
front sampling, Lava COS is a semi-open system, which method, etc.
means that in most cases the system transmits files on 3. Patient factors: patient compliance, oral environment,
proprietary platforms in a proprietary format, which can open degree, space in the mouth
be recognized by a specific CAD software and CAM
equipment to design and to fabricate the restoration, but Indirect Method
it’s still compatible with other software. In vitro, the model or impression is converted into an edit-
4. iTero system able 3D virtual model by means of an extraoral scanner.
Based on the principle of confocal microscopy, the Currently, the commonly used model scanning systems
data obtained by the system is of high definition, good include 3Shape, Dental Wings, Sirona, Girrbach, Wieland,
detail expression, and high scanning accuracy, but the and so on, and the accuracy can reach up to 15 μm.
scanning speed is relatively slow because of the layer-by-
layer scanning mode. Using red laser as the light source,
the iTero system captures all the structures and materials 4.2.2 Digital Analysis
in the mouth through parallel confocal scanning, without
the need to spray the powder on the teeth. The iTero sys- Digital analysis refers to the process that clinicians analyze
tem is an open system in which data is transmitted in an and process patients’ digital photos by means of 2D or 3D
STL format and is compatible with software that accepts software preoperatively, combining the treatment plan, to
the STL format. obtain the result expected by both doctors and patients, ben-
5. Common maxillofacial scanning equipment: 3dMD scan- eficial to the communication between doctors and patients
ner (USA), FaceScan scanner (Germany), etc. before the implementation of the irreversible operation,
improving the quality of diagnosis and treatment process.
FaceScan, based on structured light technology, consists The software used for digital analysis includes DSD (Digital
of two digital cameras, a structured light projector and scan- Smile Design), DLD (Digital Line-plane Design), and Tooth
ning software. Structured light works like this: several strips Assistant (Fig. 4.4).
of black and white are projected onto the face or object for
3D reconstruction, which will be captured by the camera,
and the software then automatically reconstructs the sur-
face. Finally, a highly accurate 3D reconstruction of the face
or object is obtained. iTero can be used to obtain 3D digital
data from the surface of complex objects quickly and
accurately.

Main characteristics of the 3dMD dynamic face system

include the following:

1. Easy to use.
2. The scanning process is fast, taking approximately 5 s,
requiring the scanned object to remain stationary.
3. High sensitivity, high resolution. Color, black and white
output format, with 640 × 480 and 1280 × 1024 resolu-
tion camera lens.
4. Can be adjusted according to the light/surface
conditions. Fig. 4.4 Simulation by Tooth Assistant

[Link]/Dr_Mouayyad_AlbtousH
4.2 Digital Design Terminology 53

4.2.3 Computer-Aided Design (CAD)

The CAD software of removable denture mainly includes

SensAble (SensAble Technologies, USA), dental system
(3Shape, Denmark), Ceramill (AmannGirrbach, Germany),
etc. Each has its own advantages, but the design procedures
are similar:

1. Determine the path of insertion, and block out undesir-

able undercuts.
2. Adjust the wax pattern, and reserve the space for retain-
ing clasp.
3. Build meshwork patterns, major connector, minor con-
nector, occlusal rest, and clasp.
4. Add wax virtually to simulate the shape of rugae, and Fig. 4.6 Arrangement of frameworks
build tissue stops and retention pins and other auxiliary
structures. are added to the structures before submitting the finished
5. Add the support, and finish design (Fig. 4.5). design (Fig. 4.6). Appropriate supports of adequate strength
are required to stabilize the RPD framework. Also, during
The traditional way to fabricate the framework is to obtain manufacturing, it prevents movement and (or) dissipates heat
the manual wax pattern first, where there are human errors away from the finished part of framework during manufactur-
and limitations in design. With the help of CAD software, ing. After that, files can be sent to a production machine.
each part of the digital framework can be added, subtracted,
deleted, hidden, and modified freely. In addition, the virtual
articulator can be used to simulate the mandibular movement 4.2.5 Computer-Aided Manufacturing (CAM)
of different patients as soon as possible through adjusting the
technique parameters, which could obtain more accurate CAM can be divided into subtractive manufacturing and
RPD. In the process of digital design, we should pay attention additive manufacturing (AM). The details are as follows:
to the combination of theory and practice and design reason- 1. Subtractive manufacturing
able and effective prostheses according to different cases. Subtractive manufacturing refers to a technology that
selectively removes materials from a blank block or disc
by means of mechanical milling, chemical treatment, dis-
4.2.4 Import and Arrangement charge processing, laser processing, etc. Computer numer-
ical control (CNC) milling system is the most widely used
For additive technology systems (laser sintering and 3D print- in prosthodontics, whose advantage lies in high accuracy,
ing) and subtractive technology systems (milling), supports high smoothness, no need for too much post-processing,
numerous kinds of materials that can be processed, good
internal homogeneity, etc.; nevertheless, the material
waste of this method is large, which can’t be used to pro-
cess nested, hollow-out, and other complex structures.
2. Additive manufacturing
Additive manufacturing, in contrast to subtractive
manufacturing, is a method with which to fabricate
objects by stacking and accumulating materials layer by
layer, also known as rapid prototyping or 3D printing. It
can be used to process complex structures, saves materi-
als, and increases production efficiency, but high cost and
rough surface are disadvantages of this method. Available
materials include metal (cobalt-chromium alloy, pure
titanium, etc.) (Fig. 4.7), resin, and wax.
Additive manufacturing has many different molding
methods, which can be divided into three categories
Fig. 4.5 Design the framework of RPD according to the different status of raw materials.

[Link]/Dr_Mouayyad_AlbtousH
54 4 Digitalization in RPD

CL 20ES stainless steel (1.4404)

CL 31AL aluminum (AISi 10Mg)
CL 41TIELI titanium alloy (TiAI64V ELI)
CL 42 TI Grade II pure titanium
CL 50WS hot processed steels (1.2709)
LaserCUSING® CL 91RW stainless hot processed steel
Processing materials CL 92PH precipitation hardening stainless steel (17-4PH)
CL 100NB nickel alloy (Inconel 718)
CL 101NB* nickel alloy (Inconel 625) *
CL 110CoCr* CoCr casting alloy (F75) *
remanium star® CL CoCr casting alloy (Dentaurum, Germany)
rematian® CL titanium alloy (Dentaurum, Germany)

Fig. 4.7 Materials can be processed by LaserCUSING® (Concept Laser, Germany)

The first kind is liquid, processed by means of stereo- (c) Laser direct metal deposition (LDMD)
lithography (SLA), which is mainly used to fabricate the Laser direct metal deposition (LDMD) was first pro-
working model of the intraoral scan and the implant posed by Sandia National Laboratory in the 1990s, but
guide. different research institutions call this technology differ-
The second kind of materials is lamellar or filamen- ently: laser engineered net shaping (LENS) of the
tous, which can be processed through laminated object University of Michigan, direct laser fabrication (DLF) of
manufacturing (LOM), fused deposition modeling Birmingham University in the UK, laser rapid forming
(FDM), electron beam fuse molding, and plasma beam (LRF) of Northwestern Polytechnical University of
fuse molding. China, etc. During the forming process, the powder is
The third kind is powder material, which can be pro- gathered on the working plane through the nozzle, and
cessed by selective laser melting (SLM), selective laser the laser beam also gathers at the point; two points coin-
sintering (SLS), laser engineered net shaping (LENS), cide to make it melt powder and then get an accumulated
and electron beam selective melting (EBSM). Among cladding solid by movements of workbench or nozzle.
them, SLS technology, which is widely used, is mainly LDMD can print high melting point metal directly, while
used to fabricate wax and resin patterns, metal restora- the diameter of focused laser spot is usually over 1 mm;
tions and guides, etc., while SLM technology is mainly the dimensional accuracy and surface roughness of parts
used to fabricate metal restorations. manufactured by LDMD technology are not ideal.
In the next part, some common metal additive manu- (d) Selective laser sintering (SLS)
facturing technologies are described: Selective laser sintering (SLS) was first proposed by
(a) Selective laser melting (SLM) Carl Deckard who came from the University of Texas at
Selective laser melting (SLM) technology was pro- Austin in the USA. Based on the metallurgical mecha-
posed by Fraunhofer Institute (German) in 1995, and the nism of liquid phase sintering, the powder material is par-
first SLM equipment was launched by MCP Hek com- tially melted, and its solid core is retained during the
pany (German). SLM technology uses high power den- process of forming. The powder is densified by subse-
sity small spot laser beam and high precision powder quent solid-phase particle rearrangement and liquid-
spreader, which forms without heating powder and melts phase solidification and bonding. SLS technology is
powder layer by layer by high-­energy laser during the suitable for titanium and titanium alloy, cobalt-chromium
forming process, forming metallurgical bond directly. alloy, stainless steel, nickel-titanium alloy, etc., and it
(b) Selective electron beam melting (SEBM) should be used under an inert gas environment like argon
ARCAM company (Sweden) proposed selective elec- or nitrogen with CO2 laser; both one-way and two-way
tron beam melting (SEBM) technology in 1994 and scanning are available. SLS technology has a relatively
launched the first equipment EBM S12 in 2002. SEBM high rate of material consumption; besides, it can also
technology preheats the metal powder to 600~700 °C process without support. However, powder material
before manufacturing, which reduces the cooling rate of won’t be melted entirely due to the semisolid-liquid-­
metal powder to improve stability of that, and then uses phase sintering mechanism, which will lead to some pro-
high-energy and high-speed electron beam to selectively cess defects of parts such as high porosity, low density,
bombard metal powder to make it melt into shape. poor tensile strength, and high surface roughness. The

[Link]/Dr_Mouayyad_AlbtousH
4.2 Digital Design Terminology 55

viscosity of solid-liquid mixture is usually high in the A prosthesis can be manufactured in different
semisolid forming system of SLS, and the fluidity of techniques; metal 3D printing technology and wax
fused materials is poor; therefore, there will be a unique molding technology are mainly used in activity
metallurgical defect of the SLS process called balling restoration:
effect. Balling effect not only will make higher surface (i) 3D printed metal
roughness but also will make it hard to spread powder SLM uses a laser to selectively melt and sinter
over the surface of sintered layer and even will hinder the metal powders layer by layer to acquire the
subsequent process. desired three-dimensional shape. The whole pro-
(e) NanoParticle Jetting (NPJ) cess includes the establishment of CAD model,
XJET (Israel) launched a metal 3D equipment of data processing and sending, powder laying,
NanoParticle Jetting (NPJ) in 2016. The technique melting and sintering, and post-processing.
mixes nanoscale metal particle into adhesive forming (ii) 3D printed wax and resin patterns (Fig. 4.8)
metallic ink. The metallic ink is sprayed out and At present, wax molding technology is mainly
printed by a special nozzle, and the adhesive is evap- divided into two types:
orated at high temperatures after molding, leaving Stereolithography appearance
the metal part for manufacturing. The printing speed Stereolithography appearance (SLA) was pat-
of NPJ is as five times as that of common laser print- ented by Charles Hull in 1984 and commer-
ing with high-dimensional accuracy and excellent cialized by 3D Systems, which is widely
surface quality, while the temperature resistance of recognized as one of the most deeply
NPJ is lower than that of other printing metals. researched and earliest 3D printing methods
(f) Inkjet 3D printing/binder jetting (3DP/BJ) in the world. This technology takes the photo-
Inkjet 3D printing/binder jetting (3DP/BJ) was sensitive resin liquid as the raw material,
proposed by MIT in 1993, which belongs to Indirect which is solidified and superimposed one by
Metal 3D printing. 3DP/BJ ejects the adhesive
according to the CAD design and bonds the metal
powder layer by layer. Next, the adhesive volatilizes
under the high-­temperature irradiation, and the parts
are manufactured by sintering after printing. This
technology is a variant of material spraying technol-
ogy, generally using a water-based adhesive. 3DP/BJ
technology can form in different materials without
adding support and has simple back disposal, so it
makes it possible to print complex parts. Some equip-
ment can realize large format forming without large-
scale distortion, but having lower precision than
SLM.
(g) Atomic diffusion additive manufacturing (ADAM)
A metal 3D printer Metal X adopting ADAM
technology was introduced by Markforged in
September 2017, which belongs to indirect addi-
tive manufacturing. This technology mix metal
powder and resin adhesive to form silk material.
The machine prints out the “green mold” after
enlarging CAD file and then sinters it after resin
removal to make the final parts consistent with
CAD file. The metals that can be used in Adam
technology include Ti6Al4V, copper-base alloy,
316L stainless steel, etc. The density of parts
reaches 95~99%. The mass production of parts can
be realized by using Adam technology but spend
long preparation time. Fig. 4.8 3D printed wax patterns

[Link]/Dr_Mouayyad_AlbtousH
56 4 Digitalization in RPD

one thin layer by the ultraviolet laser beam of design (e.g., illustrate parts that can’t be displayed on
controlled by the computer to generate the the work authorization due to dimensional restriction,
three-dimensional solid model. Its advantages especially the direction of roach clasp and minor connec-
lie in high precision as well as accurate and tors); materials, which should be strong enough to guar-
smooth surface. The representative company antee the strength of structures such as split major
is 3D Systems. connector of stress breaker design and short retainer arm
Light curing molding technology based on of esthetic clasp and which should be replaced with other
digital light processing metal materials or nonmetallic materials such as PEEK
Digital light processing (DLP) and inkjet and PEKK when patients are allergic to metal; and other
printing, based on DLP, have developed rap- ­auxiliary structures (e.g., number and location of reten-
idly and attracted wide attention due to its tion pin).
high precision and low price. However, it is 2. Digital forecast
difficult to complete large format printing Collect patient’s digital photographs of different
work. The representative company is BEGO. angles or 3D face scan data preoperatively, forecast the
There are always defects and pinholes in result through DLD, and show patients 2D and 3D prosth-
traditional process such as investment and odontic plan to obtain the consent.
casting. Digital 3D printing technology can 3. Acquisition of digital model
effectively avoid the bubbles, cracks, and Kennedy class III arches of patients can be scanned
shrinkage deformation, switching to auto- through the intraoral scanner, such as TRIOS. However,
mated production mode to simplify produc- the final impressions should be made in rubber base
tion process, with high precision, less waste materials for Kennedy class I, II, and IV arches and then
of materials, improved quality of restorations, either scanned directly or poured into stone master casts
etc. The framework of RPD requires materials that are subsequently scanned using an extraoral scanner,
with high strength, good ductility, and good such as 3Shape D800 or E3, to acquire the digital model.
processability to ensure enough retention Kennedy class III arches are usually restored by tooth-­
force and no deformation, preventing plates supported RPD without special consideration of the tis-
from crack and reducing the volume of pros- sue situation of edentulous areas, and intraoral scan data
theses. Cobalt-chromium alloy (Co-Cr alloy) can meet the need. Nonetheless, functional impressions
is now commonly used to print the frame- should always be made for Kennedy I, II, and IV class
works of RPD, due to its good mechanical arches, which can’t be acquired through the intraoral
properties and corrosion resistance. scanner. In addition, application of the intraoral scanner
will be subjected to restrictions when the range of open-
ing is small and the vestibular groove is shallow.
4.2.6 Post-processing 4. Computer-Aided Design (CAD)
The Digital Workflow of RPD Through 3Shape Dental
The printed metal prostheses need to be retrieved and sub- System
jected to post-processing following manufacturer instruc- (a) Determine the insertion path, and block out undesir-
tions to eliminate the thermal stress generated in SLM able undercuts virtually (Fig. 4.9).
process, to prevent the generation of adverse deformation, (b) Trim the wax pattern to reserve space for retentive
and to ensure the quality of the prostheses. They are then arms of clasps (Fig. 4.10).
separated from the supporting base and finished and polished (c) Build the virtual meshwork in the edentulous areas
in several steps. according to the design drawn on the model, and
adjust the distance between the crest of the cast and
the bottom of the meshwork if necessary (Figs. 4.11,
4.3 Digital Design Principles 4.12, 4.13, and 4.14).
(d) Build the virtual major connector, and adjust the
4.3.1 Digital Process of RPD position and shape of the edge (Fig. 4.15).
(e) Draw the virtual clasp, occlusal rest, and minor con-
1. Prosthodontic plan nectors three-dimensionally, and adjust technical
Clinicians make the individual prosthodontic plan parameters such as width and thickness (Fig. 4.16).
according to the intraoral situation of patients and draw (f) Build virtual retention pins and other auxiliary struc-
the framework components on the work authorization, tures, and simulate the shape of rugae in the maxil-
indicating the insertion path of the framework, key points lary RAD if necessary (Figs. 4.17 and 4.18).

[Link]/Dr_Mouayyad_AlbtousH
4.3 Digital Design Principles 57

Fig. 4.9 Determine the path of insertion and block out the undercuts virtually

Fig. 4.10 Reserve the space for clasp retentive tips

[Link]/Dr_Mouayyad_AlbtousH
58 4 Digitalization in RPD

Fig. 4.11 Plan drawn on the cast

Fig. 4.13 Adjust technical parameters of the meshwork

(k) Design the one-piece RPD.

Combine all components through the Boolean
operation function of the software after the comple-
tion of the framework, artificial teeth, and base to
design one-­piece RPD (Fig. 4.26).
5. Arrangement of the RPD
Appropriate supports of adequate strength should be
added to the polishing surface of RPD (Fig. 4.27), not the
tissue surface, to avoid damaging the shape and affecting
the adaptability of the framework during manual
grinding.
6. Computer-Aided Manufacturing (CAM)
(a) Obtain metal or PEEK frameworks by CNC milling
system.
Fig. 4.12 Build the virtual meshwork pattern
(b) Obtain metal frameworks (Fig. 4.28) or resin or wax
patterns by 3D printing (Fig. 4.29).
(g) Build tissue stops, and draw finish lines using the 7. Post-processing and Subsequent Steps
curve tool which utilizes default and customized pro- In the case of 3D printing, metal frameworks are heat-
files (Fig. 4.19). treated following manufacturer instructions to release the
(h) Add supports and finish the design (Figs. 4.20 and stress (Fig. 4.30) and then are separated from the support-
4.21). ing base (Fig. 4.31), finished and polished in several steps
(i) Design customized artificial teeth. (Fig. 4.32), delivered to the clinic after being cleaned,
Set up and align artificial teeth selected from the disinfected, and sterilized. RPD framework is checked for
tooth library, and adjust them if necessary, especially fit and occlusion intraorally and adjusted as necessary;
when designing a one-piece removable partial den- subsequent steps including the selection and alignment of
ture (Figs. 4.22, 4.23, and 4.24). artificial teeth, final wax-up and polymerization of the
(j) Design digital dental base. base, finishing, and polishing are in similar manners used
Adjust the shape of the customized base when for traditional RPD. However, there’s no need to be sub-
designing a digital complete denture or one-piece jected to post-processing for milled metal and PEEK
removable partial denture (Fig. 4.25). frameworks.

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4.3 Digital Design Principles 59

Fig. 4.14 Different shape and size of the meshwork

Fig. 4.15 Build the virtual major connector

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60 4 Digitalization in RPD

Fig. 4.16 Draw the clasp, rest, and minor connector three-dimensionally

Fig. 4.18 Adjust technical parameters of the wax

frameworks. For example, errors occurring in duplicating

the cast will result in the misfit of the pattern; incorrect
Fig. 4.17 Set up the retentive pin
ratio of powder to liquid will decrease the strength of the
investment, and then it will be prone to cracks during
The 3D printed wax (Fig. 4.33) or resin pattern is then casting or generate the wear debris and contaminate the
cast conventionally using lost-wax technique (Fig. 4.34), alloy; the mismatch between the expansion rate of the
and subsequent procedures are the same. It’s worth noting investment and the alloy may result in the misfit of frame-
that the wax or resin pattern should be invested and casted works; mixture of old and new alloys results in the uncer-
together with the refractory model to reduce the possibil- tain expansion rate; selection of the investment is
ity of deformation. complicated; improper setting of sprues and storage pool
Compared with 3D printed and milled metal frame- will result in incomplete casting.
works, there is a traditional workflow of spruing, invest- 8. CAD/CAM of the Custom Tray
ing, burnout, and casting from 3D printed resin or wax Based on the digital primary model, firstly determine
patterns to the final metal framework, which is complex the path of insertion, block out undesirable undercuts,
and has many human errors decreasing the quality of and lay thin layers of virtual wax on relief areas

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4.3 Digital Design Principles 61

Fig. 4.19 Draw the outer finish line

Fig. 4.20 Add appropriate supports to structures

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62 4 Digitalization in RPD

Fig. 4.21 Finish the design

Fig. 4.22 Select and align the artificial teeth from tooth library

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4.3 Digital Design Principles 63

Fig. 4.23 Adjust the shape of the artificial teeth as needed

Fig. 4.24 Occlusal adjustment

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64 4 Digitalization in RPD

Fig. 4.25 Design the base of RPD

Fig. 4.26 One-piece RPD

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4.3 Digital Design Principles 65

Fig. 4.27 Add supports to structures

Fig. 4.29 3D printed wax pattern

Fig. 4.28 3D printed Co-Cr framework

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66 4 Digitalization in RPD

Fig. 4.30 Post-processing for

stress release

Fig. 4.31 Manual removal of supports added to 3D printed wax Fig. 4.32 Polish the 3D printed framework
patterns

Fig. 4.33 3D printed wax pattern of the framework

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4.3 Digital Design Principles 67

(Fig. 4.35); then determine the extension range (Fig. 4.36) 4.3.2 Comparison of Digital and Traditional
and the thickness to generate a tray with preliminary Frameworks
shape; finally design the handle (Fig. 4.37), and perforate
the tray virtually according to the actual needs. Export the The conventional workflow, including making primary and
data after completion (Fig. 4.38), and print the tray using final impression, making and trimming primary and final
the resin printer. casts, waxing, investing, casting, finishing, and polishing of

Fig. 4.34 Cast metal framework by lost-wax technique

Fig. 4.35 Primary model with relief and blockout of undercuts

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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

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4.3 Digital Design Principles 69

Fig. 4.38 Finish the design

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

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70 4 Digitalization in RPD

Fig. 4.39 Traditional design and fabrication procedures of cast frameworks

Fig. 4.40 Adjust the path of insertion

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

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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

[Link]/Dr_Mouayyad_AlbtousH
72 4 Digitalization in RPD

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(%) Clasp Minor connector Major connector
Ti 5076 89 (1.75%) 49 (55%) 16 (18%) 24 (27%)
Co-Cr alloy 25542 146 (0.57%) 88 (60%) 20 (14%) 38 (26%)

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

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4.3 Digital Design Principles 73

Table 4.3 The number and prevalence of casting defects on cast frameworks
No. and status of specimens
No. of castings No castings One casting Two castings Three castings More than three castings Generalized castings
studied defect defect defect defect defect defect
90 12 26 26 18 8 16

(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 digi-
tal production and make it more widely used.
Digitalization in RPD refers to a series of digital
(d) Process integration: Facilitating the integration of process, done through the computer, including the
each link and avoiding errors in the information evaluation of the patient’s anatomy physiology, the
transmission. design of the prosthesis, the impression of arches,
(e) Efficiency improvement: Streamlining operations and the precise production of the prosthesis, making
(f) Environmentally friendly Computer-aided design and the prosthesis a perfect work of art. With the continu-
computer-aided manufacturing (CAD/CAM) replac- ous development of new materials and technologies,
ing the traditional process of waxing up, investing, the aim is to optimize the digital operation and to
and casting, greatly improving the working environ- reduce the cost, developing from powder spray to no
ment of technicians. powder spray, from rough to precise, from complex
However, there are still problems to be solved in to intelligent, from slow to fast, from manual to auto-
digital RPD at present. matic, from big to small, and from more to less.

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74 4 Digitalization in RPD

Milling

Impression

Data
CAD Workstation
Model 3D scanner transmission Selective laser melting

Intraoral scan

3D printing

Fig. 4.44 Digital workflow of the framework

Fig. 4.45 Process Workflow of cast frameworks Digital workflow of esthetic frameworks
comparison of cast and digital
esthetic frameworks Kennedy class I , II and IV cases Kennedy class III cases

Take impressions Take impressions

Make stone casts Make stone casts Intraoral scan

Esthetic analysis
Dentition analysis

Design clasps Design frameworks

digitally

form the wax pattern of 3D printed wax or resin

SLM
frameworks patterns and cast

Cast frameworks Digital esthetic frameworks

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4.3 Digital Design Principles 75

Print the Invest & Finish &

Design
0.76h
wax pattern cast polish Semi-digital worflow: 4.12h
1.29h 1.33h 0.74h

Finish &
Design Print the metal Heat treatment
polish Digital workflow: 20.85h
0.76h 7.10h 12.00h
0.99h

Waxing Finish &

Process the model Invest & cast Traditional workflow: 10.56h
Up polish
4.16h 5.00h
0.66h 0.74h

Fig. 4.46 Average production time of cast frameworks and digitalized frameworks

Fig. 4.47 Cost of a Cost of a framework (yuan)

framework fabricated by three 100
different techniques

95. 05
75

50
54. 95
45. 05

25

0
Semi-digital framework Digital framework Cast framework

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76 4 Digitalization in RPD

4.4 Application of RD Designer Software RD designer applies the CBR-RBR hybrid model to the
in RPD design of RPD. Steps are as follows:

4.4.1 RD Designer 1. Obtaining the data of medical cases, carrying out prepro-
cessing, and extracting the characteristics.
RD designer is a clinical decision support system software 2. Performing CBR case retrieval on the test data.
for removable partial dentures in prosthetic dentistry. It can 3. For test cases with a high degree of similarity, it is
be applied in clinical practice to assist doctors to complete considered that the most similar medical records in the
the design of frameworks of RPD according to the basic oral case database are the same as the diagnosis results, so
conditions of patients and to provide a standard and feasible the case can be directly output for the doctor’s diag-
delivery path of the plan. It is a supplement to the digital nosis, and the reasoning results can also be output.
process of RPDs. In addition, it can also be applied to the For the test cases with low similarity, the most similar
analysis and design of virtual cases in teaching to enhance cases cannot be found, so the RBR module is used for
the combination between teaching and clinical practices. rule inference.
4. Recording the diagnostic effect of reasoning results, add-
ing the valid results to the case database as new cases, and
4.4.2 Working Principles of RD Designer updating the decision tree rules of RBR module.

Case-based reasoning (CBR) is an important reasoning

method in the field of artificial intelligence. It gives the 4.4.3 Digital Workflow of RD Designer
solving process and result of the new problem through the
retrieval and match of previous cases. Rule-based reason- 1. Create a case. Select missing teeth according to the eden-
ing (RBR) system, also known as a production system, tulous areas of the patient (Fig. 4.48).
connects rules in series through logical relations and draws 2. Preliminary judgment. The software will judge the alter-
the required conclusions through logical derivation. native plans preliminarily based on the situation of eden-
Combination of RBR and CBR, playing their respective tulous areas, for example, elastic dentures will be
advantages, uses rules to guide case retrieval and to achieve suggested firstly when a few anterior teeth are lost.
the goal that the cases should be as few as possible and as 3. Preliminary scheme. The software will recommend the
relevant, similar or matching as possible to the target optimal plan and the alternatives according to the rules
cases. (Fig. 4.49).

Fig. 4.48 Software interface of creating a case

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4.4 Application of RD Designer Software in RPD 77

Fig. 4.49 Software interface of preliminary scheme

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

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78 4 Digitalization in RPD

Fig. 4.50 Software interface of secondary scheme

Fig. 4.51 Software interface of customized adjustment

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4.4 Application of RD Designer Software in RPD 79

Fig. 4.52 Software interface of guidance of tooth preparation

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[Link]/Dr_Mouayyad_AlbtousH
 DLD (Digital Line Design): Esthetic
Analysis and Design 5

they can choose comprehensive restoration, such as movable

The digital frameworks of RPDs are divided into ordi-
fixed combined restoration (e-clasp ceramic type or all-­
nary digital frameworks of RPDs and high esthetic
ceramic type). This high esthetic digital frameworks of
digital frameworks of RPDs. For ordinary digital
RPDs, like fixed esthetic restoration, can be predicted by
frameworks of RPDs, esthetic analysis and esthetic
DLD esthetics [2].
design are needed, and for high esthetic digital frame-
DLD esthetic prediction’s four characteristics:
works of RPDs, DLD esthetic prediction section is
added. As a feature of the design of digital frameworks
1. Effective doctor-patient communication
of RPDs with high esthetics, the esthetic prediction
2. Design of noninvasive prostheses
section is the necessary step for the comprehensive
3. Making wax-up appearance
restoration of clinical cases. E-clasp (esthetic clasp) is
4. Intuitive scheme determination
our original concept, and clasp design, which inte-
grates the esthetic analysis and design (DLD) concept
The following is a case of digital RPD’s DLD esthetic
into RPD design, is an innovation of it that makes
prediction process:
metal invisible. It is realized in a digital way, and the
production is completed by many kinds of CAD/CAM
methods, such as in-mouth, model scanning, digital
design, 3D printing, and so on.
5.1 Esthetic Analysis

First, use an intraoral scanner to obtain patients’ informa-

tion, Peng’s upper and lower dental arch information
(Figs. 5.1 and 5.2).
The intraoral scanner can be used to scan Kennedy class
III of dentition defect patients with anterior and posterior
teeth. However, if the missing teeth are excessive or it is a
Kennedy class I or II dentition defect, the effect of intraoral
collection is not ideal because of the mobility of soft tissue,
so it is not recommended to use intraoral scanners. You can
first take a plaster model and scan it with a model scanner.
The esthetic clasp can achieve the effect of invisibility After collecting the facial photos of the patients, the
through ingenious design, bringing the patient a smile with- esthetic analysis (Fig. 5.3) was carried out. The patient
out metal exposure. However, RPD generally uses finished belongs to the middle and high smile line, the exposure of
artificial teeth to arrange teeth, and most of the finished arti- the anterior teeth is relatively large when smiling (Fig. 5.4),
ficial teeth lack personalized features, and it is difficult to and the second premolars can be seen in both upper and
match the color of natural teeth, let alone simulate the fine lower jaws.
structure of the surface of natural teeth [1]. If patients have Determine the tooth position of the esthetic area as fol-
high esthetic requirements and choose RPD for restoration, lows: A5–B5 or C5–D5.

© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House Co. Ltd. 2023 81
H. Yu, Digital Removable Partial Denture Technology, [Link]

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82 5 DLD (Digital Line Design): Esthetic Analysis and Design

Fig. 5.1 Intraoral scanning of the maxillary model

Fig. 5.3 Facial analysis

Fig. 5.2 Intraoral scanning of the occlusal model

Fig. 5.4 Smile analysis

Through dentition analysis, the situation of missing teeth

was defined: A1–3, B1–2, C1–2, or D1–2.
Preliminary determination of esthetic abutment teeth: A5,
A7, and B6 (Fig. 5.5).

Fig. 5.5 Dentition analysis

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5.2 Preliminary Design of the Digital Frameworks of RPD 83

5.2 Preliminary Design of the Digital on A5 and the gap clasp on B4 and B5. Put a three-arm clasp
Frameworks of RPD on A7.
The esthetic design (Fig. 5.8) is to place the C clasp with
DLD esthetic prediction’s four processes (Fig. 5.6): a short cheek retainer on A5 and the traditional clasp on B6.
Due to the tight bite, the B6 is not designed to support it. The
1. E-clasp digital design
inclination of B6 to the buccal side is more obvious, so the
2. DLD facial fitting design
clasp position will be higher [3].
3. Personalized tooth shape and color design
The scaffolds of the two designs are completed in the
4. Making wax-up appearance
design software.
Now, we can see the buccal view of the two designs
5.2.1 E-Clasp Digital Design (Figs. 5.9 and 5.10). The common design is that the abutment
is placed in the front, and the clasp length is long, which is
In order to compare the effect, we made two designs. The easy to expose the metal.
common design (Fig. 5.7) is to put the normal length C clasp

Fig. 5.6 The digital Model observation

frameworks of RPD design
process 1 Determine the path
of insertion 1 Prepare guiding plane

2 Determine the location

and number of rests 2 Prepare rest seat

Choose abutment teeth 3 Choose clasp 3 Trimming abutment teeth

Aesthetic
Aesthetic design Accurate tooth preparation
analysis

Fig. 5.7 Common design (occlusal view) Fig. 5.8 Esthetic design (occlusal view)

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84 5 DLD (Digital Line Design): Esthetic Analysis and Design

Fig. 5.9 Common design (buccal view)

Fig. 5.11 Fitting with intraoral photo

communicating with the patient, the patient chooses to use

the second esthetic design (Fig. 5.13).

5.2.3 Personalized Tooth Shape and Color

Design

Fig. 5.10 Esthetic design (buccal view) The facial fitting photo and the digital frameworks of RPD
are used to operate, and the tooth shape prediction is realized
by using the Beauty Tooth Assistant software (Fig. 5.14).
5.2.2 DLD Facial Fitting

The fitting of the intraoral photo and the designed digital 5.2.4 Making Wax-Up Appearance
frameworks (Fig. 5.11) can be implemented in the PS
software. The results of the common design we look after According to the esthetic design of the tooth shape that the
fitting. The clasps in areas A and B are at risk of patients were satisfied with, we made the esthetic wax-up,
exposure. which needed to replicate the parameters of the original
If we take a look at the results of facial photo fitting, we design and tried it on in the patients. After the trial, it could
can see that the clasps on B4 and B5 have been exposed and be modified according to the actual situation (Fig. 5.15).
the esthetic effect is not good (Fig. 5.12). Finally, the wax-up was used to guide the final restoration
This is the effect picture of the esthetic design of facial production (Fig. 5.16).
fitting. You can see that in contrast, there is no clasp exposure After the oral trial, the patient was satisfied with its shape,
in the range of A5–B5, while the normal corner shadow and the esthetic forecast was completed. The e-clasp frame-
should cover the clasp part of B6 exposed. Compared with work design was determined, and the esthetic wax shape was
the two schemes, the esthetic design has a better effect. After completed, which can guide the final restoration (Fig. 5.17).

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5.2 Preliminary Design of the Digital Frameworks of RPD 85

Fig. 5.12 Facial fitting according to common design

Fig. 5.13 Esthetic design and facial photo fitting

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86 5 DLD (Digital Line Design): Esthetic Analysis and Design

Fig. 5.15 Tooth shape prediction

Fig. 5.14 Interface of Beauty Tooth Assistant

Fig. 5.16 Wax-up

appearance

Fig. 5.17 Trying on the wax appearance

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5.3 Accurate Tooth Preparation 87

5.3 Accurate Tooth Preparation in a total of two sides of the missing tooth space
(Fig. 5.20).
Apart from the conventional tooth preparations discussed in 3. Design the starting point and terminus of the bur.
Chap. 3, such as the rest seat and wrought wire clasp groove, Construct the digital HX-04 bur in SolidWorks soft-
tooth preparations such as guide plane and insertion path ware according to its actual size.
adjustment are often required in complex RPD cases. In the Align the starting point and the terminus of the bur
past, these more complex tooth preparations have always according to the cutting plane in Geomagic Wrap soft-
been highly dependent on visual experience and have poor ware (Fig. 5.21).
accuracy, which not only affects the efficiency of clinical
work but also affects the final restoration effect of
RPD. Therefore, complex tooth preparation of RPD urgently
needs better and more accurate solutions to improve the
quality of treatment.
With the development of digital technologies, a novel
guide plane adjustment scheme under the guidance of a digi-
tal template will be introduced as followed, mainly using the
HX-04 bur independently developed by the author’s team
based on TRS theory (Fig. 5.18):

1. Determine the insertion path.

In EXOCAD, determine a proper insertion path. Then,
place a cutting plane (20 × 20 × 0.2 mm) in the insertion
path to determine the proximal surface to be removed
(Fig. 5.19).
2. Design the major structure of the template.
The thickness of the template is designed to be 2.5 mm,
and the extensions are designed to more than three teeth Fig. 5.19 Determining the insertion path

Fig. 5.18 HX-04. The

geometric dimensions of
HX-04 bur

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88 5 DLD (Digital Line Design): Esthetic Analysis and Design

Fig. 5.21 Designing the starting point and the terminus of the bur

Fig. 5.20 Design of the major structure of the template

Fig. 5.22 Constructing the sleeve

4. Construct the sleeve. 5. Simulate the preparation track of the bur.

Construct a zirconia sleeve encircling the bur. According to the starting point and the terminus of the
Figure 5.22 shows the dimensions of the sleeve. bur, construct the preparation track of the bur by cutting
the template (Figs. 5.23 and 5.24).

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5.3 Accurate Tooth Preparation 89

Fig. 5.23 The preparation track of the bur (starting point)

Fig. 5.25 The retainer of the sleeve

Fig. 5.24 The preparation track of the bur (terminus)

6. Design the retainer of the sleeve.

Add the retainer of the zirconia sleeve to complete the
design of the template (Fig. 5.25).
7. Prepare the guide plane under the guidance of the
template. Fig. 5.26 Preparing the guide plane under the guidance of the
Place the template on the dentition, and check whether template
it is in place through the window opening on the template.
Place the bur into the sleeve from the occlusal side, and
place the sleeve with the bur into the track of the template
laterally. Then the guide plane is prepared along the prep-
aration track. Keep the handpiece in close contact with
the template during the overall process (Fig. 5.26).

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90 5 DLD (Digital Line Design): Esthetic Analysis and Design

5.4 The Digital Frameworks of RPD

Design and Production

The digital frameworks of RPD design use CAD software to

realize the virtual restoration step, which is very different
from the manual framework wax made in the past. It omits
the steps of filling the concave, copying the fire-resistant
model, and making the bracket wax and saves the working
procedure and manpower.
In the digital mode, using CAD software for computer
operation, which not only does not have the dirty and messy
environment of the mobile stent in the past but also reduces
the human error in the production process, the stent design is
more accurate, and the design process and design results can
be easily used as medical-technical communication materi-
als, which can effectively avoid the rework phenomenon
caused by poor communication.
The digital framework of RPD’s production process is
detailed in Chap. 4 (Figs. 5.27, 5.28, 5.29, and 5.30).

Fig. 5.28 Fabrication of the digital framework of RPD

Fig. 5.27 The digital framework of RPD design

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5.5 Personalized Porcelain Teeth and Simulation Denture Base Production 91

Fig. 5.29 Try-in of the

framework

5.5 Personalized Porcelain Teeth

and Simulation Denture Base
Production

1. Opaque coating:
On the framework of the bonded porcelain teeth, the
contact surface between metal and resin is treated, and
the opaque porcelain is coated.
Fig. 5.30 Bonding porcelain teeth
The first layer, thin coating, plays a bonding role, and
the second layer covers the metal color (Fig. 5.31).
In order to achieve good simulation results, personal-
ized gingival colorimetry is very important.
You can use the existing gingival shade, or you can
match the color on the spot. The gum resin is placed on
the gingiva to compare the color on the spot, which shows

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92 5 DLD (Digital Line Design): Esthetic Analysis and Design

that the color is a little light. Add an appropriate amount

of dye to the resin, then compare the color (this time the
color is close to the gingival color of the patient), and
determine the color matching scheme (Fig. 5.32).
2. Coat the bonding layer on the opaque porcelain
(Fig. 5.33).
3. In order to simulate the color of gingival blood vessels,
deeper underlying stains such as crimson and blue are
used at the membranous-gingival junction (Fig. 5.34).
4. Layered stacking of gingival resin:
Different colors of gingival resin are used in different
positions of the gums to achieve a vivid simulation effect.
Fig. 5.31 Opaque coating The following is a brief introduction to the process of
layering (Figs. 5.35, 5.36, 5.37, 5.38, and 5.39):

Fig. 5.32 Color matching for

internal colorimetry

Fig. 5.33 Coating the

bonding layer

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5.5 Personalized Porcelain Teeth and Simulation Denture Base Production 93

Fig. 5.34 The bottom

staining

Fig. 5.36 Treatment of junctions

Fig. 5.35 Gingival resin

Fig. 5.38 Gingival stippling

Fig. 5.37 Making gingival stippling stippling

Fig. 5.39 Polish smooth surface

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94 5 DLD (Digital Line Design): Esthetic Analysis and Design

(a) The treatment of the connection between the frame-

work and the neck of porcelain teeth can make the
gingiva slightly cover the neck of the teeth. Use a
lighter or root-colored gingival resin.
(b) Fill the main area of the gingiva with resin, using a
predetermined color scheme.
(c) Make a stippling effect with a toothbrush.
(d) The free gingiva of the neck should be transparent,
and the gingival resin with high transparency should
be selected.
(e) Smooth the surface to ensure a good color mixture
between the layers.
(f) The stacking of the simulation denture base is com-
pleted by light curing, and then polish it.
5. Finished and ready to try in the RPD (Fig. 5.40).

References
1. Beaumont AJ. An overview of esthetics with RPDs. J Quintessence
Int. 2002;33(10):747–55.
2. Aras MA, Chitre V. Direct retains: esthetics solutions in the smile
zone. J Indian Prosthod Soc. 2005;5(1):4–9.
3. Haiyang Y, Huang W. Classification design and clinical application
of beautiful clasp. West China J Stomatol. 2012;43–49(5):30.

Fig. 5.40 Trying in the RPD

[Link]/Dr_Mouayyad_AlbtousH
 Case Analysis of Esthetic Clasp
6

Following the clinical pathway of esthetic clasp in this

6.1 Case 1
book, prosthodontist can design RPD with esthetic clasp
When it comes to the restoration in esthetic area, prosth-
for patients easily. Through 32 typical cases, this chapter
odontists should take into account the chewing, pronuncia-
explains the clinical steps and skills of the esthetic clasp.
tion, and other functions when designing. In RPD design,
These real cases are certainly not the art performances,
how to use adjacent surface to retain is often ignored. In the
but real records of the current clinical situation in China.
following case, we are going to introduce a proximal-­
In our daily clinical work, we will encounter various
retentive e-clasp that we designed for anterior tooth:
problems. For example, the periodontal conditions of
the elderly patients are generally not good, the patients’
1. Before restoration
awareness of self-health care is not strong, it is difficult
He is a 48-year-old female patient, who is Kennedy III
for patients to adhere to the correct brushing method,
for the upper jaw and Kennedy I for the lower jaw
and the basic treatment of dental pulp and periodontal is
(Figs. 6.1 and 6.2).
not satisfactory. These problems deserve our attention.
2. RPD design and manufacturing
On A2 and A3, we designed adjacent surface hidden
clasps for anterior tooth, both of which have plate-shaped
retainer (Figs. 6.3 and 6.4). The difference is the lingual
Dentists should remember that although RPD is suit- design—palate plate and lingual rest. Others are tradi-
able for almost all the dentition defects, its efficacy is tional design.
limited. According to the complaints and the actual sit-
uation of patients, the purpose is to improve the esthet-
ics of RPD as much as possible on the basis of a
reasonable design, rather than every case must pursue
the ultimate metal-free exposure. And long term, stable,
and effective are the highest clinical pursuit.

Fig. 6.1 Maxillary esthetic teeth: A1–A5, B1–B5

© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House Co. Ltd. 2023 95
H. Yu, Digital Removable Partial Denture Technology, [Link]

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96 6 Case Analysis of Esthetic Clasp

Fig. 6.2 Missing teeth:

A3–A5; B4, B6; C6–7; D5–7

Fig. 6.4 Intraoral effect of A2, B3—adjacent surface hidden clasp for
anterior tooth

Fig. 6.3 A2, B3—adjacent surface hidden clasp for anterior tooth

For the lower jaw, the patient’s smile line is low, so

there is minimal tooth exposure. Thus, we placed low T
clasps with mesial rest on D4 and C5 (Fig. 6.5). We also
designed sublingual bar for major connector.
3. After restoration
The final result is shown in Figs. 6.6 and 6.7.

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6.2 Case 2 97

Fig. 6.7 Final effect

6.2 Case 2

1. Before restoration
Mrs. Zhou, 66 years old. Both her maxillary and man-
dibular teeth are Kennedy I type—bilateral free-end
edentia. The esthetic area teeth of this patient are A4–B4
and C3–D3, and C4 was I°loose. The point of this case is
the esthetic design of clasp put on the A4 and B4.
Conditions are shown in Figs. 6.8, 6.9, and 6.10.
2. RPD design and manufacturing
On maxillary, A area and B area lost the same teeth. To
improve retention, we let first premolar to be an abutment
Fig. 6.5 C5, D4-T clasp besides the second premolar near the gap. We put a dou-
ble T clasp on the two adjacent teeth (Figs. 6.11, 6.12,
and 6.13).
C4 and C5 could have been designed according to the
maxillary, but considering that C4 was I°loose, we just
put a T clasp on C5 (Fig. 6.14). On the opposite side, the
buccal space of the mesial abutment D6 was not enough
to put a T clasp, so we designed a traditional three-arm
clasp (Fig. 6.15).
3. After restoration
The final effect with denture is shown in Figs. 6.16,
6.17, and 6.18. The patient was very satisfied.

Fig. 6.6 Intraoral effect

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98 6 Case Analysis of Esthetic Clasp

Fig. 6.8 Free-end loss of

posterior teeth

Fig. 6.9 Dentition defect:

A6, A7, B6, B7, C6, C7, D7

Fig. 6.10 Esthetic teeth:

A4–B4, C3–D3

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6.2 Case 2 99

Fig. 6.11 A45, B45—double

T clasp

Fig. 6.12 Lingual surface

and one side of the double T
clasp

Fig. 6.13 Free end combined

with two teeth as abutment

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100 6 Case Analysis of Esthetic Clasp

Fig. 6.14 C5, T-type clasp;

D6, three-arm clasp

Fig. 6.15 Design of

mandible framework

Fig. 6.16 Intraoral

renderings of T-type clasps

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6.3 Case 3 101

2. RPD design and manufacturing

In this case, we used the modification of T clasp. But
considering she is little old, to make it easy to take off, we
designed the clasp to be another shape (Fig. 6.19). A part
of clasp arm is extended from the mesial end of the T
clasp and then got into the undercut in the distal surface
of the mesial adjacent tooth’s buccal axial ridge. It finally
ended on the buccal axial ridge, hidden by adjacent teeth
and lips (Fig. 6.20). This flexible design is called extended
T clasp.
3. After restoration
Fig. 6.17 The intraoral renderings The final effect with denture is shown in Figs. 6.21 and
6.22.

Fig. 6.18 The final effect with denture

6.3 Case 3

1. Before restoration
Fig. 6.19 Dentition defect A67, B67
Mrs. Zhang, 76 years old. Her maxillary edentia have
lost A6, A7, B6, and B7 teeth. And similar to previous
patient, she has free-end edentia as well.

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102 6 Case Analysis of Esthetic Clasp

Fig. 6.20 Extended T-type

clasp on A45 and B45

6.4 Case 4

1. Before restoration
A woman, 65 years old. In this case, we used buccal
short-arm clasp combined with T-type clasp to repair
bilateral free-end dentition defect.
Smile analysis: Median smile line, deep overbite, and
all the remaining teeth can be seen when smiling, while
mandibular anterior teeth are exposed only 1/3 of the
neck (Fig. 6.23). Esthetic area teeth are A3–B3 and C5–
D4 (Fig. 6.24). Abutment teeth are in good health and
have proper undercuts (Fig. 6.25).
Fig. 6.21 The intraoral rendering 2. RPD design and manufacturing
Maxillary framework design: Because the abutment
teeth on both sides of the gap are in good health, there is
a suitable undercut. Buccal short-arm clasps were
designed for both maxillary canine teeth (Fig. 6.26).
Mandible framework design: The mandible teeth are
not exposed too much, so we used the original undercut
of the teeth and designed the T clasps on C5 and D4
(Fig. 6.27).
3. After restoration
The final effect with denture is shown in Figs. 6.28
and 6.29.
In previous cases, we have presented patients with
Kennedy I single-ended free-end edentia and Kennedy II
double-ended free-end edentia. So in this case, we will
present Kennedy III non-free-end edentia. If only patients
keep their oral condition well, the retention and stability
of tooth-­borne type RPD will be satisfying. The choice of
Fig. 6.22 The final effect with denture esthetic clasps is wise.

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6.4 Case 4 103

Fig. 6.23 Patient’s facial

analysis. (a) Full-face photo a b
(b) Front photo of the lower
third of the face (c) Left side
photo of the lower third of the
face. (d) Right side photo of
the lower third of the face

c d

Fig. 6.24 Smile analysis: tooth position in esthetic area—A3–B3,

C5–D4

Fig. 6.25 Dentition analysis: design esthetic clasps on A3, B3, C5, and D4

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104 6 Case Analysis of Esthetic Clasp

Fig. 6.26 Maxillary

framework design: buccal
short-arm clasps were
designed for both maxillary
canine teeth

Fig. 6.27 Mandible

framework design: T clasps
were designed for C5 and D4

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6.5 Case 5 105

6.5 Case 5

1. Before restoration
A female patient is 61 years old. She lost A6 and B6 on
maxillary (Fig. 6.30), and both ends had the second molar
left. The abutments were fine. Teeth in esthetic area are
A5–B5 and C4–D4.
2. RPD design and manufacturing
In this case, we put short buccally retained clasps on
the A5 and B5, and the clasp arms ended at buccal axial
ridge. We put traditional three-arm clasps on A7 and B7
the distal abutments of the gap. The back palate plate con-
nected two sides of the RPD, making it symmetrical,
esthetic, small, and exquisite (Fig. 6.31).
Fig. 6.28 The intraoral rendering
3. After restoration (Fig. 6.32)

Fig. 6.30 Dentition defect:A6, B6

Fig. 6.29 The final effect with denture

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106 6 Case Analysis of Esthetic Clasp

Fig. 6.31 The intraoral

renderings: A5, B5—short
buccally retained arm

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6.6 Case 6 107

6.6 Case 6

Short Buccally Retained Clasp Design for Patient with

High Smile Line
1. Before restoration
Mrs. Wang, 59 years old.
Smile analysis: The patient’s smile line is high. When
she smiles, the gum exposure is seriously large (Fig. 6.33).
B1 is a residual root, which has been finished with root
canal therapy. A2 is a residual crown and the patient
refuses to remove the tooth for repair. The overbite and
overjet of anterior teeth are deep. The esthetic teeth of the
patient is A5–B4 and C3–D3, and the overdenture is
made after grinding the B1. The remaining abutments
have suitable undercuts.
Dentition analysis: The patient has Kennedy III denti-
tion defect in the upper jaw and Kennedy II dentition
defect in the lower jaw. Missing tooth are 7 which will not
be repaired in A area; 1, 2, and 4 in B area; 5–7 in C area;
and 5–7 in D area, and there is also a gap between 1 and
2 in A area. With regard to the selection of abutments, due
to the serious caries of A2, the retention form is not good,
so the clasp is not designed on A2. We design e-clasps on
A4, B3, B5, C4, and D4 (Fig. 6.34).
2. RPD analysis design and manufacturing
With regard to the selection of abutments, due to the
serious caries of A2, the retention form is not good, so the
Fig. 6.32 Final effect with denture

Fig. 6.33 Facial analysis. (a)

Facial frontal view. (b) Lower a b
facial 1/3 frontal view. (c)
Lower facial 1/3 left lateral
view. (d) Lower facial 1/3
right lateral view

c d

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108 6 Case Analysis of Esthetic Clasp

clasp is not designed on A2. We design e-clasps on A4, tion (Fig. 6.35). Mandibular framework design: Two bar
B3, B5, C4, and D4 (Fig. 6.34). clasps are, respectively, set on C4 and D4 to utilize the
Maxillary framework design: An embrasure clasp is labial undercut for retention (Fig. 6.36).
designed on A4, and a short buccally retained clasp is 3. After restoration
designed on B3, which has good concealment effect. A The final effect with denture is shown in Figs. 6.37,
three-arm clasp is put on B5 to provide sufficient reten- 6.38, 6.39, and 6.40. The patient is satisfied.

Fig. 6.34 Dentition analysis:

the e-clasps are put on A4,
B3, B5, C4, and D4. (It can
be seen that the oral hygiene
of the patient is poor, so it is
recommended to restore after
periodontal treatment.
However, the patient refuses
periodontal treatment due to
cost problems)

Fig. 6.35 Maxillary

framework design: set an
embrasure clasp on A4, a
short buccally retained clasp
on B3, and a three-arm clasp
on B5 to provide sufficient
retention

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6.6 Case 6 109

Fig. 6.36 Mandibular

framework design: set bar
clasps on C4 and D4 to utilize
the labial undercut for
retention

Fig. 6.37 Intraoral frontal view with denture

Fig. 6.39 Lower facial 1/3 lateral view with denture

Fig. 6.38 Lower facial 1/3 frontal view with denture

Fig. 6.40 Facial frontal view with denture

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110 6 Case Analysis of Esthetic Clasp

6.7 Case 7 phy and root exposure. To protect the remaining teeth,
they are not suitable for abutments. Furthermore, the
E-Clasps Design for Patient with Tooth Defects and patient has Kennedy I unilateral free-end edentia on the
Gingival Atrophy mandible. Most of the teeth have cervical wedge-shaped
1. Before restoration defects, and the abutments are in poor condition. Missing
A man, 89 years old. He came to see the doctor because teeth are A3, B5, and B6, 1–2 and 5–7 in C area, and 1–2
his old denture was not suitable after the tooth was lost. and 6 in D area (Fig. 6.42). Besides, B7 is a residual
The patient reported that he had burning mouth syn- crown. So we design e-clasps on A4, A5, B4, C3, C4, and
drome, skewed tongue, advanced age, and low esthetic D3, D4, D5 (Fig. 6.43).
requirements. 2. RPD analysis design and manufacturing
Smile analysis: The smile line of Mr. Hu is low, and Most of the teeth have cervical wedge-shaped defects,
the lower teeth area is exposed more when talking. Most and the abutments are in poor condition. In summary, the
of lower anterior teeth is missing. The patient’s esthetic e-clasps are designed on A4, A5, B4, C3, C4, and D3, D4,
teeth are A3–B3 and C3–D3 (Fig. 6.41). D5 (Figs. 6.44 and 6.45).
Dentition analysis: The patient has Kennedy III denti- 3. After restoration
tion defect in the upper jaw. On the lingual side of A6, The final effect is shown in Figs. 6.46, 6.47, and 6.48.
A7, and B7 on the maxilla, there are much gingival atro- The patient is much satisfied.

a b

c d

Fig. 6.41 Facial analysis. (a) Facial frontal view. (b) Lower facial 1/3 frontal view. (c) Lower facial 1/3 lateral view. (d) Smile analysis: The
patient has a low smile line, and the esthetic teeth are A3–B3, C3–D3

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6.7 Case 7 111

Fig. 6.42 Missing teeth: A3,

B5, B6; 1–2, 5–7 in C area;
1–2, 6 in D area, and B7 is the
residual crown

Fig. 6.44 Framework design: a one-arm clasp is set on A4, and an

embrasure clasp is set on A5. Due to insufficient retention of the abut-
ment in C area and cervical wedge-shaped defect, we design the united
short-arm clasp and extend the clasp tip appropriately to improve the
Fig. 6.43 Dentition analysis: set e-clasps on A4, A5, B4, C3, C4, and retention and support
D3, D4, D5

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112 6 Case Analysis of Esthetic Clasp

Fig. 6.45 Framework design: one-arm clasp is placed on B4; a united

short-arm clasp is placed on D3 and D4; a I-bar is placed on D5

Fig. 6.48 Facial frontal view with denture

6.8 Case 8

E-Clasps Design for Patient with Dentition Defect in

Long-Term Unrestored Condition
1. Before restoration
A female, 67 years old. The patient reported that she
had never made dentures before and chewed only with the
first molars on the right for a long time.
Smile analysis: The patient has a middle smile line.
Fig. 6.46 Lower facial 1/3 frontal view with denture When she smiles, we can see the upper canines are
torqued and the missing teeth area on mandible is
exposed. The vertical distance of lower 1/3 face is insuf-
ficient, and there is an apparent aging face. The patient’s
esthetic teeth are A3–B3 and C3–D3 (Fig. 6.49).
Dentition analysis: There are a large number of miss-
ing teeth. The patient has Kennedy III dentition defect in
the upper jaw, and two canines have a large torsion
(Fig. 6.50) with an undercut on the mesial. There is defect
in the mesial buccal wall of 6. The maxillary alveolar
ridge is full and the roots of 8 are exposed. Missing teeth
are 1–2, 4–5, and 7 in A area and 1–2 and 4–7 in B area
(Fig. 6.51). The patient has Kennedy III dentition defect
without 8 in the lower jaw, and alveolar ridge is sharp
(Fig. 6.52). Missing teeth are 1–5 and 7 in C area and 1
and 7 in D area (Fig. 6.53). There are third molars in the
Fig. 6.47 Lower facial 1/3 lateral view with denture
upper jaw and no third molar in the lower jaw.

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6.8 Case 8 113

Fig. 6.49 Facial analysis. (a)

Facial frontal view. (b) Lower a b
Facial 1/3 frontal view. (c)
Lower Facial 1/3 left lateral
view in 45°. (d) Lower Facial
1/3 right lateral view in 45°.
(e) Smile analysis: The
patient has a middle smile
line, and the esthetic teeth are
A3–B3, C3–D3

c d

Fig. 6.50 Dentition analysis:

Kennedy III dentition defect
in the upper jaw and torqued
canines

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114 6 Case Analysis of Esthetic Clasp

It can be seen from the occlusion situation that the

anterior crossbite is very serious (Fig. 6.54). Therefore, it
is recommended to increase the occlusal height during
restoration to restore the height and occlusal relationship
of the paired jaw teeth with the self-curing resin on the
occlusal surface of 6 in A area.
2. RPD analysis design and manufacturing
Maxillary framework design: Two adjacent surface
hidden clasps are designed on A3 and B3, respectively,
and are retained by the undercut of teeth’s adjacent sur-
face. Because of the mesial defect of A6, the occlusal sur-
face of A6 is raised. and then three-arm clasps are put on
A8 and B8, respectively (Fig. 6.55).
Mandibular framework design: D7 in mandible is not
repaired, a ring clasp is placed on C6, and a united short-­
arm clasp is set on the gap between D4 and D5 (Fig. 6.56).
3. After restoration
Fig. 6.51 Missing teeth: 1–2, 4–5, 7 in A area; 1–2, 4–7 in B area
The final result is shown on Figs. 6.57 and 6.58. The
patient is contented.

Fig. 6.52 Dentition analysis: Kennedy III dentition defect in the lower
jaw and sharp alveolar ridge

Fig. 6.54 Serious anterior crossbite

Fig. 6.53 Missing teeth: 1–5, 7 in C area; 1, 7 in D area

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6.8 Case 8 115

Fig. 6.55 Maxillary

framework design: two
adjacent surface hidden clasps
are designed on A3 and B3,
respectively, and are retained
by the undercut of teeth’s
adjacent surface. Because of
the mesial defect of A6, the
occlusal surface of A6 is
raised, and then two three-arm
clasps are put on A8 and B8,
respectively

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116 6 Case Analysis of Esthetic Clasp

Fig. 6.56 Mandibular

framework design: D7 in
mandible is not repaired, a
ring clasp is placed on C6,
and a united short-arm clasp
are set on the gap between D4
and D5

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6.8 Case 8 117

b c

d e

Fig. 6.57 Comparison before and after restoration. (a) Intraoral frontal (e) Facial frontal view after restoration. (f) Before restoration. (g) After
view with denture. (b) Facial lateral view before restoration. (c) Facial restoration
frontal view before restoration. (d) Facial lateral view after restoration.

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118 6 Case Analysis of Esthetic Clasp

f 6.9 Case 9

Combined C Clasps Design for Patient with Bilateral

Maxillary Free-End Edentia
1. Before restoration
A man, 46 years old.
Smile analysis: The patient has a median smile line,
whose overbite and overjet are normal. His upper lip cov-
g ers the cervix of teeth, and the lower lip covers 1/3 of the
incision. The mandibular missing area of teeth can be
seen when smiling. The esthetic teeth are A4–B3 and C5–
D5 (Fig. 6.59). Four in the right upper jaw is I°loose. The
remaining abutments are relatively stable and have suit-
able undercuts.
Dentition analysis: The patient has Kennedy I denti-
tion defect in the upper jaw and Kennedy III dentition
Fig. 6.57 (continued) defect in the lower jaw. Missing teeth are A5–A7; B4–B7;
C1, C2, and C4; and D1 and D7. Due to the severe tor-
sion, the clasp cannot be designed on C3. On A4, B3, C6,
C7, and D6, e-clasps are designed. (Fig. 6.60).
2. RPD analysis design and manufacturing
Maxillary framework design: Two split C clasps are
designed on A4 and B3, respectively, which protects the
II°loose abutment in A area to extend the remaining time
of the abutment. Besides, the clasps enter the cervical
undercut, which is good for concealment (Fig. 6.61).
Mandibular framework design: We design combined
clasps on C6 and C7. Due to the large gap between two
abutments, we put a special food-resistant impactor to fill
in the gap and a three-arm clasp on D6 (Fig. 6.62).
3. After restoration
The final repair effect is shown in Figs. 6.63, 6.64, and
6.65 The patient was contented.

Fig. 6.58 Facial frontal view with denture

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6.9 Case 9 119

Fig. 6.59 Facial analysis. (a)

Facial frontal view. (b) Lower a b
facial 1/3 frontal view. (c)
Lower facial 1/3 left lateral
view in 45° (d) Lower facial
1/3 right lateral view in 45°.
(e) Esthetic teeth are A4–B3
and C5–D5

c d

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120 6 Case Analysis of Esthetic Clasp

Fig. 6.60 Missing teeth:

A5–A7; B4–B7; C1, C2, C4;
D1, D7. Due to the severe
torsion, clasp cannot be
designed on C3. On A4, B3,
C6, C7, and D6, e-clasps are
designed

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6.9 Case 9 121

Fig. 6.61 Maxillary a b

framework design. (a) The
clasps enter cervical undercut,
which is good for
concealment. (b) Two split C
clasps are designed on A4 and
B3, respectively. (c) Buccal
view of clasp on A4. (d)
Proximal view of clasp on A4

c d

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122 6 Case Analysis of Esthetic Clasp

Fig. 6.62 Detail view of

mandible framework: a b
combined clasp is designed
on C6 and C7. Three-arm
clasp is designed on D6. (a)
Labial view of mandibular
framework. (b) Occlusal view
of mandibular framework. (c)
Three-arm clasp. (d)
Food-resistant impactor. (e)
Combined clasp

c d e

Fig. 6.63 Intraoral view with

denture. (a) Intraoral frontal a b
view with denture. (b)
Intraoral left lateral view with
denture. (c) Intraoral right
lateral view with denture. (d)
Intraoral view of food-­
resistant impactor

c d

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6.10 Case 10 123

6.10 Case 10

C Clasps Combined with Ring Clasp Design for Patient

with Unilateral Free-End Edentia
1. Before restoration
A man, 87 years old.
Smile analysis: The patient has a low smile line with
asymmetrical face and average overbite and overjet
(Fig. 6.66). The esthetic teeth are A5–B4 and C4–D4
(Fig. 6.67). Missing teeth are maxillary dentition, C5–C6,
and D5–D7.
2. RPD analysis design and manufacturing
Maxillary design: Restoration of complete denture.
Mandibular framework design: For adequate space of
lingual side and mouth floor, we design double lingual
bar as major connector. Two C clasps are put on C4 and
D4, respectively, to protect the remaining abutment, and
the buccal side of the clasps enters the distal cervical
undercut of the abutments which is good for concealment
(Fig. 6.68). C8 has an obvious mesial incline, and a ring
clasp is designed on it (Fig. 6.69).
3. After restoration
The final effect is shown in Figs. 6.70 and 6.71. The
Fig. 6.64 Comparison before and after restoration
patient is satisfied.

Fig. 6.65 Facial frontal view with denture

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124 6 Case Analysis of Esthetic Clasp

Fig. 6.66 Facial analysis

Fig. 6.67 Esthetic teeth: A5–B4, C4–D4

Fig. 6.68 Dentition analysis: design e-clasps on C4, C8, and sD4

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6.10 Case 10 125

Fig. 6.69 Mandibular

framework design: design a b
double lingual bar, put C
clasps on C4 and D4, and put
a ring clasp on C8, which has
an obvious mesial incline. (a)
Occlusal view of mandibular
framework. (b) Double
lingual bar and clasps fit on
the model in the lingual view.
(c) Splited C clasp on D4. (d)
Occlusal view of splited C
clasp on C4. (e) Buccal view
c d e
of splited C clasp on C4

Fig. 6.70 Intraoral view with

denture. (a) Frontal view. (b)
a b
Occlusal view. (c) Double
lingual bar and clasps fit in
the lingual view. (d) Right
lateral view. (e) Left lateral
view

c d

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126 6 Case Analysis of Esthetic Clasp

6.11 Case 11

Modified Extension Clasps Design for Patient with

Unilateral Free-End Edentia on Mandibular
1. Before restoration
A man, 58 years old
Smile analysis: The patient has a middle smile line
with average overbite and overjet (Fig. 6.72). Esthetic
teeth are A4–B4 and C5–D5 (Fig. 6.73).
Dentition analysis: The patient has Kennedy II denti-
tion defect in the lower jaw. Missing teeth are 1, 2, 6, and
7 in C area; 1, 2, and 5–7 in D area; and 3 and 4 in D area.
Due to the small gap in the anterior mandible, only three
anterior teeth are restored. As a result, e-clasps are
designed on C4, C6, D3, and D4 (Fig. 6.74).
2. RPD analysis design and manufacturing
Framework design: An extension clasp is designed on
D3 and D4 to protect the abutments in D area which are
II° loose and extend the remaining time of the abutment.
A C clasp is designed on C4, and a three-arm clasp is
designed on C6. (Fig. 6.75)
3. After restoration
The final repair effect is shown in Figs. 6.76 and 6.77.
The patient is satisfied.
Fig. 6.71 Facial frontal view

Fig. 6.72 Facial analysis. (a)

Facial frontal view. (b) Lower a b
facial 1/3 frontal view. (c)
Lower facial 1/3 left lateral
view in 45°. (d) Lower facial
1/3 right lateral view in 45°

c d

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6.11 Case 11 127

Fig. 6.73 Esthetic teeth: A4–B4, C5–D5

Fig. 6.74 Dentition analysis: e-clasps are put on C4, C6, D3, and D4

Fig. 6.75 Mandibular

framework design

Through the analysis design, manufacturing, and clini- comings, take full use of their strengths, and finally obtain
cal application of the abovementioned cases, we find it the clinical effect patients satisfy with. Furthermore, there
not difficult to apply e-clasps, and the patient’s esthetic are also many secondary repair patients who replace den-
effect is also significantly improved. In clinical applica- tures are very satisfied with the esthetic clasps, which
tion, we should take attention that the oral health con- proves the importance of fine design in another way.
sciousness of patients in China is generally poor and the In the aforementioned cases, all the e-clasp frame-
necessary preparations such as scaling and pulling resid- works are manufactured with traditional casting tech-
ual roots and loose teeth before restoration are also diffi- niques. With the rapid popularization and application of
cult to achieve. Some patients first time to run prosthetics various digital technologies in dentistry, 3D printing tech-
even think it is the accepted simplest requirement that nology has become the latest technology for denture
“Can eat with prosthesis.” Moreover, they think their framework fabrication. It combines traditional prosthetic
requirement of chief complaint is very low and make lit- manufacturing technology with computer-aided design
tle of the difficulty of dental prosthetists. Therefore, and computer-aided manufacturing (CAD-CAM) tech-
around the long-term, stable, and effective goals of clini- nologies, taking incremental manufacturing as its core
cal treatment, we must strengthen the doctor-patient com- feature. So it can use 3D printing to realize the wax mold
munication, actively participate in design, and think it fabrication of denture framework, which can reduce the
over clinically. Only in this way we can know their short- labor cost and digital equipment investment of traditional

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128 6 Case Analysis of Esthetic Clasp

wax making, etc. and then use the traditional dental cast-
a
ing technology to complete the framework fabrication.
Moreover, it can also directly print metal framework by
direct selective laser melting (SLM) technology, etc.
Through framework design in the CAD software and 3D
printing, finally a high-density, highly precise, and highly
personalized prosthesis is finished.
Digital technology also can make up for insufficient
information in work authorization form on processing. As
an effective tool for information exchange, digital tech-
nology is conducive to communication among dentist,
technician, and patient, determination of the treatment
b c plan, as well as fabrication of the prosthesis.
In the following cases, we are going to complete the
design and printing processes of e-clasp frameworks with
digital technology.

6.12 Case 12
d
Plate Clasp on Isolated Abutment in Digital Framework
RPD Design for Patient with Unilateral Free-End
Edentia
1. Before restoration
A woman, 78 years old.
Smile analysis: The patient has a low smile line. When
smiling, the lower anterior teeth are exposed, and the
lower lip covers the cervix of the lower anterior teeth. At
the same time, we can see the patient has the mandibular
defection of anterior teeth and maxillary edentia. What’s
Fig. 6.76 Intraoral view with denture. (a) Frontal view of framework more, she shows collapsed upper lip, deep nasolabial
try-in. (b) C Clasp on C4. (c) Extension clasp on D3 and D4. (d) Frontal groove, as well as upward corner of the mouth in the fron-
view of denture tal view (Fig. 6.78).
Dentition analysis: The upper jaw is edentulous, while
the lower jaw has the Kennedy II dentition defect, and the
gap of missing C7 is not repaired. Missing teeth are C5,
D1–D3, and D5–D7. Besides, D4 is II°loose. So e-clasps
are designed on C4, C6, and D4. C6 inclinate mesially, in
which undercut is in the mesiolingual; the remaining
abutments have moderate undercut (Fig. 6.79).
2. RPD analysis design and manufacturing
Mandibular framework design: A C clasp is designed
on C4, and a ring clasp is designed on C6, whose tip
enters the mesiolingual undercut and then a mesio-­
occlusal rest recovers the occlusal height. A plate clasp is
put on D4 to protect II°loose abutment (Fig. 6.80).
3. After restoration
The final repair effect is shown in Figs. 6.81, 6.82, and
6.83.

Fig. 6.77 Facial frontal view with denture

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6.12 Case 12 129

a b

c d

e f

Fig. 6.78 Facial analysis. (a) Facial frontal view. (b) Lower facial 1/3 frontal view. (c) Facial frontal view when smiling. (d) Lower facial 1/3
frontal view when smiling. (e) Lower facial 1/3 left lateral view in 45°. (f) Lower facial 1/3 right lateral view in 45°

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130 6 Case Analysis of Esthetic Clasp

Fig. 6.79 Dentition analysis:

e-clasps are designed on C4,
C6, and D4

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6.12 Case 12 131

Fig. 6.80 Mandibular framework design

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132 6 Case Analysis of Esthetic Clasp

Fig. 6.80 (continued)

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6.12 Case 12 133

Fig. 6.81 Intraoral view with

denture

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134 6 Case Analysis of Esthetic Clasp

Fig. 6.82 Comparison before

and after restoration. (a) a b
Lower facial 1/3 frontal view
before restoration. (b) Lower
facial 1/3 frontal view after
restoration. (c) Lower facial
1/3 lateral view before
restoration. (d) Lower facial
1/3 lateral view after
restoration

c d

6.13 Case 13

Buccally Short-Arm Clasp Combined with C Clasp in

Digital Framework RPD Design for the Patient with
Non-free-End Deletion

1. Before restoration
A woman, 76 years old.
Face analysis: The nasolabial groove is deep and the
corner of the mouth is upward.
Smile analysis: The patient has a middle smile line as
well as deep overbite (Fig. 6.84), and the esthetic teeth
are A4–B4 (Fig. 6.85).
Dentition analysis: The cervical gingivae of the entire
mouth recede and the roots are exposed. Furthermore, the
overbite and overjet of anterior teeth are deep. C6, D6, and
D7 in the mandibular are dental implants. Missing teeth
are A4, A5, B6, and B7. Besides, A6 is I°loose, and the
remaining teeth all have appropriate undercuts (Fig. 6.86).
Fig. 6.83 Facial frontal view with denture We put e-clasps on A3, A6, B5, and B8 (Fig. 6.87).

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6.13 Case 13 135

Fig. 6.84 Facial analysis. (a)

Facial frontal view. (b) Lower a b
facial 1/3 frontal view

Fig. 6.85 Esthetic teeth are

A4–B4

Fig. 6.86 Intraoral analysis.

(a) Deep overbite and overjet a b
of anterior teeth. (b) Missing
teeth: A4, A5, B6, B7. (c) C6,
D6 and D7 in mandibular are
dental implants

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136 6 Case Analysis of Esthetic Clasp

2. RPD analysis design and manufacturing

Framework design: A short buccally retained clasp
and a lingual rest are placed on A3, three-arm clasps are
put on A6 and B8, and a C clasp is designed on B5. We
consider two designs of the major connector in the palate:
posterior palatal bar or U palate plate (Figs. 6.88 and
6.89). Combined with the patient’s oral condition and
comfort, we choose the posterior palatal bar (Fig. 6.90).
Trying in of the framework is shown in Fig. 6.91.
3. After restoration
The final restoration is shown in Figs. 6.92, 6.93, and
6.94. The patient is contented.

Fig. 6.87 Putting e-clasps on A3, A6, B5, and B8

Fig. 6.88 Design one:

posterior palatal bar

Fig. 6.89 Design two: U

palate plate

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6.13 Case 13 137

Fig. 6.90 Maxillary framework design

Fig. 6.91 Trying in of the framework

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138 6 Case Analysis of Esthetic Clasp

Fig. 6.92 Intraoral view with

denture

Fig. 6.93 Comparison before

and after restoration. (a) a b
Lower facial 1/3 frontal view
before restoration. (b) Lower
facial 1/3 frontal view after
restoration. (c) Lower facial
1/3 lateral view before
restoration. (d) Lower facial
1/3 lateral view after
restoration

c d

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6.14 Case 14 139

Fig. 6.95 Facial frontal view when smiling

Fig. 6.94 Facial frontal view with denture

6.14 Case 14

Double Lingual Bar in Digital Framework RPD Design

for Patient with Unilateral Free-End Edentia in the
Lower Jaw
1. Before restoration Fig. 6.96 Esthetic teeth: A4–B4, C3–D4
A woman, 49 years old.
Smile analysis: The patient has a middle smile line and
deep overbite (Fig. 6.95). The esthetic teeth are A4–B4 clasp is designed on D4. The double lingual bar is
and C3–D4 (Fig. 6.96). designed on the lingual side of the anterior teeth, which is
Dentition analysis: Missing teeth on maxilla are A5– conducive to the self-cleaning of the patient’s mouth
A7. Due to the tight occlusion, there is no space for repair (Fig. 6.99). Trying in of the framework is shown in
(Fig. 6.97). Missing teeth on mandible are D5–D7 in D Fig. 6.100.
area. And the anterior overbite and overjet are deep 3. After restoration
(Fig. 6.98). The patient finally chose e-clasp RPD for res- The final effect is shown in Figs. 6.101 and 6.102.
toration, and we design e-clasps on D4, C6, and C7.
2. RPD analysis design and manufacturing
Mandibular framework design: Opposite embrasure
clasps are designed on C6 and C7, respectively, and a C

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140 6 Case Analysis of Esthetic Clasp

Fig. 6.97 Missing teeth on

maxilla are A5–A7, and due
to the tight occlusion, there
was no space for repair

Fig. 6.98 Missing teeth on mandible are D5–D7. We design e-clasps

on D4, C6, and C7

Fig. 6.99 Mandibular framework design: opposite embrasure clasps

are designed on C6 and C7, respectively, and a C clasp is designed on D4

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6.14 Case 14 141

Fig. 6.100 Trying in of the framework

Fig. 6.99 (continued)

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142 6 Case Analysis of Esthetic Clasp

Fig. 6.102 Frontal view with denture

6.15 Case 15

E-Clasps in Digital Framework RPD Design Without

Tooth Preparation for Patient with Bilateral Maxillary
Free-End Edentia

1. Before restoration
A woman, 58 years old.
Smile analysis: The patient shows a short distance of
lower facial 1/3 in the frontal view (Fig. 6.103). And
according to Zhang’s smiling exposed zone before resto-
ration, she has an average smiling line. The maxillary
esthetic teeth are A5–B5 (Fig. 6.104).
Dentition analysis: The maxillary missing teeth are
A4–7 and B6–7. And there are apparent spaces among the
anterior teeth, tight occlusion of remaining teeth, severely
worn teeth, deep anterior overbite, and average anterior
overjet. Besides, the teeth are in a good, clean condition,
and the remaining teeth are not loose (Figs. 6.105 and
6.106).

Fig. 6.101 Intraoral view with denture

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6.15 Case 15 143

Fig. 6.103 Facial analysis.

Normal proportion of the
three courts and short height
of lower facial 1/3

Fig. 6.104 Smiling analysis;

the esthetic teeth are A5–B5.
Smiling exposed area has
tooth defect in A area

Fig. 6.105 Dentition

analysis

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144 6 Case Analysis of Esthetic Clasp

Fig. 6.106 Tight occlusion

in the frontal and lateral view

As a teacher, the patient has high requirements for dition. However, not much teeth can be prepared because
esthetics and pronunciation due to professional reasons, of tight occlusion, and the opposite is natural teeth. In
and she is afraid of surgical implantation schemes. She order to obtain good support and stability, we design full
hopes that the restoration scheme is simple, minimally palate plate as major connector for the upper jaw, and put
invasive, and reversible and the effect evaluation after res- short buccally retained clasps on A3 and B3. A minor
toration can achieve a more natural appearance. After connector is designed closed to the natural gap between
examination, we find that the position of the posterior B3 and B4 to reduce food impaction, and a three-arm
missing tooth on maxilla is relatively backward. So the clasp with good retention is designed on B5. Because
lips and the buccal axial ridge of the abutments could be tooth grinding is unacceptable, only one rest can be
used to hide the cervical clasp. However, grinding is unac- designed on the distal side of B5 using the existing small
ceptable for the incisors of anterior teeth, and the occlusal gap (Fig. 6.107). After the metal framework is completed
surfaces of posterior teeth are severely worn, and the teeth (Fig. 6.108), try it in the mouth (Fig. 6.109), record the
are hypersensitive. All in all, it is difficult to restore. occlusal relationship, and then try the wax pattern
The lingual surfaces of maxillary anterior teeth, inci- (Fig. 6.110).
sors of mandibular anterior teeth, and the occlusal sur- 3. After restoration
faces of posterior teeth are severely worn, and there are The final repair effect is shown in Figs. 6.111 and
apparent spaces among A3–B4. 6.112. The patient is satisfied.
2. RPD analysis and manufacturing
The maxilla is Kennedy I dentition defect. A3, B3, and
B5 are chosen as abutments, and they are all in good con-

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6.15 Case 15 145

Fig. 6.107 Bilateral free-end edentia in A

and B area; A3, B3—short buccally
retained clasps. The arm of clasp does not
cross the buccal axial rigid, and the clasp
tip is hidden in the buccal view. A minor
connector between B3 and B4 is thickened
as anti-impact device

Fig. 6.108 Laser printing

and polishing of the metal
framework

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146 6 Case Analysis of Esthetic Clasp

Fig. 6.109 Trying in of the

metal framework

Fig. 6.110 Occlusal

relationship recording and
trying in of the wax pattern

Fig. 6.111 Intraoral view

with denture

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6.16 Case 16 147

Fig. 6.112 Comparison

before and after restoration. a b
(a) Lower facial 1/3 lateral
view before restoration. (b)
Lower facial 1/3 lateral view
after restoration. (c) Lower
facial 1/3 frontal view before
restoration. (d) Lower facial
1/3 frontal view after
restoration

c d

6.16 Case 16 Due to the large number of missing teeth, the RPD are
mainly supported by the mucous membrane. Besides, the
E-Clasps in Digital Framework RPD Design for Patient area of the main bearing area in B area is limited. So the
with Bilateral Free-End Edentia on Maxilla and remaining abutments and covered area should be used to
Mandible and Rare Remaining Teeth disperse the occlusal stress as full as possible. In consid-
1. Before restoration eration of severe tooth root exposure in the upper jaw, a
Smile analysis: A woman, 70 years old. In the lower lingual self-cleaning area beneath the clasp should be
facial 1/3 frontal view, the patient shows the loss of fatti- allowed for oral cleaning.
ness, apparent nasolabial groove, and mentolabial sulcus 2. RPD analysis design and manufacturing
(Fig. 6.113). Due to the loss of the maxillary anterior For the upper jaw, we design a full palate plate, a RPT
teeth, only lower teeth can be seen when smiling clasp in A area, and a three-arm clasp on B4, leaving lin-
(Fig. 6.114). The aging face seriously affects her gual self-cleaning area for all abutments (Fig. 6.116). For
appearance. the lower jaw, we design a lingual plate, short buccally
Dentition analysis: There are only A4 and B6 left in the retained clasps on both C3 and D3, a three-arm clasp on
maxilla. And B6 is with mesial amalgam filling and defect D5, and three rests in the lower jaw to disperse stress
of distobuccal cusp and serious root exposure. However, (Fig. 6.117). After the metal framework is completed
the patient is unwilling to pull the teeth. There are only (Fig. 6.118), try it in the mouth (Fig. 6.119), then record
C3, D3, and D5 in the lower jaw, and there is no contacted the occlusal relationship, and try the wax pattern in the
teeth in the mouth. Residual roots A5, B3, and D4 have mouth (Fig. 6.120).
been treated with root canal therapy, which the patient is 3. After restoration
also unwilling to remove. There are apparent tooth extrac- The final repair effect is shown in Figs. 6.121 and
tion sockets of 4, 5, and 7 in B area, and the last tooth 6.122. The patient is satisfied.
extraction has been completed for 9 months (Fig. 6.115).

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148 6 Case Analysis of Esthetic Clasp

Fig. 6.113 Facial analysis.

Loss of fattiness in the lower
face 1/3, deep nasolabial
groove and mentolabial
sulcus. Typical aging face of
the elderly after teeth loss

Fig. 6.114 Smile analysis.

Most of the anterior teeth are
missing, and only two
remaining mandibular anterior
teeth can be seen when
smiling

Fig. 6.115 Dentition

analysis. Large number of
residual roots, large tooth
exposure, poor cleaning

Fig. 6.116 Maxillary

framework design. A4—RPT
clasp, B6—three-arm clasp,
The lingual side does not
cover gingiva, which is good
for cleaning

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6.16 Case 16 149

Fig. 6.117 Mandibular

framework design. C3,
D3—Short buccally retained
clasps, D5—three-arm clasp,
lingual Self-cleaning area

Fig. 6.118 Laser printing

and polishing of metal
framework

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150 6 Case Analysis of Esthetic Clasp

Fig. 6.119 Trying in of the

metal framework

Fig. 6.120 Recording

occlusal relationship and
trying in of the wax pattern

Fig. 6.121 Intraoral view

with denture

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6.17 Case 17 151

Fig. 6.122 Comparison

before and after restoration. a b
The face collapse has been
greatly improved. The
fattiness of the lower facial
1/3 is restored. And the metal
clasp is completely hidden.
Finally the patient shows a
younger smile. (a) Facial
lateral view before
restoration. (b) Facial lateral
view after restoration. (c)
Facial frontal view before
restoration. (d) Facial frontal
view after restoration

c d

6.17 Case 17 Dentition analysis: Most of maxillary teeth of patient

are missing. The patient is with post-core porcelain crown
E-Clasps in Digital Metal Framework RPD Design for restorations on A1 and B1, whose labial edge becomes
Patient with Unilateral Free-End Defect and Severe dark and exposed (Fig. 6.124). Besides, there are lingual
Abrasion porcelain layer wear and metal exposure. A2, B2, and B3
1. Before restoration only have thin tooth wall, A3 is a residual root, and the
A man, 85 years old. The patient with Parkinson’s dis- remaining teeth A7 are in good condition. The patient has
ease has difficulty in moving. Because the old denture Kennedy II dentition defect on mandible, severe wear of
was fractured while eating, he came to see the doctor and the lower anterior teeth, and tight occlusion (Fig. 6.125).
asked to replace it. Moreover, there is a reverse and steep Spee curve on the
Smile analysis: In the frontal view, we see the loss of right side (Fig. 6.126). At the same time, the patient’s old
lip fattiness, small exposure of the upper anterior teeth, denture is examined, and it is found that the old maxillary
large exposure of the lower anterior teeth, and apparent denture is broken along the metal finish line. Hygienic con-
wear of the lower anterior teeth (Fig. 6.123). dition in the mouth is normal and food debris is visible.

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152 6 Case Analysis of Esthetic Clasp

Fig. 6.123 Facial analysis

Fig. 6.124 Post-core

porcelain crown restorations
on A1 and B1

Fig. 6.125 Severe wear of

the maxillary anterior teeth,
lingual porcelain layer wear,
and metal exposure

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6.17 Case 17 153

Fig. 6.126 Tight occlusion,

reverse, steep Spee curve

Fig. 6.127 Occlusal

relationship recording

2. RPD analysis design and manufacturing In consideration of the patient’s old age and physical
In the face of such an excessively deep and abnormal inconvenience, the number of follow-up visits should be
occlusion, it is better to correct it. However, there is no minimized and the visit time shortened. Therefore, we
obvious symptom in the temporomandibular joint exami- decided to complete the manufacturing of denture at one
nation, and the patient consciously feels no discomfort in time after obtaining the impression and the occlusal rela-
the current occlusion; furthermore, considering the tionship under the premise of ensuring the quality.
patient’s age and physical condition, we infer that the There are few remaining teeth in the upper jaw. First,
patient’s joints are in a compensatory state. Therefore, a three-arm clasp is placed on A7. The bodies of B2 and
conservative treatment is adopted to preserve the current B3 are too thin to bear the force. The remaining body of
occlusion relationship (Figs. 6.127 and 6.128). A2 are relatively larger, so a short-arm clasp is designed
In addition, another difficulty in this case is the design to close the gap between A2 and A3. We use a lingual
of the maxillary framework. Due to the patient’s tight base plate to counteract and the residual root A3 as sup-
occlusion, many missing teeth in the upper jaw and abut- port. Occlusal surfaces of artificial teeth are made of
ments on one side; it is easy to form a long arm of force. metal, and only the buccal side is filled with glue
In order to prevent the maxillary denture from breaking (Fig. 6.129). In order to ensure the mucosal retention, the
again, we choose a design of an integrated maxillary den- palate plate is extended to 2 mm behind the palatine
ture with metal occlusal surface. However, there are fewer fovea, and the postdam area is depicted. The design of the
remaining teeth in the upper jaw, and some of them have mandibular framework is shown in Fig. 6.130, the occlu-
serious defect. How not only to ensure the retention, sup- sal design is shown in Fig. 6.131, and the final RPD is
port, and stability of the maxillary dentures under the shown in Fig. 6.132.
existing condition, but also to facilitate the removal and 3. After restoration
placement of patient with Parkinson’s disease is the chal- The final repair effect is shown in Figs. 6.133 and
lenge in this case. 6.134. The patient is satisfied.

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154 6 Case Analysis of Esthetic Clasp

Fig. 6.128 Tight occlusion

Fig. 6.129 Framework

design. (a) Maxillary
a
framework design: design a
short-arm clasp to close the
gap between A2 and A3 and a
lingual base plate to
counteract, and then use A3
residual root as support.
Occlusal surfaces of artificial
teeth are made of metal and
the buccal side is filled with
glue. (b) Maxillary
framework detail. Integrated
maxillary design, no weak
points

Fig. 6.130 Mandibular

framework design and details:
the structure is an example for
easy wearing and
self-cleaning

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6.17 Case 17 155

Fig. 6.131 Overall occlusal design

Fig. 6.132 The final denture

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156 6 Case Analysis of Esthetic Clasp

Fig. 6.133 Intraoral view with denture. Be in position after adjusting the occlusion, then instruct the patient to perform try-in and removal exer-
cises and adjust the retention force appropriately

Fig. 6.134 Facial view with denture. No metal exposure after wearing the denture. The denture with suitable occlusion, and good retention is
comfortable and easy to be removed. Finally the patient shows a satisfactory smile

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6.18 Case 18 157

6.18 Case 18 and C4 are II°loose, and the remaining teeth are I°loose.
Therefore, in the subsequent design, attention should be
Multi E-Clasp Combination in Digital Framework RPD paid to avoiding the gingiva to facilitate self-cleaning.
Design for Patient with Non-free-End Edentia on the In order to improve the pink and white esthetic effect
Maxilla and Mandible of the anterior area, we proposed a removable and fixed
1. Before restoration combined restoration scheme (Fig. 6.138). However,
A man, 45 years old. because the patient came from out of town and his time
Smile analysis: The patient shows the absence of max- was limited, the anterior teeth fixed and removable com-
illary central incisors in the frontal view (Fig. 6.135). bined program was abandoned. After we informed the
According to a small amount of gum exposure when patient about the esthetic risks through the esthetic dental
smiling, the patient has an average-high smile line, and assistant, the patient still accepted.
his smile is unnatural (Fig. 6.136). 2. RPD analysis design and manufacturing
Dentition analysis: The patient’s missing teeth are A1, The upper jaw is Kennedy class III non-free-end eden-
A4–A7, B1, B4–B7, C1–C2, C5, and D5–C7. The patient tulous. Short buccally retained clasps are placed on A4
has deep anterior overbite, normal anterior overjet and B4, and traditional three-arm clasps are placed on A8
(Fig. 6.137), as well as poor periodontal condition. C3 and B8. Anterior palatal bar with posterior palatal bar is
used as major connectors, and the gingiva should be
avoided (Fig. 6.139). Check for no metal exposure using
the esthetic dental assistant (Fig. 6.140).
There are many missing teeth in D area of the lower
jaw. A mesial rest and a T clasp are placed on C4, which
reduces the lateral force. A distal rest is placed on the
abutment C8 to prevent excessive distal sinking. Since the
undercut of C8 is concentrated on the lingual-mesial sur-
face, we designed a ring clasp to take advantage of the
undercut. In D area, a C clasp is designed on D4, and a
united short-arm clasp is placed on D7 and D8, which can
play the role of a splint. Avoid the gingiva when design-
ing the connector (Fig. 6.141). After the framework is
completed (Fig. 6.142), we arrange artificial teeth
(Fig. 6.143), and try the wax pattern on (Fig. 6.144).
3. After restoration
It can be seen that the final anterior teeth esthetic effect
is not perfect, but the patient expressed acceptance
Fig. 6.135 Three courts with normal proportions and asymmetric face (Figs. 6.145 and 6.146).

Fig. 6.136 Esthetic teeth are

A3–B3; the cervix of A3 and
B3 is covered by upper lip2

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158 6 Case Analysis of Esthetic Clasp

Fig. 6.137 Intraoral view

Fig. 6.138 Informing

patients of esthetic risks
through intraoral preview
technique

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6.18 Case 18 159

Fig. 6.139 Maxillary framework

design. (a) Labial and occlusal a
view. (b) A4-short buccally
retained clasp

Fig. 6.140 Check for no

metal exposure with the
esthetic dental assistant

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160 6 Case Analysis of Esthetic Clasp

a e

Fig. 6.141 (continued)

d b

Fig. 6.141 Mandibular framework design. (a) Buccal view. (b)

Occlusal view. (c) D7, D8-united short-arm clasp. (d) D4-C clasp. (e)
C8-ring clasp

Fig. 6.142 Grinding and polishing after the framework forming. (a)
Maxillary framework completion. (b) Mandibular framework completion

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6.18 Case 18 161

Fig. 6.143 The teeth arrangement and wax pattern

Fig. 6.144 Trying in of the

wax pattern

Fig. 6.145 Comparison

before and after restoration in
the facial frontal view

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162 6 Case Analysis of Esthetic Clasp

Fig. 6.146 Comparison

before and after restoration in
the facial lateral view

6.19 Case 19

E-Clasps Combined with Deformed Occlusal Rest in

Digital Framework RPD Design to Correct Spee Curve
1. Before repair
A woman, 60 years old. Maxillary and mandibular
dentition defects have been for more than 30 years.
Smile analysis: The patient’s face is symmetrical with
a relatively normal proportion, and the height of basifa-
cial 1/3 is acceptable (Fig. 6.147). The patient has a low
smile line, whose upper teeth cannot be exposed when
smiling. The esthetic teeth are C4–D3 with the visible
cervix of teeth (Fig. 6.148).
Dentition analysis: The patient with Kennedy III den-
tition defect in the upper and lower jaw has deep overbite
(Fig. 6.149). And there is no bounce or pain in the tem-
Fig. 6.147 Facial analysis. Normal proportion of the three courts and
poromandibular joints. Her oral hygiene is average. proper height of lower facial 1/3
2. RPD analysis design and manufacturing
We design a lingual bar as the maxillary major con- D3 to enhance friction retention. Because the crown of
nector to reduce globus sensation. Short buccally retained C7 is short, metal occlusal surface is designed on C7 to
clasp is placed on the abutments A5, B4, C4, and D2 to restore a certain occlusal curve. The major connector
reduce the clasp exposure when smiling. A combined design of the mandible framework adopts a lingual plate
clasp is placed on B6 and B7 to ensure the retention of the to ensure the stability of the framework (Fig. 6.150); try
maxillary framework. the wax pattern in the mouth after teeth arrangement
Because the remaining teeth of the lower jaw are worn, (Fig. 6.151). When the patient is satisfied, complete the
the contour of the retaining teeth is utilized for clasp restoration (Fig. 6.152).
design as full as possible. The undercut of C4 is concen- 3. After restoration
trated on the lingual surface, so a three-arm clasp with The final repair effect is shown in Fig. 6.153. The clasp
lingual retentive arm and buccal resistant arm is designed. exposure is minimal when the patient smiles. The maxil-
At the same time, taking advantage of the existing gap lary artificial teeth and denture base improve the facial pro-
between D2 and D3, a short buccally retained clasp is trusion. The patient’s face is younger than the condition
placed on D2. A distal adjacent surface plate is placed on before restoration (Fig. 6.154). She is quite contented.

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6.19 Case 19 163

Fig. 6.148 Smile analysis.

This patient is low smile line.
Esthetic teeth are C4–D3

Fig. 6.149 Intraoral view

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164 6 Case Analysis of Esthetic Clasp

Fig. 6.150 Framework

design

Fig. 6.151 Trying in after teeth arrangement

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6.19 Case 19 165

Fig. 6.152 Restoration

completion

Fig. 6.153 Intraoral view with denture

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166 6 Case Analysis of Esthetic Clasp

Fig. 6.154 Comparison

before and after restoration. a
(a) Facial frontal view. (b)
Facial lateral view

6.20 Case 20 the upper jaw is too close to the outside of paired jaw
teeth. If the occlusal function is ensured according to the
E-Clasps Combined with Metal Occlusal Surface in conventional teeth arrangement and occlusal design, the
Digital Framework RPD Design for Patient with position of the artificial teeth will be too close to the lin-
Dentition Defect and Insufficient Restoration Space gual side, which affects the esthetics. Or if we arrange
1. Before restoration teeth and improve esthetics in accordance with the con-
A male, 52 years old. Ten years ago, the patient under- tour of the upper jaw, this position will lose occlusal con-
went maxillary and mandibular prosthesis. Due to the tact, which affects function and may cause elongation of
partial fracture of the denture clasp, the denture was the paired jaw teeth. Therefore, in this case, the design of
unstable. Now, he requires restoration. dentures with both esthetics and function becomes diffi-
The patient has a scar on the left cheek, mouth-­opening cult. In addition, a large amount of soft tartar deposits can
limitation, and poor oral hygiene condition. The patient be seen in the patient’s mouth, which indicates his poor
has Kennedy III dentition defect on the maxilla and oral hygiene (Figs. 6.155 and 6.156).
Kennedy IV dentition defect on the mandible. There is a 2. RPD analysis design and manufacturing
residual root B4 and deep overbite. His occlusion is so In consideration of both esthetics and function of the
tight that the left mandibular teeth contact on the maxil- denture, we apply the design of double dentition for B4,
lary alveolar ridge. The position of the alveolar ridge in B5, and B6 in the upper jaw: the inner metal occlusal sur-

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6.20 Case 20 167

Fig. 6.155 Intraoral view

Fig. 6.156 Intraoral partial view

[Link]/Dr_Mouayyad_AlbtousH
168 6 Case Analysis of Esthetic Clasp

face to restore function and the outer plastic artificial completed (Fig. 6.158), try it in the mouth. The denture is
tooth to improve esthetics. In the anterior region, a united in good position, the clasps fit the abutment, the retention
short-arm clasp is placed on A3 and A4, and a short buc- force is moderate, and there is no movement (Fig. 6.159).
cally retained clasp is placed on B3. At the same time, a The restoration is finally completed (Fig. 6.160).
three-arm clasp is placed on B7 in the posterior region to 3. After restoration
ensure the retention of the framework. A rest is set on B7, There is little clasp exposure, and denture is retentive
and a lingual plate is used as the major connector to and stable without movement. This solution restore the
ensure the entire stability. On C4 and C5, D4, and D5 in patient’s occlusal function while taking into account the
the lower jaw, united short-arm clasps are placed to esthetics. Finally, the patient expresses satisfaction
ensure retention (Fig. 6.157). After the framework is (Fig. 6.161).

Fig. 6.157 Framework

design

Fig. 6.158 Framework

completion

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6.20 Case 20 169

Fig. 6.159 The framework

tried both on the model and in
the mouth is well positioned,
the clasps fit the abutment, the
retention force is moderate,
and it is stable without
movement

Fig. 6.160 Final restoration

completion

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170 6 Case Analysis of Esthetic Clasp

Fig. 6.161 Intraoral view with denture

6.21 Case 21 we try to place the tip of the clasp on the gingival covert
location. Because there are many missing teeth and bilat-
E-Clasps in Digital Framework RPD Design for Patient eral free-end loss, a full palate is designed as the major
with Bilateral Maxillary Free-End Edentia and High connector to disperse the force (Fig. 6.164). There is
Laugh Line bilateral free-end edentia in the lower jaw. Combined
1. Before restoration clasps are placed on C3–C4 and D3–D4. Mesial rests are
A woman, 60 years old. placed to reduce the lateral force on the abutment and
Facial analysis: The patient has a normal facial pat- protect the abutment (Fig. 6.165).
tern, symmetrical face, a normal height of the basifacial When the framework is tried in the mouth, it is reten-
1/3, and a high smile line. The esthetic teeth are A3–B3 tive and stable without movement (Fig. 6.166). The
(Fig. 6.162). details of the framework are shown in Fig. 6.167. Due to
Dentition analysis: The patient has Kennedy I denti- free-end edentia in the upper and lower jaws, the vertical
tion defect on the maxilla and Kennedy III dentition height cannot be determined. The occlusal relationship is
defect on the mandible. Her missing teeth are A4–A7, recorded by a wax rim (Fig. 6.168). After arranging the
B4–B7, C1–C2, C5–C7, D1, and D5–D7 (Fig. 6.163). teeth according to the occlusal relationship, the wax pat-
She has poor oral hygiene. tern is tried in the mouth (Fig. 6.169).
2. RPD analysis design and manufacturing 3. After restoration
Maxillary dentition is bilateral free-end edentulous. C The final effect with denture is shown in Fig. 6.170.
clasps are placed on A3 and B3. Because the abutments The denture is stable with little clasp exposure when
are located in the esthetic area, in addition to considering smiling. The effect before restoration is shown in
the location of the undercut when designing the clasps, Fig. 6.171. The patient is satisfied.

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6.21 Case 21 171

Fig. 6.162 Facial analysis

Fig. 6.163 Intraoral view

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172 6 Case Analysis of Esthetic Clasp

Fig. 6.164 Maxillary

framework design

Fig. 6.165 Mandibular

framework design

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6.21 Case 21 173

Fig. 6.166 Trying in of the framework

Fig. 6.167 Framework details

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174 6 Case Analysis of Esthetic Clasp

Fig. 6.168 Recording occlusal relationship by a wax rim

Fig. 6.169 Trying in of the wax pattern

Fig. 6.170 Intraoral view with denture

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6.22 Case 22 175

Fig. 6.171 Comparison

before and after restoration. a
(a) Facial left lateral view. (b)
Facial right lateral view

6.22 Case 22

A man, 80 years old. In the past 1 year, the denture was con-
scious 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 flat, and the posterior tooth area is
blade-shape (Fig. 6.173). There are a lot of dental calcu-
lus, plaque, and pigmentation in the old denture; the den-
ture does not fit 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 for-
eign body sensation, the metal base is used. First, make
the initial impression mold (Fig. 6.174), then make indi-
vidual tray (Fig. 6.175) according to the initial model and
initial relationship, use individual tray to obtain the final
impression mold and final relationship (Fig. 6.176), try to
arrange teeth according to the final model and final rela-
tionship (Fig. 6.177), and complete the production of res-
toration after trial wearing denture (Fig. 6.178).
3. After restoration Fig. 6.172 Full-face view
See Figs. 6.179 and 6.180 for the final repair effect.

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176 6 Case Analysis of Esthetic Clasp

Fig. 6.173 Intraoral view

Fig. 6.174 The first

impression

Fig. 6.175 Individual tray

Fig. 6.176 Obtaining final impression and final relation

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6.22 Case 22 177

Fig. 6.177 Tooth arrangement

Fig. 6.178 Restoration

completion

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178 6 Case Analysis of Esthetic Clasp

Fig. 6.179 The intraoral renderings

Fig. 6.180 Comparison

before and after restoration. a b
(a) Before restoration. (b)
After restoration

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 2. RPD design and manufacturing
A woman, 78 years old. Many years ago, all the teeth The upper jaw is edentulous, so single complete den-
in the upper jaw were removed due to loose. Now, the old ture is used. For the lower jaw, the combined clasp is
denture is loose, so it is required to make a new denture. placed on D4D5, and the two arm clasp is placed on D7.
Because the upper teeth are missing, the face col- On the side of edentulous space, the three-arm clasp is
lapses, the nasolabial groove is deep, and the lower teeth placed the distal abutment C7, and the C clasp is placed
can be seen when smiling (Fig. 6.181), showing an aging on the mesial abutment C3. The C clasp design can reduce
face. The upper jaw is edentulous, the arch is sharp and the lateral force on the mesial abutment C3 while ensur-
round, the attachment position of frenum is high, the top ing the retention force and preventing the denture from
of palate is shallow, and the mandibular is Kennedy III floating. The double lingual bar major connector design
dentition defect. C4–C6 is absent in area C, and the can disperse occlusal force, which has good stability, is
­alveolar ridge in the edentulous area is in the shape of a convenient for self-cleaning, and promotes gingival
blade (Fig. 6.182). Oral hygiene is poor. In the design of health (Fig. 6.184). The design details of mandible frame-
mandibular support, it should be noted that because the work are shown in Fig. 6.185. The retention of the den-
complete denture is used in the opposite jaw, the man- ture is stable in wax pattern trial wearing (Fig. 6.186).

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6.23 Case 23 179

Fig. 6.181 Lower third of

facial view

Fig. 6.182 Intraoral condition

Fig. 6.183 Old mandibular denture

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180 6 Case Analysis of Esthetic Clasp

Fig. 6.184 Design of mandible framework

Fig. 6.185 Mandibular stent details

Fig. 6.186 Trying in of the wax pattern

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6.23 Case 23 181

3. After restoration smiling (Fig. 6.189), and the effect comparison before
The final effect of wearing denture is shown in and after the main medical history is shown in
Fig. 6.187, the upper and lower jaws are well occluded Fig. 6.190.
(Fig. 6.188), there is no metal clasp exposure when

Fig. 6.187 The intraoral renderings

Fig. 6.188 Great occlusion

of the upper and lower jaw

Fig. 6.189 Lower third of facial view

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182 6 Case Analysis of Esthetic Clasp

Fig. 6.190 Comparison

before and after wearing a b
denture. (a) Smile before
wearing denture. (b) Smile
after wearing denture

Fig. 6.191 Facial analysis

6.24 Case 24 enough retention and stability for dentures. In order to

improve the retention of the denture, we often implant
A Case of Dentition Defect Repaired by E-Clasp Digital implants in the distal space of missing posterior teeth [1],
Stent Combined with Implant change the type of the defect, and reduce the instability of
1. Before restoration the denture, so that the denture can play a better role.
A man, 72 years old. In order to solve the problems of In this case, RPD is design and manufactured. The patients
mastication and esthetics, he came to our department for underwent implant surgery first, and two implants were
treatment. implanted at the sites of 17 and 27 teeth in the upper jaw, and
Observing the exposed space of Gao’s smile can be one implant was implanted at the right premolar area of the
judged as the middle smile line (Fig. 6.191). Oral hygiene is lower jaw. In the second stage, the healing cap was exposed,
poor. The alveolar bone is absorbed to 1/3 of the middle root; and the locator abutment was connected (Fig. 6.193).
16, 17, 13–24, 26, 27, 32, 41, 42, and 44–46 teeth were miss- Considering that the patient has implant retention, the e-clasp
ing; 14, 15, 25, 35, and 36 teeth are loose for 1°; the man- is mainly used as an auxiliary retention function.
dibular anterior teeth are not arranged in an orderly manner. In this case, the hollow design is used to reduce the
The color of oral mucosa is normal, and the size of tongue is foreign body sensation in the upper jaw, the buccally
normal (Fig. 6.192). Diagnosis: (1) maxillary and mandibu- retentive clasps are designed on A5 and B4, and the mesh
lar dentition defects, maxillary Kennedy class I, and man- structure of the edentulous area is used to avoid the
dibular Kennedy class III and (2) chronic periodontitis. implant. In the case of sufficient retention, unilateral
2. RPD design and manufacturing design is adopted to reduce the denture area, and com-
In Kennedy I and Kennedy II defects, the traditional bined clasp is designed between C6 and C7 (Fig. 6.194).
removable partial denture design is difficult to provide

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6.24 Case 24 183

Fig. 6.192 Intraoral condition. (a) Intraoral condition. (b) Intraoral Local analysis

[Link]/Dr_Mouayyad_AlbtousH
184 6 Case Analysis of Esthetic Clasp

Fig. 6.193 Two implants

were implanted at the sites of
17 and 27 teeth, respectively,
and one implant was
implanted at the right
premolar area of the mandible

Fig. 6.194 Design of upper

and lower jaw framework

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6.24 Case 24 185

3. After restoration tions and relatively low requirements for abutment teeth
The final effect with denture is satisfactory (Figs. 6.195 but also includes the natural esthetic effect of fixed den-
and 6.196). tures. The following case is a combined repair of mobile
The combination of RPD analysis, design, and manu- and fixation [2].
facture not only includes the advantages of wide indica-

Fig. 6.195 The intraoral renderings

Fig. 6.196 Comparison

before and after wearing
denture

[Link]/Dr_Mouayyad_AlbtousH
186 6 Case Analysis of Esthetic Clasp

6.25 Case 25 the protrusion was more and more serious year by year.
The anterior teeth has deeply overbite and overjet, and the
A Case of Fixed-Removable Prostheses with Digital mandibular anterior teeth are directly bitten on the palatal
E-Clasp Bracket Based on the Simulate Production of neck of the anterior teeth of the upper jaw. The cusps of
Personalized Artificial Teeth A3 and B3 teeth are ground and dentin is exposed obvi-
1. Before restoration ously. The maxillary premolars are also worn to different
A woman, 82 years old. On the front view, the distance degrees. The sites of maxillary edentulous teeth are area
between the lower facial 1/3 is slightly short, and the A1, A6, A7 and area B2. The location of mandibular
nasolabial groove is obvious, and on the side view, the edentulous teeth is 1, 4, and 5 in area C and 4 and 6 in
protrusion of the mandible and the upper and lower lips area D (Fig. 6.199).
are all over the esthetic line (Fig. 6.197). When smiling, Due to the longtime of missing teeth on the right side
the protrusion of the upper anterior teeth is serious, show- of the jaw, the extension of the remaining teeth in the
ing “bucktooth” shape. Observing Cao’s smiling exposed upper and lower jaw interferes occlusion, and the lower
zone, it can be judged as the middle high smile line jaw can’t move forward. No abnormal symptoms are
(Fig. 6.198). found in the joint consultation. It is very difficult to adjust
The patient complained of slight protrusion of the and grind. In order to avoid further damage and deepen-
upper anterior teeth when he was young. After the acci- ing of the root fossa on the palatal side, it is necessary to
dent, the anterior teeth were missing due to trauma, and improve the occlusal position by 1–2 mm.
2. RPD design and manufacturing
Because of the special shape, color, and arrangement
of the anterior teeth, the arrangement of the artificial teeth
cannot achieve a better esthetic effect. With the consent
of the patients, the metal abutment teeth were designed at
the missing teeth of the esthetic stent, and then the porce-
lain crown was used for bonding.
First, make esthetic wax pattern on the model, and try
to wear it in the mouth of the patient. After the patient is
satisfied, determine the shape of the porcelain teeth
(Fig. 6.200). The upper jaw is designed with three-arm
clasps on A5 and B4. Because the missing teeth are
located in the front, the clasps of the anterior teeth adja-
cent plate bar are placed on B3 to assist the retention.
Design metal prefabricated abutment teeth in the position
of missing teeth. The esthetic wax pattern can be used as
a preparation to scan together and guide the preparation
of abutment teeth. We designed lingual plate in mandible,
three-arm clasp on C6 and D6, and design C clasp on D5.
The location of missing teeth is also designed with pre-
fabricated metal abutments (Fig. 6.201). After the occlu-
sal relationship is recorded during the trial wearing of the
stent, the porcelain fused to metal crown is made on the
Fig. 6.197 Facial analysis maxillary stent (Fig. 6.202).

Fig. 6.198 Smile analysis

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6.25 Case 25 187

Fig. 6.199 Intraoral condition

Fig. 6.200 Production of

wax pattern

[Link]/Dr_Mouayyad_AlbtousH
188 6 Case Analysis of Esthetic Clasp

Fig. 6.201 The mandible and maxillary stents fit well in the model and mouth. (a) Match the model with the wax pattern, and design the abutment
part of the stent according to the final shape of the prosthesis. (b) Fabrication of framework

[Link]/Dr_Mouayyad_AlbtousH
6.26 Case 25 189

Fig. 6.201 (continued)

3. After restoration tooth esthetic design with the help of computer before
The final result is shown in Figs. 6.203 and 6.204. creative operation. In the case of no need to grind and
The above cases adopt the comprehensive repair prepare teeth, the treatment plan is designed by software,
method, which not only achieves the esthetic effect of which is not only intuitive but also noninvasive.
fixed repair but also widens its scope of application, In the mouth, prediction technology can also be used
reduces the attrition of natural teeth, and reduces the cost in comprehensive RPD analysis, design, and manufactur-
of the whole repair. It is a multi-win repair method. ing. In the following cases, multiple factors such as fixed-­
The intraoral prediction technique is an esthetic analy- removable repair, intraoral prediction technology,
sis plan for the main medical history of esthetic fixed res- simulated resin base, and simulated porcelain teeth were
toration of anterior teeth. It is a new method of visualizing used.

[Link]/Dr_Mouayyad_AlbtousH
190 6 Case Analysis of Esthetic Clasp

Fig. 6.202 Porcelain crown making

[Link]/Dr_Mouayyad_AlbtousH
6.25 Case 25 191

Fig. 6.203 The intraoral renderings

Fig. 6.204 Comparison before and after wearing denture

[Link]/Dr_Mouayyad_AlbtousH
192 6 Case Analysis of Esthetic Clasp

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 ante-
rior teeth has a great influence 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 7 in area A and 1 in 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).
Fig. 6.205 Facial analysis

Fig. 6.206 Smile analysis

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6.26 Case 26 193

Fig. 6.207 Intraoral condition

2. RPD design and manufacturing The third step is personalized dental preview, similar to
Intraoral prediction technology: The first step is soft- DLD dental preview of fixed repair. Here, the tooth shape
ware design. In order to compare the effect, we make two prediction can be realized with the tooth assistant software
designs: (Fig. 6.210). According to the patient’s satisfied esthetic
(a) Common design: Put C clasp of normal length on A5, design tooth shape prediction, we make the esthetic wax
and place embrasure clasps on B4 and B5. Place the pattern. The wax pattern needs to copy the original design
circumferential clasp on A7. parameters, and try wearing it in the mouth of the patient.
(b) Esthetic design: Place the short buccally retentive After trial wearing, it can be modified again according to
clasp on A5, and place the traditional clasp on area the actual situation. Finally, the wax pattern is used to
B6. Because of the tight occlusion, we do not design guide the final repair system (Fig. 6.211).
the rest of B6. The buccal inclination of B6 is obvi- We design e-clasp + porcelain-fused metal framework
ous, and the position of clasp is higher (Fig. 6.208). and simulate base for Miss Peng. At the position of the
The second step is to fit the photos in the mouth with missing tooth, a metal pre-prepared abutment part must
the designed stent shape. Let’s look at the results of the be designed to bond with the subsequent porcelain tooth.
common design after fitting. The clasps in areas A and B The design points are as follows (Figs. 6.212 and 6.213):
are all at risk of exposure. Looking at the fitting results of (a) Maxillary support design: most of the maxillary ante-
the lower part, we can see that the clasps on B4 and B5 rior teeth are missing. AB11 (C clasp) clasp is
have been exposed, and the esthetic effect is not good. As designed on A5, and three-arm clasp is designed on
for the effect map of esthetic design facial fitting, it can A8 and B6
be seen that there is no clasp exposed in the range of A5– (b) Major connector to avoid the gum, so that the gum
B5 and the normal shadow of the corner of the mouth can get sufficient food massage to ensure oral health.
should cover the part of clasp that B6 is exposed to (c) Labial retention bead design—to combine with the
(Fig. 6.209). Compared with the two schemes, the effect maximum area of the simulation base. For gingival
of esthetic design is better. After communicating with tissue defect, it is suitable for patients with esthetic
patients, patients chose to use the second esthetic design. effects.

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194 6 Case Analysis of Esthetic Clasp

Fig. 6.208 Bracket design: complete the two designed bracket forms abutment tooth is located in the front and the clasp is long (half-page
in the design software. Now, we can see the front view of the two version). (a) Occlusal view of bracket design. (b) Front view of bracket
designs. The common design is easy to expose the metal because the design

(d) The best position of the cervical line is consistent The patient is satisfied with the porcelain teeth made at
with the esthetic wax pattern or more under the gum. present. The clinical bonding can be carried out in or out
The simulate base can slightly cover the neck of the of the mouth. Figure 6.215 shows the bonding in the
teeth, and the esthetic effect is better. mouth. Layered stacking of gum resin: different colors of
(e) The design of shoulder is the same as that of abut- gum resin are used in different positions of the gum to
ment to ensure the color of porcelain layer. achieve vivid simulate effect (Fig. 6.216). According to
(f) The junction line of the trailing edge is flushed with the patient’s esthetic design tooth shape prediction, we
the cervical edge, which is equivalent to the effect of make the esthetic wax pattern. The esthetic wax pattern
metal reinforcing belt. need to copy the original design parameters, and try to
(g) Fit esthetic wax pattern in three-dimensional direc- wear it in the patient’s mouth. After the trial wear, it can
tions, labial surface, incisal surface, and lingual sur- be modified again according to the actual situation.
face, and reserve appropriate thickness of porcelain Finally, the wax pattern is used to guide the final repair
layer. It can be measured with the tool provided by system.
the software and adjusted accordingly. 3. After restoration
According to the results of color comparison, the por- The final result is shown in Figs. 6.217 and 6.218.
celain teeth are made, and the esthetic wax pattern turns
guide plate to guide the porcelain process (Fig. 6.214).

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6.26 Case 26 195

Fig. 6.209 Oral photos and a

shape fitting of designed
bracket. (b) General Intraoral
prediction. (c) Esthetic
Intraoral prediction

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196 6 Case Analysis of Esthetic Clasp

Fig. 6.210 Personalized

tooth shape prediction

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

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6.26 Case 26 197

Fig. 6.212 Design of

maxillary bracket

Fig. 6.213 Trial wearing of

bracket in mouth

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198 6 Case Analysis of Esthetic Clasp

Fig. 6.214 Trying to wear

the porcelain teeth on the
bracket

Fig. 6.216 Layered stacking of gum resin

Fig. 6.217 The intraoral renderings

Fig. 6.215 Bonding of the porcelain teeth with the brackets in the
mouth

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6.27 Case 27 199

Fig. 6.218 Comparison

before and after wearing teeth

6.27 Case 27

A Case of Esthetic Restoration of Porcelain Teeth

with RPD
A woman, 43 years old. As a professional teacher, she have
had severe attrition and masticatory weakness of complete
dentition for 20 years. After the joint treatment in the joint
department, the occlusal reconstruction and the restoration
of the remaining teeth with porcelain crowns were completed
in the repair department, the patients felt that the removable
dentures were not esthetic (Fig. 6.219), and the retention sta-
bility was poor, so the restoration was required.

1. Before restoration Fig. 6.219 Old denture in the mouth

The patient’s face proportion is normal and the face is
symmetrical (Fig. 6.220). The upper and lower jaws were Place C clasp and distal adjacent plate on the A5, com-
all Kennedy II deletions. A12367 and B126 of the upper bined with A4 distal occlusal rest and lingual reciprocal
jaw are missing, and A1 and B12 are residual root, and arm. When the free end of area A is under the dislocation
A45 and B345 porcelain crowns were used for restora- force, because the point of C clasp is adjacent to the arti-
tion. C567 and D67 of mandible were missing, and C1234 ficial teeth, the rest is located in the mesial, which is more
and D1234 porcelain crowns were used for restoration likely to form the locking effect, effectively preventing
(Fig. 6.221). The patients had normal occlusion, normal the free end of the saddle base from warping toward the
overbite, normal overjet, normal joints, and good oral occlusal direction; when the free end of area A is under
health. Due to the high esthetic requirements of patients, the chewing force, the base and the clasp arm sank at the
we should consider the e-clasp restoration of personal- same time, and the mucosa and A4A5 jointly disperse
ized artificial teeth. bite force, which can reduce the burden of porcelain teeth.
2. RPD design and manufacturing We place the short buccally retentive clasp on B5 and
The remaining teeth in the mouth of the patient are all extend the lingual antergic arm to B3 to disperse the force
porcelain teeth. The design of the scaffold should be on and enhance the stability (Fig. 6.223).
the premise of ensuring the stability and esthetics of the We design I bar on buccal side of C5 and distal plate.
fixation, and try to disperse the force as much as possible Because the frenum linguae is too high, the variant
to avoid the stress concentration leading to porcelain frac- “human”-shaped double lingual bar is used. When the
ture of the porcelain teeth. See Fig. 6.222 for the predic- free end of area C is under the dislocation force, the I bar
tion of diagnosis wax pattern in the mouth. can effectively prevent the free saddle base from rising to

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200 6 Case Analysis of Esthetic Clasp

the occlusal direction; when the free end of area C is

under the mastication force, the I bar is out of contact
with the abutment teeth, avoiding the torque exerted by
the clasp on the porcelain teeth and dispersing the bite
force to the mucosa.
We design half-and-half clasp without occlusal rest on
D4. When the saddle base in D area is chewed, the base
and the clasp arm sank simultaneously, dispersing the bite
force to the mucous membrane and reducing the burden
of porcelain teeth (Fig. 6.224).
After the stent is completed (Fig. 6.225), try it in the
mouth (Fig. 6.226).
Due to the high esthetic requirements of patients, per-
sonalized artificial teeth are customized through wax pat-
tern production (Fig. 6.227), and the wax pattern is used
to complete tooth arrangement, and the we try it in the
mouth (Fig. 6.228). The posterior teeth are filled with
glue (Fig. 6.229), and the anterior teeth are made of metal
substrate and then porcelain on them (Fig. 6.230).
Because there are five missing teeth in the anterior tooth
area, the actual space is only allowed to repair four teeth,
and the space was too large for the target repair space of
four teeth, so it is necessary to reduce the distance
between mesial and distal line angles and deepen the
Fig. 6.220 Full-face view

a b c

Fig. 6.221 Intraoral condition. (a) Right view of occlusion. (b) Positive view of occlusion. (c) Left view of occlusion

Fig. 6.222 Intraoral

prediction

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6.27 Case 27 201

Fig. 6.223 Design of

maxillary bracket

Fig. 6.224 Design of

mandible bracket

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202 6 Case Analysis of Esthetic Clasp

Fig. 6.225 Bracket

completion

Fig. 6.226 The fitting of the stent in the mouth is great

Fig. 6.227 Personalized artificial wax teeth

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6.27 Case 27 203

Fig. 6.228 Try wearing after tooth arrangement

Fig. 6.229 In order to avoid overweight of the stent, the posterior are made of resin teeth

Fig. 6.230 Porcelain after

making substrate of anterior
teeth

color of the adjacent surface, so as to achieve the effect of e-clasp met the patients’ higher esthetic expectations.
crown narrowing visually while retaining the adjacent The patient is very satisfied (Figs. 6.233, 6.234, and
contact (Fig. 6.231). After the porcelain teeth are bonded, 6.235).
the gingival porcelain is porcelained, and the restorations PEEK (polyether ether ketone) is a kind of special
are finally completed (Fig. 6.232). engineering plastics with high performance. Since it was
3. After restoration developed, it has been used as an important strategic mili-
Denture retention stability is good, and the produc- tary material. Due to its excellent chemical stability, good
tion of personalized artificial teeth and the design of biological properties, and mechanical properties close to

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204 6 Case Analysis of Esthetic Clasp

Fig. 6.231 Porcelain teeth

completion

Fig. 6.232 After the porcelain teeth are bonded, gingival porcelain is porcelained; the restorations are finally completed

Fig. 6.233 The intraoral renderings

Fig. 6.234 Full-face view

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6.28 Case 28 205

Fig. 6.235 Comparison

before and after wearing teeth

natural teeth and dense bone, PEEK and its composite 6.28 Case 28
materials have attracted attention in the field of stomatol-
ogy. At present, PEEK and its composite materials have A Case of Non-free-End Mandibular Loss Repaired by
been used in fixed repair, removable partial denture repair, PEEK Bracket RPD
and implant repair. 1. Before restoration
In the field of removable restoration, PEEK shows A woman, 65 years old. There are fixed restoration on
many advantages: because PEEK has high elasticity, it A4–A7 and B5–B7, and C126 and D126 are missing. The
can reduce the torque on the distal and mesial abutment anterior teeth have tight occlusion with deep overbite and
teeth and is especially suitable for the cases of free-end normal overjet, and pigmentation is visible on the tooth
loss; PEEK has no metal color and peculiar smell, and surface. C4 is I°loose, and the remaining teeth are not
the taste of patients is better, and compared with the loose (Fig. 6.236).
traditional metal stent, PEEK stent has no metal color 2. RPD design and manufacturing
and is more esthetic; PEEK is lighter than metal, and In this case, cobalt chromium alloy [3] and PEEK are
patients wear better. It is also reported that PEEK mate- used to make stent respectively. The mandible is Kennedy
rial has low plaque adhesion, which is helpful for peri- III dentition defection, and the remaining teeth are not
odontal health. However, PEEK is not a perfect loose, so it is considered to select the teeth on both sides
material. Although its elasticity is high, its relative of the missing space as the abutment and use the mesial
strength is insufficient, and it may not be suitable for rest to reduce the lateral force on the abutment. Consider
some delicate structures. Therefore, PEEK tends to placing combined clasps between C45 and D45, respec-
make relatively simple stent, especially plate struc- tively, and ring clasp on C7. Double lingual bar is used in
tures. However, due to the limited scientific evidence major connector. Due to the low strength of PEEK, it is
and the lack of generally accepted stent design rules, it necessary to thicken the metal stent structure properly
is less used in clinical final repair and is more com- and then cut it to get PEEK framework (Fig. 6.237).
monly seen in temporary repair. 3. After restoration
In the next four cases, we used PEEK as the stent The final result is shown in Figs. 6.238 and 6.239. The
material for repair and achieved good results. patient is much satisfied.

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206 6 Case Analysis of Esthetic Clasp

Fig. 6.236 Intraoral condition

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6.28 Case 28 207

Fig. 6.237 Bracket design.

(a) Machining of two kinds of a
stent materials (cobalt
chromium alloy on the left
and peek on the right). (b)
Proper thickening of PEEK
clasps

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208 6 Case Analysis of Esthetic Clasp

Fig. 6.238 The intraoral

renderings

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6.29 Case 29 209

Fig. 6.239 The weight of

PEEK bracket is 58% lighter
than that of CO-Cr alloy
bracket

6.29 Case 29 tion, it needs to use the base for retention, which requires
that the base has a certain range, and the edge of the base
One Case of Dentition Defect Repaired with PEEK is well sealed. Therefore, this case combines two tech-
Stent Combined with RPD niques of esthetic clasp with absorbable denture to obtain
1. Before restoration good retention and esthetic effect. First, make the primary
A woman, 66 years old. The upper jaw is Kennedy III impression (Fig. 6.241), obtain the primary model
dentition defect, the remaining teeth in the upper jaw are (Fig. 6.242), make individual trays (Fig. 6.243), make the
A3–B3, and only C3 is left in the lower jaw; C3 is once final impression (Fig. 6.244), obtain the final model
loose. It can be seen that alveolar bone resorption is seri- (Fig. 6.245), design the bracket on the final model
ous, especially that the mandibular alveolar bone is in (Fig. 6.246), and make the wax pattern (Fig. 6.247) after
poor condition (Fig. 6.240). the bracket is completed.
2. RPD design and manufacturing 3. After restoration
For the patients with few remaining teeth, the main After the repair, the facial pattern is good without
support mode of removable denture is mucous membrane clasp exposure. The patient feels comfortable and satis-
support, and when using the remaining teeth for reten- fied (Figs. 6.248 and 6.249).

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210 6 Case Analysis of Esthetic Clasp

Fig. 6.240 The remaining

teeth are few, and the
condition of the remaining
alveolar bone is poor

Fig. 6.241 Primary

impression

Fig. 6.242 Primary model

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6.29 Case 29 211

Fig. 6.243 Making

individual trays

Fig. 6.244 Silicone rubber

for final impression

Fig. 6.245 Final model

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212 6 Case Analysis of Esthetic Clasp

Fig. 6.246 Design of

maxillary bracket

Fig. 6.247 Bracket

completion and wax pattern
production

Fig. 6.248 The intraoral

renderings

Fig. 6.249 Full-face view

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6.30 Case 30 213

6.30 Case 30 exposed zone of Zhang is observed, which could be

judged as a low smile line, and the tooth position of the
A Case of Upper and Lower Dentition Defect Repaired esthetic area of the upper jaw is A3–B3 (Fig. 6.250).
by PEEK Stent RPD The upper jaw are Kennedy I dentition defection, and
1. Before restoration the lower jaw are Kennedy III dentition defection. It can
The proportion of the patients’ face is normal, but it is be seen that there is a black triangle between A1 and B1.
not symmetrical. The line between the pupil and the line The remaining teeth are not loose. The oral hygiene con-
between the mouth corner are not parallel. According to dition is general, and pigmentation can be seen on the
the main medical history before restoration, the smiling tooth surface (Fig. 6.251).

Fig. 6.250 Lower 1/3 facial

view

Fig. 6.251 The intraoral renderings

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214 6 Case Analysis of Esthetic Clasp

2. RPD design and manufacturing teeth avoid the gums to ensure self-cleaning effect. There
Because the patients are not willing to receive too are Kennedy III mandibular defect. C4 and D5–D6 are
much attrition, we only prepare a small number of teeth selected as abutment teeth. We place a one-arm clasp on
in the mandible and use the existing conditions of the C4 and three-arm clasps on D5D6 to ensure the mandibu-
remaining teeth as much as possible to place the rest. The lar retention. Lingual plate is used for major connector
palatal plate was extended to the lingual side of A3B3, so (Fig. 6.252). After completing the bracket, arrange teeth
as to achieve the purpose of both abutment teeth and and try wax patterns on (Fig. 6.253).
mucosa support. A one-arm clasp is placed on A4. In 3. After restoration
order to make full use of tooth undercut to increase reten- The final result is shown in Figs. 6.254, 6.255, and
tion force, the clasp of B5 is extended to B4. The anterior 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

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6.31 Case 31 215

Fig. 6.254 The intraoral renderings

Fig. 6.255 Fitness and occlusion of denture are great

Fig. 6.256 Facial effects

6.31 Case 31 In the oral examination, the upper jaw is Kennedy II

dentition defect, and 25–27 are absent, 24 is residual root,
A Case Study on the Design of PEEK Stent and PEEK 16 is I°loose, and 14 and 23 have wedge-shaped defects;
Integrated Removable Partial Denture the lower jaw is Kennedy II dentition defect, 37, 45–47
are absent, 36, 42, and 44 are I°loose. The oral health
1. Before restoration condition is poor, and there are many calculi (Fig. 6.258).
A man, 86 years old. The facial asymmetry can be 2. RPD design and manufacturing
seen in the frontal view, but the middle line of dentition is In this case, we have designed two schemes: one is
in harmony with the middle line of the face. The esthetic traditional design, and the other is a combination of arti-
tooth position which can be seen in the smile view of the ficial teeth and stent to form integrated stent. Such stent
face is 14–24 in the upper jaw (Fig. 6.257). will not form weak points because of the need to design

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216 6 Case Analysis of Esthetic Clasp

Fig. 6.257 Facial analysis

Fig. 6.258 Intraoral condition

the finish line. At the same time, due to the low density of not affect the esthetics. In the second visit, alginate
PEEK, the weight of the whole stent is also very light. impression material was used to take impression, and
(a) Scheme I the plaster model is filled, then temporary base and
(i) Conventional stent design: In this case, both wax rim were made to obtain the occlusion relation-
upper and lower jaw major connectors were plate ship, and then the dental model scanner was used to
design, combined with the traditional one-arm scan to obtain the digital dentition model and occlu-
clasp and three-arm clasp to sure the retention of sion relationship of patients.
the whole stent (Figs. 6.259, 6.260, 6.261, 6.262, (i) Digital design of integrated bracket (Fig. 6.265)
and 6.263). The dentition model and occlusion relation-
(ii) Repair effect is in Fig. 6.264. ship of the patients were imported into the dental
(b) Scheme II design software for the restoration design. The
The design of rest and retainer in scheme I is not design of artificial teeth is carried out after con-
changed, and the artificial teeth and bracket are firming the path of inserting and automatically
designed as a whole. Because the missing teeth are filling out the unwanted undercut. According to
all posterior teeth, not in the esthetic area, so it will the shape of the remaining teeth, the suitable

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6.31 Case 31 217

Fig. 6.259 The CAD design

of PEEK bracket

Fig. 6.260 Maxillary bracket completion

artificial teeth can be selected in the tooth shape the one-arm clasp was placed on 17 and 23. The
database; and the size, axial direction, and shape combined clasp and the one-arm clasp were also
of the teeth can be adjusted individually; and the used for retention of the mandible bracket. The
teeth can be arranged according to the principle clasp is semicircle, because PEEK elastic modu-
of alveolar crest. lus is lower than that of metal clasp; in order to
After the tooth arrangement is completed, the ensure the retentive force of clasp, set the depth
bracket is designed. The palatal plate/lingual of clasp tip into the undercut to 0.5 mm, the
plate was chosen as the major connector to radius of clasp is 1 mm, the arm of snap ring is
enlarge the stress area of the mucosa and avoid 1.3 mm, and the body of clasp is 1.5 mm. In
local pressure resulting in tenderness. The com- addition, the net minor connector in the tradi-
bined clasp was placed between 14 and 15, and tional bracket design is removed, and the plate-­

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218 6 Case Analysis of Esthetic 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

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6.31 Case 31 219

Fig. 6.264 The intraoral renderings

Fig. 6.265 Digital design of integrated bracket

Fig. 6.266 STL data export

after bracket design

shape major connector is used to cover the bracket (Fig. 6.267). The weight of maxillary
extension range of the base in advance. stent is 8.2 g, while that of mandibular stent is
After the design of human teeth and brackets, only 6.9 g.
the design of artificial gingiva was carried out. 3. After restoration
According to the shape of adjacent teeth, the Trying in of the denture shows that the stent is suit-
natural cervical line, gingival papilla, and root able, occluded well, and has good retention. The facial
protrusion are formed. Combine the STL data of view shows part of the clasp entering the esthetic area
the bracket, artificial teeth, and gingiva to obtain (Fig. 6.268), but the patient indicates acceptance. The
the designed data (Fig. 6.266). patient feels that the quality of the stent is very light, the
(ii) Machining of integrated support self-report has no metal odor, and the comfort is better
Use the CAD/CAM cutting machine to cut than the traditional metal removable partial denture. The
the PEEK disk, remove the support rod, and pol- patient was satisfied with the final results.
ish and finish the production of the integrated

[Link]/Dr_Mouayyad_AlbtousH
220 6 Case Analysis of Esthetic Clasp

Fig. 6.267 Bracket

fabrication completion

Fig. 6.268 Repair effect

6.32 Case 32 Import digital files of another patient’s casts with simi-
lar dentition scale. Adjust models to the same size of tar-
1. Before restoration get dentition, and remove tooth dental crowns to simulate
A 58-year-old woman with severe dentition defection patient’s dentition defect. Design and separate trays into
(Fig. 6.269), whose oral opening was limited to approxi- two or three parts and 3D print them (Figs. 6.270 and
mately 40 mm (width) and 25 mm (height) as the result of 6.271). Insert CAD/CAM custom sectional trays into
scleroderma. Oral examination showed a severely patient’s mouth, and take each impression. Pour dental
absorbed alveolar bone with 16, 17, 25–27, and 36–46 stone to make casts and then scan them after setting.
teeth missing. Mobility of 11, 12, 21, and 25 was degree Align sectional models to form final maxillary and man-
III; mobility of 13–15 and 22–24 was degree dibular models (Fig. 6.272).
I. Nonrestorable teeth (11, 12, 21, 25) were extracted. Embrasure clasps were planned bilaterally of the max-
2. RPD analysis design and manufacturing illary dentition (in 14–15 and 23–24 spaces) to further dis-
Record the maxillary and mandibular dentition size perse occlusal forces to the abutment teeth. Also, the
from CBCT data for tray design. combined clasps can act as a periodontal splint to stabilize

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6.32 Case 32 221

Fig. 6.269 Pretreatment

condition. (a) Facial frontal
view. (b) Oral condition. (c)
Oral fissure evaluation

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222 6 Case Analysis of Esthetic Clasp

Fig. 6.270 Design process of

custom trays. (a) Dentition a
size simulation. (b) Dentition
defect simulation. (c) Models
relief. (d) Custom trays
design

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6.32 Case 32 223

Fig. 6.271 CAD/CAM

custom sectional trays. (a)
a
Maxillary custom sectional
trays. (b) Mandibular custom
sectional trays. (c) 3D-printed
maxillary custom sectional
trays. (d) 3D-printed
mandibular custom sectional
trays

3D-printed maxillary custom sectional trays

d

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224 6 Case Analysis of Esthetic Clasp

a c

d
Fig. 6.272 Alignment of models. (a) Alignment of maxillary models.
(b) Final maxillary model. (c) Alignment of mandibular models. (d)
Final mandibular model

Fig. 6.272 (continued)

the remaining teeth, which had been influenced by severe

alveolar absorption. Since the RPD is in one piece and not
foldable, a shortened RPD design was adopted, which
referred to the restoration of dentition only to the first
molars instead of the second molars. As for the mandibu-
lar RPD, ring clasps with mesial rests were placed bilater-
ally on the second molars to provide more retention and
stability. Due to the mesio-ligual inclination of the abut-
ment teeth, the tips of clasps were placed at the lingual
undercut area, and the rests were placed at the mesiocclu-
sion surfaces. The third molars were excluded from the
RPD design in order to reduce the RPD length (Fig. 6.273).

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6.32 Case 32 225

a a

b b

Fig. 6.273 Design of frameworks. (a) Design of maxillary framework.

(b) Design of mandibular framework

Fig. 6.275 Fabrication of RPD. (a) Record occlusal relationship. (b)

Arrangement of maxillary dentition. (c) Arrangement of mandibular
dentition
Fig. 6.274 Trying in of resin frameworks

The frameworks were 3D printed with Co-Cr alloy 3. After restoration

and were tried intraorally (Fig. 6.274); the maxilloman- It’s the final effect of patient with denture (Fig. 6.276),
dibular relationship in centric relation was recorded. The reporting satisfaction with the treatment results.
artificial teeth were arranged and were trimmed and pol-
ished (Fig. 6.275).

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226 6 Case Analysis of Esthetic Clasp

6.33 Case 33

1. Before restoration
A 7-year-old kid diagnosed with ectodermal dysplasia
(EDA) was referred for restoration treatment (Fig. 6.277).
EDA is a group of complex diseases with more than
200 different pathological damages, predominantly affect-
ing the developmental defects of ectodermal tissues like
the sweat glands, hair, nail, teeth, and nervous system. Its
oral representation can be congenital missing tooth, tooth
dysplasia, and conical tooth, which affect severely the
chewing, pronunciation, and appearance of patients and
will harm the physical and mental health of the patients.
Fig. 6.276 Facial view with denture

Fig. 6.277 Pretreatment

condition. (a) Facial frontal a
view. (b) Oral condition.
(c) CBCT

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6.33 Case 33 227

The patient’s oral cavity was characterized by congen- final model (Fig. 6.278). The treatment of the patient
ital missing teeth, and the patient is too young with active will be throughout the whole life cycle, so we record
skeletal development to be repaired with implant denture. the change of the jaw position and jaw digitally, as
Early complete denture not only can restore the shape of the approach to evaluate the repair effects and the
teeth to reconstruct occlusion and the function of chewing basis of the following repair at return visit.
and pronunciation but also can accelerate the develop- Due to the considerable aging changes of hard and
ment of jaw and temporomandibular joint, which can pre- soft tissues and anatomic structure of young edentu-
vent malocclusion, improve patient’s facial contour, lous patients’ oral system and the appearance of den-
establish good relations between the face and the skele- ture is basically a constant except occlusal surface
ton, promote his physical and mental health, and raise the abrasion, we specially design a custom gothic arch
life quality. positioning plate with coordinate system and scale on
2. Treatment plan the denture (Fig. 6.279), which can be used to deter-
Considering the particularity of the patient, we made a mine the change of jaw position at return visit and
sequential treatment plan for him: also can establish an intraoral coordinate system to
(a) Stage I: Removable denture restoration immediately. record the change of the jaw in different development
Make the final impression with a two-step impres- stages throughout the whole life. The following is the
sion; after that, make the complete denture on the approach we used:

Fig. 6.278 Trying on

Fig. 6.279 Maxillary and

mandibular custom gothic a
arch positioning plate. (a)
Design data. (b) Print

[Link]/Dr_Mouayyad_AlbtousH
228 6 Case Analysis of Esthetic Clasp

After the first treatment, we made four blocking Record the horizontal jaw position in the same
points on the maxillary positioning plate (Fig. 6.280) way every 3 months in the first year (7–8 years old).
and then made CBCT images with the plate seated on When the coordinate deviation between two visits is
the complete denture to obtain the relative position large, complete denture should be fabricated again.
relationship between the jaw and positioning plate The data recorded is two-dimensional.
(Fig. 6.281). Next, we placed the maxillary guide on
the maxillary denture and mandibular guide with a
tracing screw product on the mandibular ridges.
Relining with bite silicone rubber is necessary if the
tissue surface of the denture or the mandibular guide
was not fit with alveolar ridge. Until the maxillary
and mandibular guides were seated stably, we can
describe the horizontal jaw position curve on the
maxillary guide; due to that, there were no artificial
teeth. After adjusting the height of tracing screw, we
asked the patient to bite at CR position and do
­protrusive and lateral movements and recorded the
coordinates of the CR position (Fig. 6.282).

Fig. 6.282 Obtaining the relationship between horizontal jaw posi-

tion. (a) Placed the custom gothic arch positioning plate. (b) The
Fig. 6.280 Blocking points recorded relationship between horizontal jaw position

Fig. 6.281 Relative position

relationship between the jaw
and the positioning plate

[Link]/Dr_Mouayyad_AlbtousH
References 229

We make CBCT images with complete denture maintenance of health after restoration are the major
and maxillary positioning plate at return visit every premise of any successful restoration.
year. Fit observation point data of the jaw were Dentists should remember that although RPD is
recorded every return visit through positioning suitable for almost all patients with dentition defects,
plate to determine the change of the jaw. The data the limitation of its curative effect is objective after
of the jaw and jaw position recorded is all. According to the patients’ complaints and the
three-dimensional. actual situation of the patients, the purpose of our
(b) Stage II: The first permanent prosthesis will be car- repair is to improve the esthetics of the denture as
ried out with implant and removable treatment. much as possible on the basis of following the rea-
According to the change trend of core indicators of sonable design, rather than pursuing the ultimate
observation points, implant will be placed at maxil- metal-free exposure for every case of clasp. And
lary 13–14 and 23–24 teeth and mandibular 33–34 based on the three words of patient safety, “long-
and 43–44 teeth in plan. Return visit every 3 months, term, stable, and effective” are the pursuit of medical
and observe the data changes of observation points, technology that we can never abandon.
and replace the denture periodically in accordance
with specific conditions.
As mentioned at the beginning of this chapter, the References
remaining periodontal condition of patients with den-
tition defect in China is generally not good, the con- 1. Cochran DL. The scientific basis for and clinical experiences with
Straumann implants including the ITI® Dental Implant System: a
sciousness of patients’ self-care is not strong, and the consensus report. J Clin Oral Implants Res. 2000;11(sl):33–58.
correct brushing and cleaning are difficult to be 2. Stude S. A retrospective study of combined fixed-removable
implemented in place. The basic treatment of dental reconstructions with their analysis of failures. J Oral Rehab.
pulp and periodontal is not in place, and other prob- 1998;25(7):513–26.
3. Vallittu PK, Kokkonen M. Deflection fatigue of a cobalt-­chromium,
lems are common, which need to be looked at and titanium and gold alloy cast denture clasp. J Prosthet Dent.
solved urgently. Perfect basic treatment and scientific 1995;74(4):412–9.

[Link]/Dr_Mouayyad_AlbtousH
[Link]/Dr_Mouayyad_AlbtousH
 Communication and Cooperation
Between Clinicians and Technicians 7

Both clinician and technician play the most impor- 7.1 General Process of Clinician-Patient-­
tant roles in the whole treatment process of restora- Technician Communication
tion, and their common goal is to provide prosthesis
with beautiful appearance as well as functions to the There are mainly three ways to increase the information capac-
patient. ity during communication: filling work authorization form,
exchanging digital image data, and direct communication.

7.1.1 Fill Work Authorization Form

To reach this goal, they are supposed to promote
their cooperation except finishing their own tasks and For there are a number of e-clasps, it’s easy to get confused
responsibilities. Only when both of them realize that when filling the form, and sometimes it might cause misun-
each other is a key partner in the treatment and it is derstanding. Undoubtedly, it would be easier if there is elec-
significant to trust each other and maintain commu- tronic form with pull-down options. However, design
nication can the cases acquire satisfying treatment drawing sometimes is irreplaceable. The diagram below is
result. work authorization form for e-clasp offered exclusively in
this book. The front of it there is basic information of
patient, smile exposed area, and framework design (Fig. 7.1).
On the back of the form, there is a diagram of 15 e-clasps
introduced in this book (Fig. 7.2). It is simple and clear, easy
to identify, and unique. Work authorization form is an
important channel to increase the information capacity dur-
ing communication between clinician and technician.

Example
Suppose a patient who missed A5, A6, B5, and B6, with
A3 II°loose and B2 I°loose. Fill the form after analysis
and design.

© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House Co. Ltd. 2023 231
H. Yu, Digital Removable Partial Denture Technology, [Link]

[Link]/Dr_Mouayyad_AlbtousH
232 7 Communication and Cooperation Between Clinicians and Technicians

Fig. 7.1 Work authorization

form for e-clasp (front)

[Link]/Dr_Mouayyad_AlbtousH
7.1 General Process of Clinician-Patient-Technician Communication 233

Fig. 7.2 Work authorization

form for e-clasp (back)

Other requirement

Icons of Anterior esthetic clasp

Short buccally retained clasp C clasp L clasp Modified RPI clasp

T clasp Adjacent surface Twin-flex clasp

hidden clasp

Icons of Posterior esthetic clasp

Short-arm embrasure clasp Plate-bar claps Lingually retained short buccal arm clasp

Lingually retained L clasp Lingually retained J clasp RLS clasp

TEREC hidden clasp Saddle-lock clasp

1. Record the missing teeth (Figs. 7.3 and 7.4). 4. Design of smiling exposed zone. According to the esthetic
2. Record the agomphiasis (Fig. 7.5). teeth showed by the smiling exposed zone, via comparing
3. Describe the smiling exposed zone. Through natural com- to the missing teeth, we decide the esthetic abutment.
munications with patients, for example, asking about and Then comparing the real oral exposure again, we decide
recording their essential information, such as name and the esthetic clasps and describe and simply label its name
age, we can observe the exposed zone of the mouth when (Fig. 7.7).
engaged in verbal activities, or we can observe the exposed 5. Design of non-esthetic area. We don’t have to choose
zone in smile by letting the patient say “cheese” (Fig. 7.6). e-clasps here. We decide the abutment and describe and

[Link]/Dr_Mouayyad_AlbtousH
234 7 Communication and Cooperation Between Clinicians and Technicians

Fig. 7.3 Mark the missing

teeth on the chart “Design of
the framework”

Fig. 7.4 Mark the missing

teeth on the chart “Design of
the exposed area in smile”

Fig. 7.5 Mark the

agomphiasis and its mobility

Fig. 7.6 Mark the exposed

area in smile

simply label the name of clasps. Then we draw out other can authorize the technician to dye the artificial tooth.
parts of the framework (Fig. 7.8). Specifically, the clinician does colorimetry in consulting
6. Other information. If the patient would like to make an room and recording the colorimetric message on the
icing on the cake and laboratory conditions permit, we exposed area in smile (Fig. 7.9). The technician uses pho-

[Link]/Dr_Mouayyad_AlbtousH
7.1 General Process of Clinician-Patient-Technician Communication 235

Fig. 7.7 Describe the

esthetic clasps and simply
label their name

Fig. 7.8 Describe the traditional clasps and simply label their name

Fig. 7.9 Record the

colorimetric message

tocurable resin to do personalized dyeing, according to 7. Accomplishing. At this point, our work authorization is
the mark on the work authorization. Clinicians can record accomplished, in which the design of the exposed zone in
the colorimetric message on the blank of the chart “Design smile is essential and is the important position reference
of smiling exposed zone.” for the wax pattern production of clasp (Fig. 7.10).

[Link]/Dr_Mouayyad_AlbtousH
236 7 Communication and Cooperation Between Clinicians and Technicians

Fig. 7.10 Accomplish the

work authorization

7.1.2 Transfer Digital Image Data 7.1.3 Communicate Directly

After recording patient’s image date by digital cameras in the When technicians got the above information, clinicians and
consulting room (Fig. 7.11), clinicians can quickly transfer technicians can also communicate through telephone, inter-
that to the technicians through the network to enrich com- view face to face, and other ways to keep efficient communi-
munication information. cation. Clinicians and technicians are the most important two

[Link]/Dr_Mouayyad_AlbtousH
7.2 The Necessity of Digitalization in Clinician-Patient-Technician Communication and Cooperation 237

Fig. 7.11 Patient’s image

data

roles in the restoration of esthetic clasp. Only ­communicating

plaints, and pay attention to the way of language communi-
effectively and trusting each other can they achieve the ulti-cation. Through good communication with patients,
mate goal of satisfactory effect. clinicians should respect their rights, gain their trust, help
them establish the final achievable goals, and correct some
unrealistic expectations in the meantime.
7.2 The Necessity of Digitalization Along with the progress of society and science and tech-
in Clinician-Patient-Technician nology, digital diagnosis and treatment and processing tech-
Communication and Cooperation nology are becoming increasingly important in the field of
stomatology. On one hand, digital technology shows its char-
With the establishment of new medical model and clinician-­ acteristics and superiorities in oral scanning, design, and
patient relationship, clinicians are required to have good production. On the other hand, it highlights a series of advan-
communication skills, learn to listen to patients’ chief com- tages such as convenience, accuracy, efficient, and unam-

[Link]/Dr_Mouayyad_AlbtousH
238 7 Communication and Cooperation Between Clinicians and Technicians

biguous transmission of digital technology in ervation, and query of information. Digital impressions
clinician-patient-technician communication and and models are also convenient to store and transmit.
cooperation. Digital colorimetry makes colorimetric results more
accurate and intuitional. Digital design and analysis
improve clinician-patient-technician communication, so
7.2.1 The Basic Meaning of Digital Clinician-­ that patients have the right to choose and know in advance.
Patient-­Technician Communication 2. The need for the development of efficient and accurate
and Cooperation medical care
With the popularization and application of digital
The so-called digital clinician-patient-technician communi- technology, hospitals, clinics, and denture factories all
cation and cooperation mainly refers to using a series of digi- over the world are able to communicate anytime and
tal technology and equipment (involving photography anywhere. Patients’ requirements for the treatment
technology, scanning technology, multimedia technology, process and prosthetic effect are getting higher and
electronic colorimeter, oral and facial scanning system, digi- higher, which not only promotes the development and
tal analysis and design, digital production, and so on) to application of digital technology but also meets the
transform patient-related oral and maxillofacial information needs of patients. The chairside dental technician can
into digital information form for preservation, analysis, assist clinicians in data and information collection,
design, transmission, production, processing, etc. It ensures digital analysis, computer-­aided design, and computer-
the accuracy and completeness of relevant information and is aided production.
conducive to save storage space and materials, quickly Efficient and accurate medical treatment requires both
search and trace information, facilitate clinician-patient-­ clinicians and technicians to supervise and manage the
technician communication and discussion, and establish a processes of denture analysis and design, tooth prepara-
database to facilitate the big data analysis and promote medi- tion, mold taking, occlusal and jaw position relationship
cal progress. Due to the complex form of dentition defect recording, etc. Moreover, feedback problems to clinicians
and the different health status of alveolar ridge and oral and patients in time put forward suggestions on the revi-
remaining teeth, the design and manufacture of denture is sion of production. For patients who require individua-
very complicated, which requires good and effective com- tion or have special requirements, it’s imperative to fully
munication and exchange among clinicians, patients, and understand their gender, age, skin color, occupation, etc.,
technicians, and makes use of digital technology and equip- conduct personalized colorimetry and tooth arrangement,
ment for close cooperation to attain good final prosthetic and digitally obtain the patient’s oral and maxillofacial
effect. information. In particular, the concept of esthetic restora-
tion requires that dentures not only have masticatory
function but also have to be beautiful and comfortable to
7.2.2 The Necessity of Digitalization meet the needs of patients. Therefore, we need the digital
in Clinician-Patient-Technician design and production to make the restoration system
Communication and Cooperation more accurate and more in line with clinical requirements
while to save time and procedures; avoid communication
1. Meeting the needs of the development trend of digital oral obstacles among clinicians, patients, and technicians; and
diagnosis and treatment and manufacturing technology improve the accuracy of restoration and the efficiency of
With the rapid development of digital diagnosis and diagnosis and treatment.
treatment technology and manufacturing and processing 3. The need for clinician-patient-technician communication
technology, as well as the promotion of national policies, There are common problems in the traditional produc-
the popularization of digital technology is bound to be the tion process, such as incomplete filling of processing
future development trend of the medical field. Using digi- design forms, poor quality of models or impressions, etc.,
tal technology can support, improve, and promote the resulting in technicians not well understanding the design
quality and efficiency of the entire medical system, facili- intention of clinicians and the needs of patients. Digital
tate patients to seek medical treatment, and improve technology can provide a good platform for communica-
patients’ satisfaction. tion and exchange between clinicians and technicians,
The traditional paper medical records is replaced by which is able to completely deliver the patients’ informa-
electronic ones, which benefits to the classification, pres- tion and needs to technicians and clearly express the cli-

[Link]/Dr_Mouayyad_AlbtousH
7.3 The Application of Digitalization in Clinician-Patient-Technician Communication and Cooperation 239

nicians’ design requirements. With the progress of should fully communicate with each other and find and
society, patients’ demand for restoration is getting higher solve problems with a scientific attitude, so as to improve
and higher, and more personalized needs are highlighted, the satisfaction of patients and the effect of restoration.
which also requires clinicians and technicians to carry out
personalized analysis and design of patients; good
­communication and cooperation are needed among the 7.3 The Application of Digitalization
three sides to achieve the final satisfactory results. in Clinician-Patient-Technician
During the clinicians’ operation, it is difficult to express Communication and Cooperation
clearly and simply to patients in words. Therefore, digital
or multimedia technology can be a better choice to vividly Digitalization has gradually penetrated into all aspects of the
show the steps and process of treatment, so that patients medical process, from electronic medical records at the ini-
can be more at ease with treatment. This form of digital tial stage of medical treatment to digital analysis and to the
and multimedia technology has more advantages for low- final production and design of digital models. The digital
level education or elderly patients. For the digital informa- technology runs through the whole process and is conducive
tion and the process of digital analysis and design could be to good communication and cooperation among clinicians,
presented to patients, patients can fully understand the patients, and technicians. The following digital technologies
prosthetic effect and timely put forward suggestions for all benefit to that in the treatment process, improve the
modification for full communication and exchange, in ­satisfaction of medical treatment, and avoid the rework rate
order to achieve satisfactory prosthetic effect. and clinician-patient disputes.
Moreover, the mode of digital telemedicine can also
provide diagnosis and treatment for patients who are 1. Multimedia technology (Fig. 7.12): Multimedia video
inconvenient to come to the hospital, achieve good com- animation or photos can be used to show the treatment
munication results, and improve the medical level in process to patients and communicate well with patients to
remote areas and townships. With the progress and devel- avoid disputes and contradictions in the treatment
opment of dental technology, patients have proposed process.
higher requirements for the quality and effect of oral res-
toration, from the traditional simple treatment of diseases
to now paying attention to esthetic and esthetic effects.
There are higher requirements for the shape, arrange-
ment, and color of teeth, which urges a more clear and
accurate communication between clinicians and patients
in turn. Digital technology can not only well reappear
patient information, analyze the designed restoration, and
provide patients with prediction of prosthetic effect but
also assist clinician-patient communication, transmit
medical knowledge and information, deepen patient
understanding, and improve patient satisfaction.
The three sides are able to communicate through net-
work digital means such as telephone, video, e-mail, and
so on, for example, using colorimeter in clinic to get colo-
rimetric data which can be sent directly to the technician
to create a lifelike restoration, using the intraoral scanner
to obtain the oral information of the patient without mak-
ing an impression, and using computer-aided design and
computer-aided manufacturing technology to make
model. Then, the technician can produce a restoration on
the model without model transmission, avoiding defor-
mation and damage of the model. Since good communi-
cation is an essential condition to ensure the quality and
effect of restoration, clinicians, patients, and technicians Fig. 7.12 Facial scanning

[Link]/Dr_Mouayyad_AlbtousH
240 7 Communication and Cooperation Between Clinicians and Technicians

Fig. 7.13 Digital impression

Fig. 7.14 Operating interface of Beauty Tooth Assistant

2. Electronic medical records: It can completely reflect all convenient for the communication between clinicians
the diagnosis and treatment information of patients, so and patients. The three sides can discuss and commu-
that clinicians can make a reasonable diagnosis and treat- nicate the design effect, determine the final satisfac-
ment plan according to their health status. tory repair effect and the best treatment plan, and
3. Digital impression (Fig. 7.13): It can clearly reappear the improve the satisfaction of prosthetic effect. The com-
oral and maxillofacial conditions of the patients, so that monly used digital line surface analysis and design
the patients have a clearer understanding of their oral software are Beauty Tooth Assistant (Fig. 7.14), Smile
conditions. Then the clinicians need to explain the oral Designer Pro, Digital Smile System, Photoshop,
conditions to the patients in order to make them conceive Keynote, PowerPoint, etc.
a reasonable expectation for the prosthetic effect. Preview steps for esthetic design analysis using digital
4. Digital colorimetry: Use the digital colorimeter to directly techniques and methods (Fig. 7.15).
conduct colorimetry of natural teeth, on the precondition 6. Digital image data: It is convenient for clinicians to con-
that eliminating the interference of objective and subjec- duct research and analysis; facilitate the communication
tive factors in order to improve the accuracy of colorim- between clinicians, patients, and technicians; complete
etry. Meanwhile, show the expected restoration color to transmission of esthetic information; improve the repair
patients. effect; and avoid clinician-patient disputes to a certain
5. Digital analysis and design: Using digital analysis and extent.
prediction software to provide patients with visual 7. Digital occlusal analyzer: It detects the occlusal distri-
foresight of postoperative effects, which can also pro- bution, the occlusal balance, the distribution of bite
vide clinicians with more treatment choice. By loading force, etc., comprehensively and systematically ana-
the oral and maxillofacial photos of the patients and lyzes the patient’s occlusal status, and accurately guides
referring to the anatomical characteristics, carry out clinicians and technicians to design and process the
the digital line surface analysis and design, which is prosthesis.

[Link]/Dr_Mouayyad_AlbtousH
7.4 The Prospect of Digitalization in Clinician-Patient-Technician Communication and Cooperation 241

Fig. 7.15 Esthetic repair

prediction process
First-level Second-level Third-level
Prediction Prediction Prediction

(Figure (Wax Pattern (Intraoral

Prediction) Prediction) Prediction)

nology including VR and AR can be helpful to achieve the

7.4 The Prospect of Digitalization further clinician-patient-technician communication and
in Clinician-Patient-Technician cooperation. VR (virtual reality) uses computer simula-
Communication and Cooperation tion to create a virtual world in three-dimensional space,
providing users with sensory simulations such as vision,
To sum up, good communication among clinicians, patients, hearing, and touch, as if they were in the real world. AR
and technicians is the basis of our clinical work. In clinical (augmented reality) increases the perception of the real
operation, clinicians should think of the patients and take world through the information provided by the computer
their safety as the purpose and as far as possible to reduce the system and overlays the virtual objects, scenes, or system
damage to them. Clinicians and technicians should respect prompts generated by the computer into the real scene,
and cooperate with each other and maintain timely commu- showing the scene that can’t be realized in the real world,
nication. Additionally, proactive perspective-taking creates a so as to achieve the “enhancement” of reality and achieve
harmonious relationship between the three sides to provide a sensory experience beyond reality. From the above, this
better medical services for patients, finally successfully technology can be used in the future to predict the pros-
­realizes the desire of patients’ chief complaint, and reduces thesis and prostheses effect before the actual operation, to
the occurrence of clinician-patient disputes and clinician-­ simulate the patient’s face shape and smile after wearing a
technician disputes. denture, and so on.
Digital technology combines a series of high and new With the development and deepening of digital technol-
technologies, such as electronic information technology, ogy, networking, effect analysis prediction, four-dimensional
material manufacturing technology, and multimedia technol- technology, VR/AR technology, and chairside system will be
ogy, which has brought great changes to the development of popularized to facilitate more intuitive communication and
stomatology. Different digital technologies are applied in all exchange among clinician, patient, and technician. It will
fields and stages of stomatology, which improves the produc- also lead to a new model for clinician-patient-technician
tion accuracy, saves resources and time, facilitates the pres- communication and cooperation and further improve medi-
ervation and transmission of information, and effectively cal quality and patient satisfaction. Nowadays, digital tech-
avoids the disputes between clinicians, patients, and nology has brought a new development direction for dental
technicians. clinical and restoration production, and it will soon enter the
Undeniably, digitization will bring greater revolution all-digital era of high-efficiency and low-energy consump-
and development in the future. Using virtual reality tech- tion in the near future!

[Link]/Dr_Mouayyad_AlbtousH
[Link]/Dr_Mouayyad_AlbtousH
Conclusion

Throughout the history of dentition defect restoration, all kinds of classical restoration technologies can give full
removable partial denture (RPD) restoration technology has play to their strengths and achieve the ultimate goal of “long-­
always been one of the important means of dentition defect term, stable, and effective.” From the perspective of clinical
restoration. More than 90 years ago, normalized RPD practice, guided prosthodontics is the embodiment of digital
appeared in the modern sense, and the casting method was prosthodontics.
used to make RPD framework. Implant-supported RPD-­ The underlying work we need to do now is the “revolu-
combined restoration was adopted 40 years ago; 35 years tion” of the discipline foundation for the future digital resto-
ago, the design expert system of RPD was established. ration. In view of the advantages of digital RPD, it is not
Framework was made with resin wax produced by 3D print- comprehensive to say that RPD is “widely applicable.” More
ing technology and casting technology 16 years ago; 14 accurately, it is theoretically suitable for all dental defects.
years ago, selective laser melting made direct printing of “Cheap” is no longer the label for digital RPD. “Easy to get
metal supports possible. With the rapid development of digi- and wear” is clearly a weakness or a “feature,” but it can
tal technology, the application of various high and new digi- never be an “advantage.” Therefore, the biggest advantage of
tal technologies, like computer-aided design and digital RPD should be “minimally invasive and reversible”
computer-aided manufacture, has directly changed the sub- and the “integration” of various high and new restoration
ject basis of prosthodontics and of course brought new theo- technologies. On the other hand, the application of new digi-
retical thinking. tal composite materials, esthetic clasp and simulation base
In the face of dentition defect RPDS design, today, we can technology, etc. can greatly improve the esthetics of RPD, so
use almost all of the latest technology to restoration the the biggest disadvantages of RPD at present are insufficient
known, such as implant-supported RPD, fixed-removable functional recovery and poor comfort. It is worth noting that
prostheses, the digitized segmented RPD, integration of under the general background of integrated prosthodontics,
PEEK or PEKK RPD, or implant surgery guide and tooth high and new prosthodontics such as implant and esthetics
preparation guide for dentition defect, the principle of reten- are inseparable from the clinical design principles contained
tion and stability support is derived from the design principle in classic restorative methods such as removable restoration
of RPD, fragmented digital restoration cannot effectively and overdenture restoration.
support the integration ability and demand of digital restora- The integrated application of digital technology in the
tion, while the digital RPD is the best entry point for inte- field of RPD has given a new life of RPD. From taking
grated or comprehensive restoration technology. On the one impression to the design and precision machining production
hand, it is because the effectiveness of traditional RPD is in of restoration, constantly optimize the digital operation,
urgent need of improvement, and although “hanging without reduce the cost of digital, from experience to digital, from
dying,” it has been ignored for a long time. Secondly, digita- artificial to intelligence, from man-made slow work to auto-
lization provides an integrated platform and historical oppor- matic production, from personal operation to network AI
tunity for various new restoration technologies, which can expert system to assist decision-making, known or unknown
effectively improve or solve various problems of RPD, mak- future of all kinds of advanced digital technology will con-
ing it an integrated restoration solution more acceptable to tinue to bring new content for digital RPD, constantly enrich
Chinese patients. At present, all kinds of classical restoration and integrated type new scheme of prosthodontics.
technologies have both advantages and disadvantages. Therefore, the digital RPD technology interpreted in this
Digital restoration technology provides new solutions, pos- book combines various digital technologies, adopts innova-
sibilities, and innovations for integrated restoration, so that tive clasp design and digital new material application, and

© Springer Nature Singapore Pte Ltd. and People’s Medical Publishing House Co. Ltd. 2023 243
H. Yu, Digital Removable Partial Denture Technology, [Link]

[Link]/Dr_Mouayyad_AlbtousH
244 Conclusion

shows the new connotation of integrated prosthodontics, take and efficiency of RPD. Also, it is the cognitive basis for fur-
“long-term, stable and efficient” as the goal, realized the low ther learning esthetic restoration and implant restoration,
burden of disease and curative effect of high quality to two or solid understanding of its related basic principles and clini-
more things, balance esthetics and function. It is a minimally cal diagnosis and treatment scheme design, and standardiz-
invasive repair technology to improve the quality, efficacy, ing clinical operation.

[Link]/Dr_Mouayyad_AlbtousH
[Link]/Dr_Mouayyad_AlbtousH