DENTAL TECHNIQUE

Fabricarea unei proteze parțiale detașabile care combină tehnici

convenționale și digitale
Kyung Chul Oh, DDS, PhD,a Jeongho Jeon, CDT,b and Jee-Hwan Kim, DDS, MSD, PhDc

With the advancements in ABSTRACT

cOmputer-aided design and Acest articol descrie un procedeu de lucru combinat convențional și digital pentru fabricarea protezelor parțiale
cOmputer-aided manufacturing detașabile (RPD). După scanarea mulajului dentar și a ansamblului cadrului RPD, dinții artificiali și regiunile de
(CAD-CAM) and additive bază ale protezei au fost proiectate cu ajutorul unui software de proiectare asistată de calculator. Ansamblul
manufacturing technOlOgy, re- dinților artificiali și al bazei protezei a fost frezat ca o singură structură cu ajutorul unui disc de ceară și apoi a
fost plasat pe cadrul RPD. Dinții artificiali au fost frezați suplimentar dintr-un disc de polimetilmetacrilat. Au
pOrts On remOvable partial fost urmate procedurile convenționale pentru proteză investiție până la procedura de eliminare a cerii, după care
prOsthodOntics have fOcused On ansamblul a fost înlocuit cu dinții artificiali în copefia de flasculat, iar materialul de rășină protetică a fost
the methods Of fabricating injectat pentru a prelucra RPD. Această tehnică a permis ca RPD să fie fabricată în aceeași formă ca în starea de
remOvable partial denture proiectare. (JProsthetDent2021;125:588-91)
(RPD) framewOrks.1-3 In addi-
tion, studies investigating the fit
Of the RPDs have been cOnducted at the framewOrk limitations may exist in establishing prOper inter-
level, many of which included a framew Ork fabricated occlusal relationships. Hence, this repOrt describes a
using additive manufacturing.4-7 method invOlving digital techniques fOr the steps
HOwever, the authors are unaware of repOrts us- fOllOwing the cOnventional framewOrk fabrication,
ing digital techniques in the steps that fOllOw the thereby enabling RPD fabrication with custOm artifi-
framewOrk fabrication: artificial tOOth arrangement cial teeth.
and resin base fabrication. The wOrkflOw fOr resin-
based remOvable cOmplete denture fabrication can
be achieved by using a digital technique alOne or by TECHNIQUE
fOllOwing cOnventional prOcedures. HOwever, fabri-
cating an RPD requires the cOnstruction Of a metal 1. Fabricate the RPD framewOrk and evaluate its
framewOrk. Thus, a single-step digital wOrkflOw fOr adaptation On the cOrrespOnding dental cast
RPD prOduction has nOt been achieved because RPDs (Fig. 1).
cOmprise 2 different materials e acrylic resin fOr the 2. After applying blOckOuts On the dental cast where
denture base and metal fOr the framewOrk e and required, scan the dental cast and RPD framew Ork
simultaneous fabrication Of the metal and acrylic resin assembly by using a desktOp scanner (Identica T500;
parts is limited with the current technOlOgy. There- Medit CO) and save the scanned file in the standard
fOre, the cOnventional prOtOcOl has been applied fOr tessellation language file fOrmat.
artificial tOOth arrangement and denture base design. 3. ImpOrt the standard tessellation language file intO
As cOmmercial artificial resin teeth are prefabricated, the CAD sOftware (exOcad DentalCAD; exOcad

K.C.O. and J.J. contributed equally to this work. Supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT)
(grant number 2018R1C1B6005989).
a
Clinical Assistant Professor, Department of Prosthodontics, Yonsei University College of Dentistry, Seoul, Republic of
Korea. bCertified Dental Technician, Central Dental Laboratory, Yonsei University Dental Hospital, Seoul, Republic of
Korea. cAssociate Professor, Department of Prosthodontics, Yonsei University College of Dentistry, Seoul, Republic of
Korea.

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588 THE JOURNAL OF PROSTHETIC DENTISTRY

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April 2021 589

Figure 1. Dental cast with removable partial denture framework adapted.

Figure 2. Arrangement of artificial teeth and definition of denture base
regions in CAD software. CAD, computer-aided design.

Figure 3. Fabrication of artificial teeth and denture base assembly in single structure. A, Milling of artificial teeth and denture base assembly using wax. B, Artificial
teeth and denture base assembly adapted to dental cast.

GmbH), arrange the artificial teeth, and define the

denture base regions (Fig. 2).
4. Fabricate the artificial teeth and denture base as-
sembly as a single structure by using a wax disk
(Easymill Wax; High Dental KOrea) and a milling
machine (M4 Wet Heavy Metal Milling Unit; Zir-
kOnzahn). Evaluate its adaptation On the RPD
framewOrk placed On the cOrrespOnding dental
cast (Fig. 3). The thickness Of the denture flange
area can be increased, if necessary, by adding wax
(Pinnacle mOdeling wax; Dentsply SirOna).
5. Fabricate the artificial teeth by using a pOlymethyl
methacrylate disk (VIPI BlOck Trilux; Dental VIPI
Ltda) and a milling machine (M4 Wet Heavy Metal Figure 4. Additional fabrication of artificial teeth using polymethyl
Milling Unit; ZirkOnzahn) (Fig. 4). methacrylate disk.
6. Place the artificial teeth and denture base assembly flasks and place the artificial teeth in an inverted
On the RPD framewOrk and fOllOw the cOnventional
manner intO the cOpe of the flasks (Fig. 5).
prOcedures fOr denture investment. After the wax 7. Inject the denture resin material (IvOBase Hybrid;
elimination prOcedure, remOve the artificial teeth IvOclar Vivadent AG) by using the injection mOlding
and denture base assembly frOm the cOpe of the technique tO prOcess the RPD (Fig. 6).

Oh et al THE JOURNAL OF PROSTHETIC DENTISTRY

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590 Volume 125 Issue 4

Figure 5. Key procedures for combination technique. A, Dental cast with artificial teeth and denture base assembly embedded in cope of flask. B, Cope of flask wax
eliminated. C, Artificial teeth placed into cope of flask.

Figure 6. Final procedures. A, After injection of denture resin material using injection molding technique. B, Definitive RPD adapted onto
corresponding dental cast. RPD, removable partial denture.

RPD framework fabrication

Scanning of dental cast and RPD framework

Artificial tooth arrangement and denture base

design using CAD software

Milling of Milling of artificial

artificial teeth and denture base assembly tooth parts using
as single structure using wax disk PMMA disk

Placement of Placement of
artificial teeth and denture base assembly PMMA-based artificial tooth parts in
on dental cast inverted manner

Investment of dental cast and Removal of

wax elimination procedure wax-based artificial
teeth and denture base
assembly
Fabrication of RPD
using injection molding technique

Figure 7. Schematic diagram of combined conventional-digital technique for fabrication of RPDs. Blue boxes indicate conventional procedures for RPD fabrication; green
boxes indicate digital procedures for RPD fabrication. Boxes with red border are key features of technique: artificial teeth and denture base assembly replaced with artificial
tooth parts in denture-processing procedure. RPD, removable partial denture; CAD, computer-aided design; PMMA, polymethyl methacrylate.

THE JOURNAL OF PROSTHETIC DENTISTRY Oh et al

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 April 2021
Table 1. Advantages and disadvantages of combined conventional and digital
workflow for fabricating removable partial dentures
Advantages Disadvantages
More favorable interocclusal Possible inferior wear resistance compared
relationship with conventional denture teeth
Virtual occlusal adjustment Not fully digitalized
Flexibility in selecting materials
for denture teeth
Strong bond between metal
framework and resin base
8. Finish the RPD with rOtary instruments (Tungsten
Carbide Cutters; NTI-Kahla GmbH) and pOlish it
with a pOlishing medium (Pumice; Whip Mix COrp)
On a wet rag wheel (Leather buff f Or acrylics; Bre-
dent) mOunted On a dental lathe (Dental POlishing
Lathe; KaVO Dental) and with pOlishing brushes
(COttOn buff and Leather buff; Bredent).
DISCUȚIE
Tehnica descrisă a urmat protocoalele convenționale
pentru procedurile de fabricare a cadrului și de
prelucrare a protezei și a folosit abordarea digitală
pentru aranjarea dinților artificiali, proiectarea
regiunilor de bază ale protezei și fabricarea de
componentelor într-o etapă intermediară (Fig. 7).
Această tehnică are mai multe avantaje (tabelul 1).
Personalizat pot fi proiectați dinți artificiali
personalizați, permițâ nd o relație interocluzală mai
favorabilă . Ajustarea ocluzală se realizează virtual în
cadrul software-ului CAD, economisind potențial timp
de laborator și clinică dentară . Comparația RPD
definitiv cu designul inițial este prezentată folosind ca
exemplu software-ul de metrologie (Geo- magic Control
X; 3D Systems) (Fig. 8). Tehnica oferă , de asemenea,
flexibilitate în selectarea materialelor pentru dinții
artificiali; pentru frezare pot fi selectate materiale
ceramice de zirconiu sau de ră șină . La pacienții care
necesită reabilitarea unei zone edentate anterioare,
ansamblul unitar poate fi utilizat în interiorul gurii
pacientului pentru a evalua estetica și poate fi ușor
modificat dacă este necesar. Se creează o legă tură
puternică între structura metalică și baza de ră șină,
deoarece au fost urmate procedurile convenționale
pentru investirea protezelor. Cu toate acestea, tehnica
actuală are limită ri, inclusiv faptul că a utilizat dinți
frezați a că ror rezistență la uzură poate fi inferioară
celei a dinților artificiali convenționali pentru proteze.
Sunt necesare studii pentru a evalua dacă duritatea
dinților artificiali frezați dintr-un disc de PMMA este
comparabilă cu cea a dinților artifici din ră șină
prefabricați, disponibili în comerț.
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591
Figure 8. Superimposition of initial design and definitive outcome of RPD
using metrology software. Artificial teeth are within tolerance range (±200
mm; shown in green in color map). RPD, removable partial denture.
REZUMAT
Tehnica descrisă a permis finalizarea RPD în aceeași
formă ca și starea de proiectare. Dinții artificiali pot fi
personalizați folosind o gamă largă de materiale, ceea
ce poate optimiza relația interocluzală .
REFERINȚE
Han J, Wang Y, Lu P. Un raport de proiectare preliminară a structurilor
protetice pentru proteze parțiale detașabile utilizând un pachet software
dezvoltat în mod specific. Int J Prosthodont 2010;23:370-5.
1 Williams RJ, Bibb R, Rafik T. O tehnică de fabricare a modelelor
pentru structurile de proteze parțiale detașabile utilizând mulaje
digitalizate și topografie electronică. J Prosthet Dent 2004;91:85-8.
2. Eggbeer D, Bibb R, Bibb R, Williams R. Computer-aided design and
rapid prototyping of removable partial denture frameworks Proc Inst
Mech Eng H 2005;219:195-202.
R. Computer-aided design and rapid prototyping of removable partial
denture frameworks Proc Inst Mech Eng H 2005;219:195-202.
3. Tregerman I, Renne W, Kelly A, Wilson D. EVALUAREA
scheletelor de proteze parțiale detașabile fabricate prin 3 tehnici diferite.
J Prosthet Dent 2019;122:390-5.
Wilson D. EVALUAREA scheletelor de proteze parțiale detașabile
fabricate prin 3 tehnici diferite. J Prosthet Dent 2019;122:390-5.
4. Arnold C, Hey J, Schweyen R, Setz JM. acuratețea protezelor
parțiale detașabile fabricate prin CAD-CAM. J Prosthet Dent
2018;119:586-92.
protezelor parțiale detașabile fabricate prin CAD-CAM. J Prosthet Dent
2018;119:586-92.
5. 6. 6. Lee JW, Park JM, Park EJ, Heo SJ, KOAK JY, Kim SK.
Precizia unei proteze parțiale detașabile digitale fabricate prin turnarea
unui model rapid PROTOTYPICAL: Un studiu clinic. J Prosthet Dent
2017;118:468-74.
6. Wu J, Wang X, Wang X, Wang X, Zhao X, Zhang C, Gao B. Studiu
privind metoda de fabricare a cadrului protezei parțiale detașabile prin
proiectare asistată de calculator și PROTOTIPARE rapidă. Rapid
PROTOTYPING Journal 2012;18:318-23.
Autor corespondent:
Dr. Jee-Hwan Kim
Universitatea Yonsei Colegiul de Stomatologie
50-1 Yonsei-ro, 50-1 Yonsei-ro,
Seodaemun-gu, Seul 03722
April 2021 591
REPUBLICA COREA
Email: jee917@yuhs.ac

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