Dr. Varun Jaiswar1, Dr. Anuradha Mohite2, Dr. Jyoti Nadgere3, Dr. Janani Iyer4

1Post-graduate student

2Associate Professor

3Professor & Head of Department

4Professor

Department of Prosthodontics and Crown & Bridge, Mahatma Gandhi Mission's Dental College and Hospital, Navi Mumbai

 

ABSTRACT

Rehabilitation of partially edentulous patient can be challenging in Kennedys Class I and Class II situations. Dental Implant and removable partial denture can be planned in such cases. In case of excessive bone loss and uncontrolled systemic conditions, implants are contraindicated. Cast partial denture (CPD) is the treatment of choice for such patients. Cast partial dentures (CPD) can also be fabricated using a Hybrid technique to speed up procedure. This case series presents, case reports of patients in which a Hybrid technique was used for fabrication of cast partial dentures.

Key Words - Digital Dentistry, Aesthetic clasp, Cast partial Denture, Hybridization.

Citations: Jaiswar V, Moite A, Nadere J and Iyer J. Hybridization of Cast Partial Denture fabrication: A Case series. J Prosthodont Dent Mater 2023;4(1):77-.84.

 

INTRODUCTION

The partial edentulism affects the remaining teeth and the musculature around. The muscles of mastication loose tonicity which affects speech, facial expression and mastication. Cast partial denture (CPD) is the treatment of choice for such patients.1 CPD fabrication is divided into three phases: the planning phase (diagnosis), mouth preparations, and designing of the partial denture.2,3 Fabrication of CPD is costly, time- consuming. CPD can be also fabricated using a Hybrid method by incorporating digital technology. Hybrid method not only speed up the procedure but also patient compliance and satisfaction4.

 

CASE REPORT 1:

A twenty-six-year-old male patient reported to the Department of Prosthodontics and Crown & Bridge, with chief complaint of an unpleasant smile due to missing teeth in the upper anterior region. Patient gave history of trauma 10 years back and extraction of the anterior teeth. On examination, teeth missing 11, 12, 13, 21, 22 in maxilla and in mandible teeth missing 42 and rotation seen with 41,43. Radiographic examination revealed that remaining teeth were sound and no pathology. Various treatment options were discussed with patient including implants. Patient opted Cast partial denture. Cast partial replacing11, 12, 13, 21, 22 was planned with aesthetic clasps on 14 and 23. Primary impression were made with Condensation silicone ( Zhermack , Zetaplus )for maxillary arch and alginate( Zhermack ,Tropicalgin) for mandibular arch.

Figure 1: Mouth Preparation and Intraoral Scan

Figure 2: Evaluation of Scan and 3D printed model

Figure 3: Metal Framework trial with Esthetic clasps and Try-in

 

I Intraoral scans of the teeth and other oral tissues were obtained and 3D models were printed utilizing the intraoral scans after mouth preparation on these models CPD was fabricated according to the design and aesthetic clasps were added in the anterior region on 14 and 23(fig 2 & 3).

Fig 4: Final Cast Partial Denture Insertion

Fig 5: Pre - Operative and Post – Operative

 

CASE REPORT 2 :

A seventy-three-year-old male patient, reported to Department of Prosthodontics and Crown & Bridge, with chief complain of difficulty in chewing due to multiple missing teeth in both upper and lower jaws. Patient gave history of multiple extractions due to caries and mobility. On examination, completely edentulous maxillary arch and missing teeth 31, 32, 36, 37, 41, 42, 47 in the mandibular arch. On Radiographic examination, all the other remaining teeth were sound and no pathology was present. Various treatment plans were discussed with patient including dental implants for fixed prosthesis. Patient gave history of diabetes and was under medication. Considering the patients age and systemic condition and financial constraints of the patient, option of implants was ruled out. An upper arch complete denture and lower arch cast partial denture was planned.

Figure 6: Digital Designing of the Cast Partial Denture

Primary impression was made impression compound (DPI,India ) of maxillary arch and alginate (Zhermack, Tropicalgin) for mandibular arch. Mouth preparations were done as per designing. CPD was designed accordingly (fig 6).

Figure 7: Metal Framework trial and Jaw Relation

Border molding was done using low fusing impression compound and final impression was made using zinc oxide eugenol (DPI, India) for impression of maxilla and condensation silicon for mandible.

Figure 8: Try - in of upper Complete Denture and lower Cast Partial Denture

Figure 9: Processed maxillary complete denture and mandibular cast partial denture

Figure 10: Pre-operative and Post – operative

 

DISCUSSION

Innovative techniques like CAD-CAM, 3D Printing, newer impression materials, presents precise prosthesis to the patients. Incorporation of these digital techniques have improved and fasten the manufacturing of CPD, over conventional fabrication10

Digital technology have certain drawbacks like it cannot record tissues in function, hence using a hybrid technique for certain steps of conventional fabrication and certain steps of digital fabrication can be used, to fasten fabrication of CPD .10 The digital workflow of a CPD fabrication helps in surveying, designing the CPD, and manufacturing by 3D printing or milling. The final impressions can be made conventionally, recording the tissues in a functional state and then scanning the impression and transferring it to digital workflow11,12

Direct metal production system improves the productivity, reducing the workflow load and manufacturing costs of the CPD. Digital production is environment friendly as it decreases the wastage of wax, metal alloy, and the investment materials. The remaining uncured metal powder after sintering can be recycled for reuse. Digital designs can be saved in database. Saving digital designs facilitates their transfer between dentists and technicians and also useful if new denture to be made for patient12.

Hybrid technique not only speed up the fabrication process but also improves the fit of the prosthesis, which improves the aesthetics and masticatory efficiency

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