# Creating a Monolithic Partial Denture
## Introduction
[0] Probably one of the easiest things that we could print same day for our patients is a quick little monolithic partial denture. These are really fun to make, very, very efficient, and could print in just about fifteen to twenty minutes. You will be your patient's hero if they come in with no tooth and it's an emergency. Maybe they snap the tooth off at the gum line and you need to extract and graft and give them something. This is a good option for them. So let me show you how we do this.
## Setting Up in Exocad
[26] First thing we're gonna do in Exocad is go to default client, and just let's just call this monolithic. And I'm gonna go ahead and just, pick tooth number eight. We're gonna call it atomic panic, three d print, and virtual gingiva, yes. We're gonna click that. And I'm gonna click okay. That's it. That's the only setting that I'm gonna worry about. I'm gonna hit save and go to design.
[55] Actually, one thing that we could do and we could do it I wanna show you how to do an expert mode, which is the copy mirror. You could do it there in the setup tab, which will prompt you in the wizard, but we'll do it in expert mode so you know. Let me go here. I'm gonna go find my mono my case that I need to do my monolithic flipper on. Let's see.
## Designing the Denture
[90] Okay, I'm gonna load up my upper and my lower. And the very first thing in Exocad, like always, step number one is to rotate the model and look straight down on the ridge here. And looking at the occlusal surfaces, right down the incisal edge, and you see a little bit of the buccal of the anteriors as well, and hit next. It wants me to pick the path of insertion of my partial denture.
[113] Now this is the virtual surveyor. This is really important to determine fit of your partial denture. You see the salmon colored band? This is as if you put this on a surveyor and set the tilt, and this is the lead pencil line right here. All this salmon color represents blockout wax or severe undercuts in relation to the tilt that we select.
[135] When we rotate the model and hit set from view, the angulation of the block out changes. The survey lines change instantly, and you could see the survey lines. So what for me in this particular case, one thing that I wanna mention is when you do have single tooth potential space, it's kind of important to set the tilt of the model, straight down center over the ridge like this.
## Adjusting the Model
[160] And also splitting the difference of the guide plane. So, for example, you don't want it to be like this because then look, it's gonna add a ton of block out on the guide plane of the contralateral tooth. You wanna be just perfectly straight down over that adenctial space. Okay? You want an equal amount of blockout wax on the guide plane areas of the of the adjacent teeth. And in the anterior, if you are gonna clasp the anterior buccal, you do want the blockout wax to be in the right location.
[192] Now, one thing that if you are gonna do lingual plating, you do not want to have blockout wax up onto your occlusal surfaces. So when we look at this tilt, we do wanna make sure that our tilt line here is such that you don't have such a drastic amount of blockout wax on your premolars, which I am going to be actually plating, which I recommend for printed prosthetics. Okay. So that looks really good.
## Finalizing the Design
[220] Now, we're we're gonna go ahead and look at our bottom properties. 30 microns default for spacer, which is good. 17% smoothing is pretty good. Anywhere between 517%. Seventeen % would be the maximum. Tool diameter, because we're printing a hundred microns, if you're milling, you could drag that up to your burr size plus 200 microns. Allow a hundred microns. That's good just in general for a, printed partial denture to start with. And so what we're going to do is hit apply.
[252] And what exocad is going to do is duplicating this model and applying all these changes to it to create something called the virtual wax up bottom. That's this little tab right here. And it's the virtual wax up bottom. This is the most important thing to determine fit because this is actually what the model fits to, the virtual wax up bottom is what your partial is gonna fit to. It does not fit to your intraoral scan. It fits to this.
[279] Now if you just went ahead and hit next, your your partial will just slide in and out loosey goosey. It'll be terrible for the patient. We need to go back and add selective retention and reciprocation on various different strategic areas to, make this not only, more stable in the mouth, but also, something that's gonna be retentive but safe. So it's not putting too much pressure on any given tooth. So the way that I like to do that is go to freeform right here.
## Adding Retention
[310] And I'm gonna go ahead and on my add remove tool, the first thing I like to do is my primary retention, which is my clasp teeth. Let's just let's just say I'm gonna clasp this lateral. I wanna go ahead and go back to the, just for the clasp tip in this embrasure space, I'm gonna hold my shift button down and click and melt back the block out wax to the original tooth, location right here. So if you look, the software has added bunches of block out waxes. You could see here. That's what this green all this stuff right here is tons and tons of wax to ensure a ultra passive fit of your prosthesis.
[353] The only area I want to actively engage this lateral is the clasp tip of my, buccal clasp right here. And so everything else I wanna leave with the standard blockout. I also want to engage some secondary retention here, 200 microns. So I'm gonna go to my lingual. Now 200 microns might not seem like a lot, but on this scale here, you see red as 200 microns. It's a lot.
## Final Adjustments
[384] In fact, if you didn't wanna clasp this tooth at all, you could come here and engage 200 microns strategically here and have enough click with the, prosthetic to where it snaps in. However, I like belts and suspenders. I like backup plans plans, b and c. So I'm gonna actually class this tooth here and have secondary retention here, And that looks really good to me. One thing that you wanna make sure is that you do have some area on your guide plane, coronal to or incisal to your block out wax so that you have a good seal. K. That looks really good. So I'm gonna go ahead and hit next.
[425] And now it wants me to place a tooth, but instead of doing that, I'm gonna go to expert mode, right click on my model, and I'm gonna go to copy mirror. I'm gonna click the mirror image right here and have direct copy. Click right there on number nine. Come right over here to this edentulous space and just click, and it's going to actually place that tooth. You have all your tools to be able to manipulate where that tooth is in space. Control to rotate. Click it to move it.
## Conclusion
[469] Okay. Once we have our tooth kind of the way that we want it in the position roughly the way we want it, we're gonna click okay. And we're gonna go back to our wizard. Okay. Now we're in the free forming tab. And in this tab, I like to, do very few manipulations, especially if you're mirror imaging things. You don't want to spend a lot of time changing the shape of a mirror imaged tooth away from the natural shape. So all I like to do is hit cut all intersections and that's gonna cut my static occlusion, my pontic pressure, and my proximal contact. That's that cut all intersections button.
[521] And it looks like it cut everything perfectly fine, just like that. And, if I go to my settings under my adapt, you could see my basal's at zero. My static occlusion's at a hundred plus 100 microns, which means a hundred microns out of occlusion, which is after we apply the glaze or the candy coat, it's gonna be perfect. And my proximal contact set is zero which means, no binding on the interproximal. So that looks great.
[542] Now if you wanted to you could go ahead and, put this in the virtual articulator. This is a good time to do that. Expert mode, tools, articulator, assuming you have that module in exocad. It's gonna go ahead and attempt to position this. It might be very far off from what you see here. So I'm just gonna go ahead and go to automatic right here, and I click, let me turn off my scan and my tooth.
[573] If you if you wanna turn them off, you could hit these buttons up here, turn things on and off, or you could just hit a for s for scan, a for antagonist, f for full contour on your keyboard. Right? So you could turn things on and off that way. And I I go to this patient only has three incisors. So I'm gonna go like right to the middle of one of those incisors. Go to the mesial buccal of 18, mesial buccal 31, and hit perform alignment. And it's gonna try to put that into Bachwell's triangle, which just goes by averages.
[610] It's better than nothing. It would be better to have, like, a, say, a face scan that you had pinned to this previously where you could actually use anatomical landmarks, but this is just gonna gonna get you by in a jam. Okay. So we have that. We're gonna hit okay. I'm gonna hit fix by cutting away intrusions, and then I'm gonna hit start movements. It's gonna go ahead and go through average movements, and I'm gonna click okay.
[639] So now I'm going to go right back to my wizard and I'm right back in my free forming tab. However, now if I come over here I have this dynamic button. And I just want to make sure in protrusion, let me turn that dynamic off, I'm going to hit lower here, which means my lower is going to move. I'm going to turn on my lower and I want to look. I'm going to hit my include healthy as well.
[663] I just wanna make sure that when I slide, my partial is not the only thing hitting. I want it kinda to be out of occlusion, which it is, but let me make it bad so in case you guys have one that's bad. Let me just add a bunch of material here. Yeah. Let's say my dynamic's like that. How do I fix it? Well, it's really easy. Okay? So the first thing I like to do, let me just cut my static occlusion, so it'd be more like you guys. So, I go to my adapt dynamic, and I want it to cut the dynamic away.
[704] I'm gonna go to 220 microns. Okay? And I'm going to hit this little arrow, and I'm going to hit exclude selected parts, and I want to protect my static occlusion mark. So I'm going to turn off my dynamic here, and I'm just going to paint a little ball around my static, two little static occlusion spots, and I'm gonna say protect those. I also wanna protect my incisal edge because I don't want the software to grind my incisal edge shorter.
[732] Okay. So I got that protected. Now, check this out. I'm gonna turn on my dynamics so you can see what we're doing. It is going I'm gonna hit the dynamic button now. It's gonna slice that all away. So I have perfect little tracks kind of pre burnt into my tooth so that now, guys, when I slide in protrusion here, I have no interferences. Look at that. Watch. Immediate disclusion.
[759] And in this particular patient, we're riding heavy on the cusp, is a little bit on this lateral. And then we pick up tooth number nine right here. But nothing on our partial denture tooth. So we're golden there. And so let's just check ourselves. I have, let me look, my proximal contacts are oasis blue color, like a lagoon blue. That's perfect. My static occlusion is a perfect true blue, which is 100 microns out of occlusion.
[790] When I turn on dynamic, I don't have big tracks of dynamic, interferences. And my tissue pressure is true blue, which is, basically zero microns, and I look underneath, I don't have a pontic sticking through. That's because, we did that adapt basal. Okay? If you have pontic coming through, you have not adapted your basal. So now I have a perfect pontic here. I like it. So I'm gonna go ahead and hit next.
[818] Okay. So now we draw our major and minor connectors in clasp. This is super easy. In this particular case, I'm gonna start in the embrasure space of my premolar. But notice there's block out wax in that embrasure. Just what that means is that you're not gonna have sharp little spikes of your three d print or your prosthesis going into tight little embrasure spaces, which is really nice.
[845] So I'm gonna go ahead and start curving the gentle horseshoe, and I'm gonna hide it into this rugae. Now when you're new to printing and you're new to design, you tend to, like, make these so skinny. Like, I let me just show you what you guys tend to do. Let me clear it. You guys tend to do stuff like this. Like, you make these they look like honestly, I think you think that the materials are, like, super have, like, miraculous powers.
[881] And you print these, like, little slivers like this, and it basically is gonna last until the patient gets to the parking lot. You're like, yeah, man. Let's go. It's super slender. This is worthless. You you need to understand a few basic parameters here. Let me clear this. Number one. When you're designing for printing, you need big, broad surfaces with lingual plating. Here, I'm actually gonna stop at the premolar, so I'm gonna drag these balls back here like that.
[918] Now when you lingual plate, not only do you wanna be off of the block out wax, which if I go over here and I turn on my block out wax, see the little icon right there? I could see it. Wanna be off of your block out wax, so that's sealed onto those two surfaces, but then also you have to worry about your occlusion. So you could hit a for antagonist and turn that on. See? Now, when you get to your Pontic site, turn that off by hitting f on your keyboard.
[949] And your guide plane should be mid proximal or one millimeter lingual to mid proximal. For printed, I like it to be mid proximal. What does that mean? It means if you split this tooth buccal lingually right in half, that line will fall right on that. Then I have to decide where do I want my tissue and clots to be. So I'm gonna go ahead and give me a little little tissue collar here for strength. Remember, everything is about strength with printing.
[977] I'm gonna go ahead and give me a fin for this clasp apical to the blockout if I can. Yeah. Apical to the blockout. And then I'm gonna drop the tip of the clasp right in that blockout where we remove the blockout. And then as I start to curve around, I want it to be just right along this blue line right here. See the blue line? That meant that means zero block out Following that blue line, we turn off that tooth right up to mid proximal again, and then I'm gonna start my lingual plating. Let me turn on my antagonist.
[1024] Dropping down here for occlusal issues. Yeah. Each ball is clickable and movable. And then double click when you get back to the first ball. There we go. Now for a monolithic partial denture, how thick can you have it? Well, 1.5 millimeters, unfortunately, is the thinnest you'd ever wanna go for a monolithic partial denture, and that is if you're using the latest generations of materials, that are more tough like Onyx tough two or rodent titan or materials like that.
[1060] We're gonna go ahead and accept this, but if you didn't like an area, you could move a green ball and hit apply. Or if you wanted to change the thickness, you could drag the thickness. Let's say you wanted it beefy, like this person is just breaks everything. Go to two and hit apply. You can make it beefier. And the whole thing will be exactly two, which is a split file. Unfortunately, we have to go to, we have to go to too often, which is beefy.
[1093] But for this, we're gonna go to 1.5, and notice our cervical thickness is one. I'm gonna hit next. So now we have the ability to sculpt the tissues, and this is where people spend a lot of time on unnecessarily. The only thing that you wanna do is go to your free, smooth, and hold your shift button down and flatten the lingual border here where the tongue would meet that seam to make it as thin as possible. Do not be tempted to thin anything else out. You will have a compromised partial.
[1120] To thin anything else out. You will have a compromised partial. And then the last other area that we thinned, I'm gonna put my brush size on small, and I'm not gonna hold shift down. I'm gonna thin the tip of my clasp, and I like to have the green band here, and the orange band be about the same thickness. So it's looking pretty good. Just like that. Only the tip. And then right up here where the lip would meet that border, I'm gonna thin it. It won't let you get thinner than one unless I hit this desired thickness button and keep bottom boundary fixed.
[1161] Then I could actually get thinner than one and make it even smoother. Just be careful because if you do do this, there's a good chance you could not only be, you could actually be changing the fit and other things, as it relates to the thickness. It could be almost unprintable if you make it too thin where you have, like, a jaggedy print. So be careful if you do that. Okay. I'm gonna go ahead and hit next, and that is the end. We are done. What it's gonna do is actually going to slice the whole thing to print. Let me turn off these colors. Let me turn off true smile.
[1196] Look at that. Check that out, guys. That is our little this is the way it fits. So, like, look. This this is actually a real gap. That's that's the way it's gonna fit because of what? If it's the block out model, not the intraoral scan. So if you don't like that because you have some personal problems or you want everything to be perfect, you have to change your block out settings. I like this. I want it to click in and snap in and only touch where I want it to touch as far as it relates to providing pressure.
[1224] And this is the settings that I use for my patients, and I love it. Lot less stress put on the teeth. It's gonna click in and be tight. That is perfect. Now if you want to add, like, a patient name or anything like that, you could go to, freeform restorations at the end. You could go for you could do a few cool things. You could turn on your show distances here and go switch to show, distance to scan data.
[1261] And I'm gonna put this on hundred microns. You could add a bead line, which is a little pressure on the tissue. It's a little bit thick of a bead line, but I'm gonna go go for it. 200 microns is all you want. See the colors? 200 microns is red. This red orange, once you start to get into yellows and greens, it's too strong based off of this color setting. Okay? See that the scale changes the colors. So that's that's what you need to understand.
[1293] This is also where you could add extra retention or remove retention. For example, you could turn on your scan. You gotta be careful here because you make it not fit, but you could be like, I don't know what you would ever do here, but you could, like, you could make it tighter there. But you look. You gotta be careful. Your distance to scan data, if it's 200 microns on a hard tissue surface, it might not see.
[1321] But what we normally do in this tab is we go to attachment, subtract, all the way down under the library to text. Oops. I don't wanna load from file. You can though. You could like cut like, a sports team logo in there or something. But we're gonna just hit text, and I'm gonna just type in the patient's name. And you come right over and you'll click it. And once you click it, you could drag it, and you could hold control and rotate it.
[1349] Now as a general rule, the thickness should be about point eight depending on the thickness of your partial, and the size is anywhere between four and five, five being much easier to print, and you hit apply. And it's gonna slice the name into the prosthesis, and hit next, and you wanna save that. Now check this out. Let me turn off my colors. We have WALL E. Cut in. Now what you do clinically is you print this bad boy, and then you take a color like blue or like Empress Direct resin stains, like blue or gray or pink even from Anax Dent red,
[1380] And you just paint it in the grooves and press with a gloved hand into the area and the resin would flow into that area and you cure it with the light and it's gonna be a perfect little name, in the prosthesis. Alright. So that that is how easy it is to create a little monolithic flipper. Stay tuned for some other videos like split file and things like that.
