DENTAL TECHNIQUE

Digital scanning to aid guiding plane and rest seat

preparations for removable partial dentures
Robert W. Loney, DMD, MS,a Chris J. Lee, DDS, MSc,b and Pierre-Luc Michaud, DMD, MSc, FRCD(C)c

Rudd et al1 have outlined the ABSTRACT

rationale and protocol for pre-
This article describes the use of a digital intraoral scanner to aid clinicians making rest seat and
paring rest seats and guiding guiding plane preparations, simplifying the procedure and reducing the time needed to analyze the
planes prior to fabricating a cast abutment modifications. No additional equipment is required other than a diagnostic cast and a
removable partial denture digital scanner with preparation comparison software. (J Prosthet Dent 2017;-:---)
(RPD). Proximal guiding planes
reduce the possibility of food entrapment between the TECHNIQUE
tooth and framework, aid in stabilizing the partial denture
against lateral forces, reduce wedging stresses, and pro- 1. Make a diagnostic cast.
vide some retention.1-3 Rests provide support to prevent 2. Place the cast on a cast holder, select a path of
injury to soft tissues under partial dentures and maintain insertion by using a surveyor, and design an RPD,
the attached clasp assemblies in the proper position.1 Both determining locations for rest seat and guiding
the guiding plane and the rest seat preparations can be plane preparations. Mount the cast on a tripod for
challenging.4,5 future reference for the path of insertion.
Preparing parallel planes on the axial surfaces of RPD 3. With the cast still on the cast holder at the proposed
abutment teeth can be difficult and time consuming.6-8 path of insertion, prepare the diagnostic cast with
Typical solutions to these problems use verification de- ideal guiding planes and rest seats. Use burs, hand
vices,4,9,10 matrices,11 indexes,6,12 reciprocating handpie- instruments, or surveying tools such as the surveyor
ces,13 intraoral surveyors8,14 and paralleling devices7,10,15 wax carving tool to create parallel guide planes by
and the time-consuming use of impressions and casts16 scraping gently against the cast in designated areas
to evaluate abutment modifications. (Fig. 1).
In addition to guiding planes, ensuring that the 4. Scan each prepared abutment on the cast sepa-
preparation of rest seats is of adequate depth with respect rately, and save each scan separately as a master
to the opposing occlusion is also difficult. Practitioners preparation, using preparation comparison software
have shown difficulty preparing rest seats of adequate (Cerec Omnicam and prepCheck software; Dentsply
depth with regard to ideal dimensions.5,17,18 Sirona). Do not scan the entire arch, because the
Although most digital scanners can be used to analyze software will take too long to perform the analysis.
preparations for complete coverage restorations, the au- In this technique, guiding planes are not compared
thors are unaware of information for assisting with abut- with each other but rather with the ideal guide
ment tooth preparations for RPDs. This article describes plane(s) on the same tooth on the prepared cast.
their use for analyzing and preparing abutments, simpli- 5. In the prepCheck software, define the crown margin
fying the procedure, and reducing the time required. arbitrarily as the free gingival margin. Because the

a
Professor and Chair, Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada.
b
Assistant Professor and Director, General Practice Residency, Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University,
Halifax, Nova Scotia, Canada.
c
Assistant Professor, Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada.

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Figure 1. Cast with prepared parallel guiding planes. Figure 2. Gingival margin traced on scanned cast.

Figure 3. Occlusal table traced on scanned cast. Figure 4. Tooth from cast defined as master preparation for comparison.

gingival margin is not visible interproximally, select the

marginal ridge contact areas between the teeth (Fig. 2).
Similarly, define the occlusal table of the crown
preparation arbitrarily as a line connecting cusp tips
and marginal ridges (Fig. 3). Making these designa-
tions is arbitrary but will allow the prepared tooth to be
designated as a master crown preparation that can be
used to evaluate intraoral preparations (Fig. 4).
6. Perform the intraoral preparations. Prepare and
compare both the guiding plane and the rest seat
on 1 tooth before proceeding to other abutments.
a. Starting with the first tooth, use the prepared cast
on the surveyor to help orient the bur for guiding
plane preparations. Prepare the guiding plane(s) as
closely to the selected path of insertion as possible. Figure 5. Analysis of prepared tooth with inadequate reduction shown
b. Scan the intraoral guiding plane preparation on in green.
the first tooth and open the scan in the preparation
comparison software. Compare it with the scan of indicate areas that require additional reduction,
the corresponding prepared tooth on the cast. and the red areas indicate excessive preparation.
Areas of adequate, insufficient, or excessive prep- Moving the cursor over these areas will provide a
aration will be rendered in corresponding colors. quantitative value of how much the intraoral
Using prepCheck software, the blue areas indicate preparation deviates positively or negatively from
adjustments of proper dimensions, the green areas the ideal preparation on the cast (Fig. 5). It is better

THE JOURNAL OF PROSTHETIC DENTISTRY Loney et al

- 2017
Figure 6. Ideal guiding plane with adequate reduction in blue and slight
divergence in red.
for guiding planes to slightly diverge toward the
occlusal surface. If in doubt, prepare the guiding
planes with slight excess divergence to ensure they
draw (Fig. 6).
c. Make adjustments intraorally to improve the
guiding plane preparation as required.
d. Rescan and re-evaluate using the comparison
software and repeat until a satisfactory guiding
plane preparation is achieved for the first tooth.
e. Prepare and analyze the rest seat on the same
tooth before moving to the other abutments.
7. Complete all abutment preparations sequentially in
a similar manner.
8. Make a definitive conventional or digital impression
to fabricate a removable partial denture framework.
DISCUSSION
One advantage of the described technique is that prep-
arations can be completed efficiently one tooth at a time.
Because the comparison is made with the ideal tooth
prepared on the cast and not between abutments intra-
orally, the authors who developed this technique found
the evaluation of preparations to be easier and more
objective. The comparison software provides the visual-
ization of location and amount of tooth structure to
be altered. Parallelism, preparation proportions, and
undercuts are straightforward for assessment, using the
described technique. Rescanning a tooth that requires
additional adjustment takes minimal time and does not
involve additional laboratory steps.
One disadvantage of the described technique is that it
requires preparation comparison software that is not
packaged with all scanners. Another minor disadvantage
Loney et al
3
is that most existing software is designed for crown
preparations and requires that a margin and an occlusal
table are defined artificially to make comparisons
between cast and intraoral preparations. Future modifi-
cations of software could remedy these problems.
SUMMARY
This report describes a technique using a digital intraoral
scanner to prepare and evaluate rest seat and guiding
plane preparations for removable partial dentures. The
technique is efficient, requires no additional laboratory
steps, and provides objective display of preparation
parameters.
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Corresponding author:
Dr Pierre-Luc Michaud
Dalhousie University
Faculty of Dentistry
5981 University Ave
PO Box 15000
Halifax, NS, B3H 4R2
CANADA
Email: PL.Michaud@Dal.ca
Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.
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