Diagnosis for Complete Denture
Transcript of Diagnosis for Complete Denture
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SEMINAR
Diagnosis and Treatment Planning for Complete Dentures
Dr. Yashpreetsingh A. Bhatia
P Student
Department of Prosthodonti!s " Cro#n " Bridge$
College of Dental S!ien!e " Resear!h Centre
Introduction:
BEFORE DENTURE CONSTRUCTION IS BEGUN, it is vital that a diagnosis and then
a prognosis be made
! thoro"gh diagnosis aids in ma#ing a realisti$ prognosis and the end res"lt is that it
helps to o"tline the treatment that is best s"ited %or ea$h individ"al patient
&Barone ' Diagnosis and prognosis in $omplete dent"re prosthesis J. Pros. Den.
1964;14()*+&)-
Diagnosis, in its broadest sense is an eval"ation o% e.isting $onditions /ore spe$i%i$all0,
it involves identi%0ing, and ma#ing 1"dgements abo"t, depart"res %rom a health0 state
&Cha0tor D Diagnosis and treatment planning %or dent"lo"s or potentiall0 edent"lo"s
2atients 2rosthodonti$ Treatment %or Edent"lo"s 2atients( Complete Dent"res !nd
Implant&s"pported 2rosthesis )3e St 4o"is /osb05 )**6(+(+-&77
Definitions:
Diagnosis: the determination o% the nat"re o% a disease
Prognosis:
a %ore$ast as to the probable res"lt o% a disease or a $o"rse o% therap0
Treatment plan: the se8"en$e o% pro$ed"res planned %or the treatment o% a patient a%ter
diagnosis
Case history: the $olle$ted data abo"t an individ"al, %amil0, environmental %a$tors
9in$l"ding medi$al3dental histor0: and an0 other in%ormation that ma0 be "se%"l in
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G e n e r a l I n f o r m a t i o n
E s t a b l i s h i n g r a p p o r t
H i s t o r y t a k i n g
E x a m i n a t i o n
D i a g n o s i s & P r o g n o s i s
T r e a t m e n t P l a n
anal0;ing and diagnosing $onditions or %or instr"$tional p"rposes5 best termed the patient
histor0
&The glossar0 o% prosthodonti$ terms The Journal Of Prosthetic Dentistry5 )**
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General In%ormation( This $an be $olle$ted b0 dental
assistant
Case No(
Date(
Name(
!ge( !pparent v3s a$t"al
Se.(
2hone No (
So$ial In%ormation(
=no>ledge o% a patient?s so$ial ba$#gro"nd $an help the
dentist "nderstand the patient?s e.pe$tations @ ho> their
dental stat"s has evolved
Ra$e(
O$$"pation(
!ddress o% residen$e(
The first visit:
AThe patients %irst visit is a $r"$ial one be$a"se it is the o$$asion >hen the seeds o%
s"$$ess or %ail"re are so>n
Both patient and dentist approa$h the visit >ith pre$on$eived e.pe$tations as to the
pro$ed"res to be emplo0ed and their anti$ipated o"t$omes
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&arb G istor0 ta#ing, treatment planning, and improving dent"re& bearing areas %or
edent"lo"s patients Prosthodontic Treatment for Edentulous Patients: Comlete
Dentures !nd "mlant#suorted Prosthesis 1$%e St 4o"is /isso"ri5 )*)( hat $an I do to help 0o"
&Barone ' Diagnosis and prognosis in $omplete dent"re prosthesis J. Pros. Den. 1964;14(
)*+&)-
Chief Complaint:
Con$ern o% patient & Com%ort, aestheti$s, %"n$tion and retention dent"res
AIt is ver0 important to listen $losel0 and to observe the patient %or the e.tra verbal and
nonverbal messages that are $oming as %ast as the patient spea#s
&=oper ! The initial intervie> >ith $omplete dent"re patients( Its str"$t"re and strateg0 '
2ros Dent 7+*5 )-3( ith these dent"res9aestheti$s:,
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ADo 0o"r dent"res h"rt 0o" 9$om%ort:
/ / Devan said A>e m"st meet the mind o% the patient be%ore >e meet the mo"th o% the
patient
ental !ttitude:
o"se $lassi%ied patients into %ollo>ing %o"r ps0$holog0 t0pes(&
2hilosophi$
E.a$ting
Indi%%erent
0steri$al
&eart>ell C Diagnosis S0llab"s o% Complete Dent"res 63e 2enns0lvania5 76(*&6)
&!ppleb0 R C et al 2atient eval"ation %or $omplete dent"re therap0 ' 2rosDent(
7+*()63(&+
"# Philosophical:$
Ideal
Understanding Do not "nne$essaril0 $riti$i;e
The0 $orre$tl0 interpret their problems neither overstating nor "nder e.pressing
%# E&acting:$
/ethodi$al, pre$ise and a$$"rate
Demanding
Can be managed i% handled properl0
I% he is intelligent and "nderstanding, he $an be the best t0pe5 ho>ever i% he la$#s
intelligen$e and "nderstanding e.tra ho"rs spent prior to treatment in patient ed"$ation isthe best treatment plan
'# Indifferent:$
No $on$ern Not interested
4a$# motivation
2a0 no attention to the instr"$tions
Non $ooperative
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(# Hysterical:$
Emotionall0 "nstable
E.$itable, h0pertensive
Gr"mbling even >ith little things
2atients having %amil0 problems or ps0$hologi$al dist"rban$es "s"all0 %all into this
$ategor0
)# Critical:$
Find %a"lt >ith ever0thing that is done %or them
Never happ0 >ith their previo"s dentist
Fail"re to re$ogni;e this $ategor0 o% patients ma0 $a"se immense problems %or the
ine.perien$ed dentist
E.er$ise %irm $ontrol over these patients Dentist m"st dire$t all the treatment @
de$isions !dvise medi$al $ons"ltation
*# +keptical:$
ave had bad res"lts >ith previo"s treatment
!re do"bt%"l i% an0one $an help them
O%ten in poor health
Un%avorable oral $onditions
Cond"$t a thoro"gh e.amination ta#ing more time than "s"al, sin$e $are and attention to
detail at this time >ill help the patient to develop $on%iden$e in the dentist
edical History:
It provides important insights regarding patients dental prognosis
! patient in good general health is generall0 able to a$$ept and ad1"st to a $omplete
dent"re better than one >ho is in poor health
&Beeson 2 The mo"th e.amination o% %or $omplete dent"res( ! revie> ' 2ros Dent
7+*5 )-3
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&! different imression techni'ue may (e indicated. )maller teeth and a smaller food
ta(le should (e considered* and eriodic ad+ustments are usually re'uired.,
&Beeson 2 The mo"th e.amination o% %or $omplete dent"res( ! revie> J. Pros. Dent.
7+*5 )-3 relations are di%%i$"lt to re$ord and repeat
Aeberdens nodes involving terminal 1oints o%
%ingers di%%i$"lt %or patient to insert @
$lean dent"res
-ral alignancies:$
Radiation therapist and s"rgeon sho"ld be $ons"lted
Dent"re sho"ld be "sed on limited time basis, depending on rea$tion o% tiss"es
Pemphigus:$
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Oral m"$osa J e.tremel0 pain%"l
Constant "se o% dent"res is $ontraindi$ated
.eurological disorders:$
eg Bells 2als0, 2ar#insons Disease
Tremor, rigidit0, slo>ness o% movement, and post"ral
instabilit0 Di%%i$"lt0 in re$ording 1a> relation and Dent"re retention
Thyroid disorders:$
/ental attit"de and ph0si$al abilit0 ma0 be a%%e$ted
!$$ording to Shriber, an e.$ess o% th0roid s"bstan$es and derivatives in the %orm o%
medi$ation $an $a"se rapid alveolar resorption and lo> tiss"e toleran$e
&Shriber, 'D Blood $hemistr0 & a diagnosti$ aid in dent"re prosthesis, ' 2ros Dent5
7n allerg0 sho"ld be re$orded
I% !llerg0 to monomer present & Cast metal dent"res
4ate., Ni$#el
enopause:$
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Bone $hanges J generalised osteoporosis
Emotional dist"rban$es
2atient m"st be treated ps0$hologi$all0 %irst
Drug History:
I0 1erostomia 2dry mouth#:$
!ntihistamines J Benadr0l
!tropine, belladona
!ntih0pertensives
Nitrogl0$erin
!ntips0$hoti$ dr"gs 3 Tri$0$li$ antidepressants3 antian.iet0 agents
!mphetamines
De$ongestants
II0 Possible ucosal Changes:$ Dilantin
!drenal $orti$osteroids
III0 +ialorrhea:$
Cholinesterase inhibitors & /0asthenia gravis
!drenergi$ stim"lating dr"gs J Epinephrine
Sialogog"es J 2ilo$arpine
I30 Dysphagia:$
2henothia;ine derivatives Belladona derivatives
!ll agents that lead to .erostomia $an $a"se D0sphagia
30 Postural hypotension:$
Nitrogl0$erine
Di"reti$s
Sedatives
Tri$0$li$ antidepressants
3II0 /ronchial spasm, bradycardia, and dyspnoea:$
Can $a"se di%%i$"lties in managing the patient d"ring dent"re $onstr"$tion
Inderal J blo$#ing agent "sed to prevent arr0thmia in heart patient
3III0 Hypoglycaemic shock:$
Ins"lin
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I10 /ehavioural changes 4 confusion:$
2atient a$$eptan$e o% dent"res ma0 be a%%e$ted
!drenal $orti$osteroids J %or arthritis, allergies
!nti 2ar#insonism agents J eg artane, a#ineton, nor%le.
Digitalis and related $ardia$ gl0$osides& eg digo.in, digito.in
10 .ausea and vomiting:$
!spirin
!nalgesi$s
Digitalis
1I0 !nticoagulants:$
eparin, di$"marol, $o"madin
Cons"lt ph0si$ian
Dental History:
"0 Duration of edentulousness:$
Ca"se %or the tooth loss eg periodontal diseases, $aries,
and tra"maet$
Se8"en$e o% tooth loss
%0 Denture History:$
Reason %or the repla$ement
2atients opinion abo"t dent"re
/aterial "sed %or dent"re base
No o% previo"s dent"res >ith d"ration
E.isting dent"re eval"ation
Kag"e $omplaints, sometimes $ontradi$tor0, and not 1"sti%ied b0 e.amination o% the
present prosthesis & indi$ation o% a problem patient >ith "nrealisti$ e.pe$tations
E&isting denture evaluation
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3ague complaints, sometimes contradictory, and not 5ustified by e&amination of the present
prosthesis $ indication of a problem patient 6ith unrealistic e&pectations0
Pre$e&traction Records:
"0 Pre$e&traction photographs:$
7ront photograph: Fa$ial s0mmetr0 and %orm
4ip %"llness, 4ip $ompeten$e 3 in$ompeten$e
Kisibilit0 o% teeth and gingivae
Dental midline
Nasolabial %old
Chara$teri;ation
Profile photograph:
Fa$ial pro%ile Kerti$al dimension o% lo>er third o% %a$e
%0 Radiographs:
-P8:
Si;e and shape o% teeth
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Dental midline
Canine and molar relation
9ateral cephalogram 4
Fa$ial pro%ile,
Kerti$al proportions o% %a$e,
2osition and in$lination o% teeth,
Over1et, overbite,
Orientation o% o$$l"sal plane and its relation >ith palatal plane and mandib"lar plane
'0 Dentulous Casts:
!r$h( shape, si;e and s0mmetr0
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Si;e and shape o% teeth
Over1et, overbite
Dental midline
Cross bite
Kestib"lar depth
8eneral E&amination:
AThe eval"ation o% the patient begins at the time o% his %irst $onta$t >ith the o%%i$e
&=oper ! The initial intervie> >ith $omplete dent"re patients( Its str"$t"re and strateg0 '
2ros Dent 7+*5 )-3(
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!uare!uaretaperin
g
Tapering"#oid
%0 7acial form:
-ouse and oo* /rush and /isher and 0illiams $lassi%ied %a$e %orm as(
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traight Prognathic
$etrognathic
'0 7acial profile:
Hhile observing the pro%ile, dentist sho"ld as# the patient to J Sit "pright
Het the lips
2la$e them into light $onta$t and
Rela.
Fa$e observed b0 a side vie>
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(0 uscle tone
o"se $lassi%ied the m"s$le tone as(
Class I( Normal tension, tone and pla$ement o% the m"s$le o% masti$ation @ the %a$iale.pression No Degeneration 9Immediate dent"re patients:
Class II( Normal m"s$le %"n$tion b"t slightl0 de$reased m"s$le tone
Class III( De$reased m"s$le tone and %"n$tion Us"all0 a$$ompanied >ith ill&%itting
dent"res, de$reased verti$al dimension, de$reased biting %or$e, >rin#les in the $hee#s anddrooping o% the $ommiss"res
&o"se, / / Relationship o% oral e.amination to dental diagnosis ' 2ros Dent5l7rin#ling aro"nd the modiol"s o% the mo"th and the
vermilion border o% the lip >ill be >ea#, t"rned in,
and not ver0 visible
Restoration o% lip s"pport and vermillion border
>idth m"st be $onsidered d"ring pla$ement o%
anterior teeth
I% the anterior teeth are set too %ar ling"all0 or palatall0, lips >ill la$# the ne$essar0
s"pport
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%lass III& short
%lass I &normal
%lass II &long
9ip 9ength:
4ip length is $lassi%ied as (&
9ip thickness:
Thi$# lips J need lesser s"pport %rom the arti%i$ial teeth and the labial %lange
Thin lips J rel0 on the appropriate labioling"al position o% the teeth, %or their %"llness
and s"pport
9ip fullness:
Related to s"pport it gets %rom the m"$osa or dent"re base and the teeth behind lipsRelated to s"pport it gets %rom the m"$osa or dent"re base and the teeth behind lips
!n e.isting dent"re >ith an e.$essivel0 thi$# labial %lange $o"ld ma#e the lip appear to
be too %"ll
9ip mobility:
Class I( normal lip mobilit0Class I( normal lip mobilit0
Class II( red"$ed lip mobilit0Class II( red"$ed lip mobilit0
Class III( paral0sis 9eg stro#e vi$tims, Bells pals0:Class III( paral0sis 9eg stro#e vi$tims, Bells pals0: "nilateral mo"th droop and %a$ial"nilateral mo"th droop and %a$ial
as0mmetr0as0mmetr0
2atients ma0 be $o"nseled regarding treatment limitations >hen dealing >ith s"$h ph0si$al
$hallenges
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Other>ise patients ma0 have "nrealisti$ e.pe$tations regarding %"n$tional and estheti$
res"lts
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*0 Temporomandibular 5oint e&amination:
Che$# mo"th openingChe$# mo"th opening
Che$# %or tenderness, $li$#ing or $repit"sChe$# %or tenderness, $li$#ing or $repit"s
Smoothness o% mandib"lar movementSmoothness o% mandib"lar movement
Severe 1oint pain $an indi$ate a severe dis$repan$0 in KDOSevere 1oint pain $an indi$ate a severe dis$repan$0 in KDO
0 .euromuscular evaluation:
E.amination o% spee$h @ ne"rom"s$"lar $o&ordination
+peech:
Classi%ied J b0 abilit0 o% the patient to arti$"late and $oordinate
T0pe ( Normal Capable o% prod"$ing an arti$"lated spee$h >ith their e.istingT0pe ( Normal Capable o% prod"$ing an arti$"lated spee$h >ith their e.istingdent"resdent"res
T0pe )( !%%e$ted Impaired arti$"lation or $oordination o% spee$h >ith their e.istingT0pe )( !%%e$ted Impaired arti$"lation or $oordination o% spee$h >ith their e.isting
dent"resdent"res
2atients >hose spee$h >as altered d"e to a poorl0&designed dent"re re8"ire more time to
adapt to a proper arti$"lated spee$h in the ne> dent"re
.euromuscular Coordination :
The patient is to be observed %rom the time he3she enters the $lini$
Gait, $oordination o% movements, ease o% movement, steadiness are important pointsGait, $oordination o% movements, ease o% movement, steadiness are important points
to be $onsideredto be $onsidered
!bnormal %a$ial movements li#e lip sma$#ing, tong"e tremors, "n$ontrollable!bnormal %a$ial movements li#e lip sma$#ing, tong"e tremors, "n$ontrollable
$he>ing movements $an in%l"en$e $omplete dent"re per%orman$e and ma0 also lead$he>ing movements $an in%l"en$e $omplete dent"re per%orman$e and ma0 also lead
to prostheti$ %ail"reto prostheti$ %ail"re
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&Kive# R et al Diagnosis and prognosis in $omplete dent"re patient & a s0stemati$ revie>
"ndian Journal of 2esearch; )*-( +( -&)*
Intra oral e&amination:
: So%t tiss"e e.amination): ard tiss"e e.amination
+oft tissue e&amination:$
ucosa:
Colo"r( Coral pin# 3 Redness
Condition(
o"se $lassi%ied the $ondition o% the m"$osa
as(&
Class I( ealth0 m"$osa
Class II( Irritated m"$osa
Class III( 2athologi$ m"$osa
&o"se, / / Relationship o% oral e.amination
to dental diagnosis J Prosthet Dent;
l7ith red"ndant
tiss"e This re8"ires tiss"e treatment S"$h $ondition ma0 re8"ire s"rgi$al $orre$tion
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Kariation in tiss"e thi$#ness ma#es it di%%i$"lt to e8"ali;e press"re "nder the dent"re and
to avoid soreness
Thinning o% the tiss"es L depleted repair potential renders dent"re bearing m"$osa o% the
basal seat %riable and easil0 tra"mati;ed
Border atta$hment(
Class I( !tta$hments a>a0 %rom $rest o% ridge !t least *<
in$hes distan$e bet>een the atta$hment and $rest o% the ridge
Class II( Distan$e *)< to *< in$hes
Class III( Distan$e less than *) in the mandible >ith respe$t
to the $rest o% the ridge
94o$ated a>a0 %rom the $rest o% ridge:
Class)( medi"m 9nearer to the $rest o% ridge:
Class-( %reni en$roa$h on the $rest o% the ridge and ma0
inter%ere >ith the dent"re seal S"rgi$al $orre$tion ma0 be
re8"ired
So%t palate
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Class I( ori;ontal $"rving do>n>ards
/ost %avorable as more s"r%a$e area $overed %or retention @
>ider seal area
/"s$"lar a$tivit0 minimal
/ore than n>ard sharpl0 at +*oo angle Greater movement o% so%t palate d"ringangle Greater movement o% so%t palate d"ring
%"n$tion and the narro>er seal area& hen$e less %avorable%"n$tion and the narro>er seal area& hen$e less %avorable
K&shaped palatal va"lt & $lass IIIK&shaped palatal va"lt & $lass III
Flat palatal va"lt & $lass I or $lass IIFlat palatal va"lt & $lass I or $lass II
2ter0gomandib"lar raphe
Behind ham"lar not$hes & signi%i$ant >hen prominentBehind ham"lar not$hes & signi%i$ant >hen prominent
Can displa$e dent"re J re8"ires relie% in e.treme $asesCan displa$e dent"re J re8"ires relie% in e.treme $ases
Tong"e(
o"se $lassi%ied tong"e %orm as(
Class ( tong"e is normal or ideal in development, si;e, and
%"n$tion ! s"%%i$ient n"mber o% nat"ral or arti%i$ial teeth are
properl0 distrib"ted to maintain the normal %orm and
%"n$tion o% the tong"e
Class )( the nat"ral teeth have been absent %or a s"%%i$ient
period to permit a $hange in the %"n$tional a$tion and %orm
o% the tong"e
Class -( tong"e is e.$essivel0 large !ll, or pra$ti$all0 all, o%
the teeth ma0 have been absent %or an e.tended period o%
time, or there ma0 be an abnormal development o% the si;e o% the tong"e Ine%%i$ient
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dent"res sometimes $reate a Class - $ondition in the %"n$tional a$tion and %orm o% the
tong"e
Tong"e position(
Classi%i$ation a$$ording to Hright
Normal
Class ( Retra$ted
Class )( Retra$ted
&/aller SK ! revie> on diagnosis and treatment planning %or $ompletel0 edent"lo"s
patients J"!D) 5 )**(3)(n>ard and
is e.posed ba$# to the molar area The lateral borders are raised above the o$$l"sal plane
and the ape. is p"lled do>n into the %loor o% the mo"th
Class )( Retra$ted( The tong"e is ver0 tense and p"lled ba$#>ard and "p>ard The ape. is
p"lled ba$# into the bod0 o% the tong"e and it almost disappears The lateral borders rest
above the mandib"lar o$$l"sal plane The %loor o% the mo"th is raised and tense
Floor o% mo"th(
Hide variation in anatom0 and %"n$tional relation to the ridge $rest
I% near the ridge $rest at rest or the magnit"de o% movement is great& retention and stabilit0
poor
I% %loor o% the mo"th &ver0 high and $lose to the ridge $rest, ma0 spill over the ridge andeliminate the alveoling"al s"l$"s I% these tiss"es $annot be sele$tivel0 pla$ed b0 the dent"re
%lange, the prognosis o% mandib"lar dent"re poor
Saliva(
Class I( The saliva is normal in amo"nt and $onsisten$0
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Class II( There is an e.$essive amo"nt o% thin, >ater0 saliva or thi$#, rop0 saliva
E.$essive saliva ma0 $a"se gagging and >ill "s"all0 $ompli$ate impression ma#ing
Class III( Ins"%%i$ient saliva red"$es the retentive 8"alities o% the dent"re and ma0 $a"se
an e.$essive dr0ness o% the m"$osa
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Hard tissue e&amination:
!r$h si;e(
Dent"re bearing area in$reases >ith ar$h si;e @ in$reases retention
Dis$repan$0 bet>een the mandib"lar and ma.illar0 ar$h si;e & di%%i$"lties in arti%i$ial
teeth arrangement and de$rease the stabilit0 o% the dent"re resting in the smaller one o%
the t>o ar$hes
!r$h %orm(
2la0s a role in s"pport o% a dent"re and in tooth sele$tion
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%lass I
%lass II
%lassIII
!uare
'&shaped
(lat hortIn#erted
(lat
In#erted )&shaped
In#erted*
TallIn#erted
Maxi
llary
Mandibular
Ridge $onto"r :
Resid"al ridge 9$ross se$tional: $onto"r
Ideal ridge & >ell developed high ridge >ith broad $rest and parallel sides T0pes based
on shapes(
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Ridge relation(
The positional relation o% the mandib"lar ridge to the ma.illar0 ridge
& G2T
/a.illa resorbs& "p>ard and in>ard
/andible resorbs& do>n>ard, %or>ard, and laterall0
Class I ( Normal
Class II( Retrognathi$
Class III( 2rognathi$
Inter ar$h spa$e(
Small amo"nt o% inter ridge distan$e leads to di%%i$"lt0 in setting teeth and maintaining a
proper %ree>a0 spa$e !lso #no>n as inter ar$h spa$e and $an be $lassi%ied as (&
Class ( Ideal inter&ar$h spa$e to a$$ommodate the arti%i$ial teeth
Class )( E.$essive inter&ar$h spa$e
Class -( Ins"%%i$ient inter&ar$h spa$e to a$$ommodate the arti%i$ial
teeth
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Ridge parallelism(
Ridges that are not parallel& $a"se movement o% the bases >hen teeth o$$l"de be$a"se o%
"n%avorable dire$tion o% %or$es
/!NDIB4E
ard palate(
U&shaped palatal va"lt( most %avorable %or retention @ lateral stabilit0
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K&shaped va"lt( less %avo"rable %or retention
Flat palatal va"lt( also "n%avo"rable
K& shaped va"lt( asso$iated >ith Class III so%t palate
Flat palatal va"lt( "s"all0 asso$iated >ith Class I or Class II so%t palate
Bon0 prominen$es
Kis"al e.amination & %ollo>ed b0 man"al palpationS"l$"s areas, the ridge $rest and slopes @ palatal areas are palpated
/idpalatal raphe & 2rominent in some individ"als
Bon0 spi$"les and sharp ridge $rest & Res"lt o% resorption
2alatal %oramen& Borders are sometimes raised and sharp
2rominent genial t"ber$les& Res"lt o% e.treme resorption
Bon0 %ragments& Fra$t"red d"ring e.tra$tion Fo"nd o$$asionall0 e.tr"ding thro"gh
m"$osa
Fra$t"red root pie$es& O$$asionall0 %elt 1"st belo> m"$osa
Tori
Classi%ied as(& Class ( !bsent or minimal in si;e Do not inter%ere >ith dent"re $onstr"$tion
Class )( /oderate si;e /ild di%%i$"lties in dent"re $onstr"$tion and "se
Class -( 4arge tori Compromise %abri$ation and %"n$tion o% dent"res
0perplasti$ tiss"e(
Hhen present "nder ill %itting dent"res it ma0 present as an ep"lis %iss"rat"m, papillar0
h0perplasia or h0perplasti$ %olds
2atient sho"ld be instr"$ted to rest the tiss"es b0 not >earing the e.isting dent"re
2roper oral h0giene and tiss"e massage
E.isting dent"re sho"ld be re%itted >ith a tiss"e $onditioning or temporar0 relining
material
4ast resort is s"rgi$al $orre$tion
Radiographic E&amination:
Con$l"sions rea$hed in vis"al and e.plorator0 e.aminations o% the dent"lo"s patient m"st beveri%ied b0 roentgenograms and, in 8"estionable $ases, %ollo>ing $ons"ltation >ith the
patients ph0si$ian, b0 laborator0 and ba$teriologi$ e.aminations
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M"alit0 o% Bone(
Retained roots( Sho"ld be advised %or e.tra$tion
Impa$ted teeth(
O2G
2anorami$ radiographs also aid in determining the amo"nt o% ridge resorption
Hi$al @ S>oope advo$ated meas"ring the distan$e %rom the in%erior border o% the mandible
to the in%erior margin o% the mental %oramen and then m"ltipl0ing it b0 -, the res"ltant prod"$t is a reliable estimate o% the original alveolar ridge $rest height
Class I( /ild resorption, is a loss o% "pto one third o% the original verti$al height
Class II( /oderate resorption, is a loss %rom one third to t>o thirds o% verti$al height
Class III( Severe resorption, is a loss o% t>o thirds or more o% verti$al height
CT S$an
9aboratory Reports:
O$$asional0, >e ma0 need to advise the patient to "ndergo vario"s laborator0 tests to s"pport
o"r $lini$al and radiographi$ %indings These lab reports in$l"de(
Fasting @ post pranidial blood s"gar
Bleeding time, $lotting time, prothrombin time, platelet $o"nt J Bleeding disorders
b level J anemia
istologi$al e.amination J pre $an$ero"s lesions, $ar$inoma, pemphig"s, et$
Urine e.amination & 1a"ndi$e
Diagnosis:
2atient has $ompletel0 edent"lo"s "pper @3or lo>er edent"lo"s ar$h9es: and >ith all other
aspe$ts e.amined @ $onsidered, $on$l"sion %or the best treatment possible is made
Treatment planning:
/at$hing possible treatment options >ith the patient needs and s0stemati$all0 arranging the
treatment in order o% priorit0 b"t in #eeping >ith a logi$al or te$hni$all0 ne$essar0 se8"en$e
Re8"ires & broad #no>ledge o% treatment possibilities @ detailed #no>ledge o% patient
needs
Driven b0 diagnosis, prognosis, patient health, and attit"des into a$$o"nt
Hh0 treatment plan
Treatment Options
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!d1"n$tive Care(
Elimination o% in%e$tion
Elimination o% pathoses
S"rgi$al improvement o% dent"re s"pport @ spa$e
Tiss"e $onditioning
N"tritional $o"nselling
PR-+TH-D-.TIC C!RE
7or potentially edentulous patients
Removable Partial Denture
Conventional
Interim
Transitional
Complete Denture
Immediate or $onventional
De%initive or interim
Tooth, implant or so%t tiss"e s"pported
PR-+TH-D-.TIC C!RE
7or completely edentulous patients:
Complete dent"re
So%t tiss"e s"pported3 Implant s"pported
Removable3 Fi.ed
Refusal of Treatment
Respe$t patients >ishes and in$l"de it in the treatment plan >henever possible
Sometimes, a patients demands are "nreasonable or against pro%essional 1"dgment or
ethi$s
Dentist ma0 re%"se treatment or re%er him to another dentist %or a se$ond opinion
Prognosis:
!%ter $onsidering all %a$tors J an e.perien$ed dentist m"st be able to predi$t the degree
o% s"$$ess that $an be e.pe$ted Give patient a %air idea o% the possible o"t$ome that $an be e.pe$ted
In$l"des a reali;ation b0 the patient o% >hat $an and $annot be a$hieved
4eads to more realisti$ e.pe$tations and less %r"stration
Conclusion
! s"$$ess%"l restoration does not 1"st happen& it is planned
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Thoro"gh diagnosis enables "s to ma#e a realisti$ prognosis
These data aid in o"tlining the treatment that is best s"ited %or the individ"al patient, ie
>e plan s"$$ess
References:
: Barone ' Diagnosis and prognosis in $omplete dent"re prosthesis J. Pros. Den. 7656( )*+&)-
): Cha0tor D Diagnosis and treatment planning %or dent"lo"s or potentiall0 edent"lo"s
patients Prosthodontic Treatment for Edentulous Patients: Comlete Dentures and
"mlant # suorted Prosthesis 13%e St 4o"is /osb05 )**6(+-&77
-: The glossar0 o% prosthodonti$ terms The Journal Of Prosthetic Dentistry. )** ' 2ros Dent
7+*5 )-3