Diagnosis for Complete Denture

8/15/2019 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


24/33

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


25/33

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


27/33

%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


31/33

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


32/33

!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


33/33

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

Diagnosis for Complete Denture

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