diagnosis & treatment plan

Diagnosis & Treatment plan FOR COMPLETE & REMOVABLE

PARTIAL DENTURE

2Definition

Diagnosis : is the determination of the nature of the disease.

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Diagnosis

Patient interview Clinical Examination• Purpose of

treatment.• Shared decision

making.

• Extra-oral examination

• Intra-oral examination

4Patient InterviewThe dentist should follow the sequence that includes:1. Chief complaint and its history.

2. Medical history review.

3. Dental history review specially related to prosthetic experience .

4. Patient expectations.

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Mental attitude:(House classification) Philosophical Exacting Hysterical Indifferent

6First classification (House classification)…

Class 1 -Philosophical patient

a. Those who have presented themselves prior to the extraction of their teeth, have no experience in wearing artificial dentures and do not anticipate any special difficulties in that regard.

7Class II – Exacting patient

a. Those who, while suffering ill health, are seriously concerned about the appearance and efficiency of artificial dentures. They are, therefore, reluctant to accept the advice of the physician and the dentist and are unwilling to submit to the removal of their natural teeth.

8Class III – Hysterical patient

a. Those in bad health with long neglected pathological mouth conditions, and they are dento-phobic and submit to the removal of their teeth as a last resort and who are positive in their minds that they can never wear artificial denture

9Class IV – Indifferent patient Those who are unconcerned about their appearance and feel very little or no necessity for teeth for mastication. 'They are therefore non-persevering, and will not maintain the dentures probably and do not appreciate the skill and effort of the dentist. They are managed to survive without dentures.

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Clinical History & Examination

11 General information Medical history Dental history

Extra-oral examination Intra-oral examination Radiographs Diagnostic cast

12General Information –

A. Name

B. Age/gender

C. Occupation

D. Race

E. Address

F. telephone contact number

13Medical HistoryAn accurate history must be obtained and conditions linked to complete denture treatment must be noted to arrive at a particular treatment plan and care of the dentures thereafter.

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Clinical examination

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Extra-oral Examination

Intra-oral Examination

Visual Examination

16Extra-oral Examination

1– Facial Form

172– Facial profile

183-Symmetry

symmetrical Asymmetrical

194– Facial Height

Normal facedecreased Increased

206– Lip Examination

Lip support Lip mobility Thickness of the lip Length of the lip Health of the lip

217– Complexion: (the skin color)Dark/fair/medium/ruddy..

228- TMJ Examination

1. Examine range of joint movement.

2. Pain.

3. Muscles of mastication.

4. Joint sounds upon opening and closing.

239-Neck Examination

Palpate the neck for any lymph node enlargement which may mean some indication of oral cancer.

2410- thyroid gland palpation

Don’t forget to ask the patient to swallow during palpation.

2511- Mouth opening

2612-Neuromuscular Examination

• Speech (scanning, hot potato, slurred..)• Gait• Coordination( cerebellar disease )• Tremor (Parkinson’s)• Tics (habitual spasmodic contraction).• Muscle examination (tone-power-movement-wasting).

27Intra-oral Examination

28Residual alveolar ridge

1. Ridge size2. Ridge form3. Ridge contour4. Ridge relation5. Ridge parallelism6. Ridge defects

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Ridge size should be observed for two reasons:-

1. Denture bearing area increases with arch size and in turn increases the retention.

2. Discrepancy between the mandibular and maxillary arch sizes can lead to difficulties in artificial teeth arrangement and decreases the stability of the denture resting in the smaller one of the two arches.

Size

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Play role in the support of the denture & in the selection of teeth

Arch Form

31Ridge relation

refer to the anterior posterior relationship between the ridges

32Tuberosity

Palpate for undercuts - if extreme, denture might not seatIf enlarged with fibrous tissue surgical reduction to make room for dentures

33Bony Defects

Bony Protuberances:

Extra-bone on the lip and cheek side of the ridge is called an EXOSTOSIS. These are almost always need to be removed if being fitted for dentures. They are quite routine to remove, and most of the time can be removed at the same time the teeth are extracted

34Bony Undercut:

35Tori

36Mucosa:

Color of the mucosa Condition of the mucosa (healthy-irritated-

pathologic) Thickness of the mucosa

37Gag reflex and palatal sensitivity:

• A patient protective gag reflex can compromise a dental treatment plan if the reflex is an active one.

• The cause of which can be due to systemic disorders, psychological, extra oral, intraoral, or iatrogenic factors.

• The management of such case is through clinical, psychological, pharmacological means.

38Tongue examination

• Tongue size

• Position ( next slide )

• Lateral border

• Ventral surface

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favorable retruded tongue position

Favorable tongue position improves stability and retention of the mandibular denture

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• The lateral border of the tongue

• The ventral surface

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the shape of the vault of the palate should be examined

Hard Palate

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Some oral lesions

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Oral Lichen Planus

44Chronic Candidiasis

45Angular Cheilitis

(secondary to chronic candidiasis)

46Inflammatory Fibrous Hyperplasia

47(Epulis Fissuratum)

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The quality and quantity of the saliva are crucial factor in the patient ability to tolerate the denture since both the flow rate and viscosity are important to the denture success.

Thick ropy saliva tend to dislodge dentures, while thin saliva or low salivary flow tend to provide an insufficient film for the retention or lubrication of the saliva.

Saliva:

49Radiographs:Used to detect:

1. Areas of infection and other pathologies

2. The presence of root fragment, bone spicules and irregular ridge formation.

3. The relative amount of alveolar bone loose.

50Diagnostic cast:

Supplement oral examinationPermit a topographic survey of the

dental archPatient education and motivationCustom tray fabricationConstant referencePatient’s record

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Treatment PlanTreatment plan : is the sequence of the procedures planned for the treatment of a patient after diagnosis.

52Development of treatment plan:

Phase |

Collection & evaluation of data

Pain, infection control

Biopsy

Patient motivation

53Phase ||

Removal of deep caries

Extirpation of necrotic pulp

Extraction of non-retainable tooth

Periodontal treatment

54Phase |||

o Pre-prosthetic surgical procedures

o Definitive endodontic procedures

o Definitive restoration of teeth

55Phase |V

Construction of removable partial denture OR compelet denture.

56Phase V

• Post-insertion care.

• Periodic recall.

• Reinforcement of education and motivation of the patient.

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Thank you