Purpose of Dental Treatment: is to respond to the
patient’s needs both
1. Those perceived by the patient and
2. Those demonstrated through the clinical
examination and pt. interview.
The fundamental objective of pt. interview is to listen carefully to what the pt. has
stated in order to gain a clear understanding of why the pt. is presenting to this
evaluation (chief complains).
Prosthodontics
Dep. College of
Dentistry University
of Mosul
Diagnosis and Treatment
Planning for Removable Partial
Denture Patients
Dr. Inas Aziz M. Jawad
The achievement of the patient’s dental treatment includes 4 distinct
processes:
1. A systematic pt. interview to understand the pt. desires and chief complaints
and history behind them.
2. A diagnostic clinical examination to ascertain the pt. dental needs.
3. Developing a treatment plan that reflects the best management of desires and
needs.
4. Executing (accomplishing) appropriately sequenced treatment plan.
What does involve the patient interview?
1. Clinical symptoms of pain
1. Difficulty with function
2. Appearance
3. Problems with an existing prosthesis
4. Symptoms related to the teeth, periodontium,
jaws or previous dental treatment.
5.
Oral habits (Bruxism, Clenching & t
hrusting )
Definition of Removable
Partial
Denture
(RPD):
Prosthesis
that
replaces
some teeth in a partially
dentate arch. It can be
removed from the mouth and
replaced at will.
The formats of the pt. interview should
follow a sequence:
1. Chief complaint and its history
2. Medical history review
3. Dental history review, (especially
related to previous prosthodontic
experience)
4. Pt. expectations.
Shared decision making:
The dentist responsibility is to help the pt. to participate in a process of identifying
the best decision for course of treatment.
:
A complete oral examination should precede any treatment decision.
I-
Preliminary
diagnostic appointment
(to determine the need for management of
acute needs). It should be accomplished in the following sequence:
1. Visual evaluation of teeth, periodontium and residual ridge (by instrumentation,
visual examination and palpation). The objectives are to reveal:
many of the signs of oral and dental diseases like caries, and tooth
sensitivity to percussion ( may be due to tooth movement caused by an
unstable occlusion or ill-fitting prosthesis, tooth or restoration in traumatic
occlusion, periapical or pulpal abscesses, acute pulpitis, gingivitis or
periodontitis or cracked tooth syndrome)
No. of remaining teeth
no. and condition of restored teeth
Teeth mobility (may be caused by trauma from occlusion, inflammatory
changes in the periodontal ligament or loss of osseous support)
Furcation involvement.
extruded or malposed teeth,
decalcification
Periodontal, gingival and mucosal conditions (any ulceration, swelling, or
color change)
Location, no. and length of edentulous areas
Quality of residual ridge, sharp or prominent bony areas; soft or hard tissue
undercuts, and/or enlarged tuberosities.
Presence of tori and other bony exostoses
reduced interarch space,
unfavorable occlusal planes,
Determination of the depth of floor of the mouth by using a periodontal probe
Occlusal relationships.
2. Vitality test of abutment teeth
3. Pain relief and temporary restorations: objectives:
to relieve discomfort arising from tooth defects
to determine the extent of caries
to arrest further caries activity
4. Oral prophylaxis: to thoroughly and completely clean the teeth from accumulated
calculus and debris.
5. Radiographic survey: objectives:
To locate areas of infections or pathosis
To reveal the presence of tooth fragments, foreign objects, bony spicules,
irregular ridge forms.
To reveal the presence and extent of caries, recurrent caries, marginal
leakage and overhanging gingival margins.
To reveal the prognosis of present endodontic filling
To reveal the periodontal conditions
To evaluate the alveolar support of abutment teeth
6. Diagnostic casts: objectives:
Analyzing of existing occlusion
Permit a topographic surveying
Permit a logical and comprehensive presentation to the patient
Fabrication of special (custom) trays
Used as a constant references as the work progresses
Considered as a permanent record of the patient.
II-
Second (definitive) diagnostic appointment
: It is used to complete the
collection and evaluation of diagnostic data. It includes the following:
1. Mounted diagnostic casts
2. Definitive oral examination
3. Consultation requests
4. Development of treatment plane
Mounting the diagnostic casts:
A. If the occlusion is harmonious and the proposed prosthesis is a tooth- borne, a
simple hand articulation of diagnostic casts is required
B. If the occlusion is not harmonious and/ or the proposed prosthesis is a tooth/
tissue borne, mounting of diagnostic casts is necessary.
Procedure of mounting the casts:
To accomplish proper positioning of the diagnostic casts on a dental articulator, the
casts must be properly related to one another, and to the opening/closing axis of the
articulator.
The mounting procedure may be divided into three distinct phases:
A) Orientation of the maxillary cast to the condylar elements of an articulator
exactly as the maxillary arch is related to the patient's condyles by means of a
facebow transfer.
B) Orientation of the mandibular cast to the maxillary cast at the patient's centric jaw
relation by means of an accurate centric relation record.
C) Verification of these relationships by means of additional centric relation records
and comparison of occlusal contacts on the articulator with those in the mouth.
Objectives of mounting the diagnostic casts:
1. To reveal malpositioned teeth, low-hanging tuberosities, compromised interarch space,
and defective restorations.
2. To permit evaluation of occlusal relationships from facial and lingual aspects.
3. Helpful in patient education.
4. Provide a record of the patient's condition before treatment.
Evaluation of diagnostic data
All diagnostic data must be collected before an effective evaluation can be made.
The practitioner must correlate intraoral findings with those of the radiographic
survey, the mounted casts, the survey and analysis of the diagnostic casts, and
other relevant information. Results should be used in the development of a sound
treatment plan.
Goals (objectives) of ultimate porsthodontic treatment plan:
a) Disease management
b) Preservation and restoration of remaining teeth and oral tissues.
c) Coordinated prosthetic treatment.
d) Restoration of esthetics and function
.
Indications for a RPD treatment:
a) Long edentulous span
b) Reduced periodontal support of the remaining teeth
c) Need for cross arch (bilateral) stabilization
d) Excessive bone loss of the residual ridge
e) Distal Extension Situations (no abutment tooth
posterior to the edentulous area)
f) Patient desires
g) Childhood
h) Physically or emotionally handicapped patients.
i) Economic Considerations
Definitive RPD:
either
a) Tooth borne
b) Tooth/Tissue borne
Temporary RPD is a
tissue borne prosthesis
What are the ideal requirements of the abutment tooth?
a) Free from caries or restorations
b) Favorably contoured crown
c) Crown of adequate length
d) Healthy periodontal status
e) Long root with large surface area
f) Good vertical and horizontal position within the arch
g) Stable opposing occlusion