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INTRODUCTION
PURPOSE AND UNIQUENESS
PATIENT INTERVIEW
INFECTION CONTROL
CLINICAL EXAMINATION
DIAGNOSTIC CASTS
INDICATIONS
PHASES OF TREATMENT PLANNING
REFERENCES
DIAGNOSIS
Diagnosis is the determination of nature of disease.
Clinical diagnosis include:-Personality evaluation
-Clinical examination
-Radiographic examination.
Post-clinical or derived diagnosis deals with the
evaluation of the patients condition using the
diagnostic data collected during clinical diagnosis.
Patient Interview
The dentist should follow a sequence that includes
1) Chief complaints and its history
2)Medical history review
3)Dental history review;especially related to
previous prosthetic experiences
4)Patient`s expectation
Health Questionnaire:
Diabetes
Decrease resistance to infection
Patients often display reduced salivary output.
Arthritis
If it is in TMJs, may produce changes in occlusion
Very rare in TMJ, and if it is in TMJ it is usually a
secondary site
Parkinsons Disease
Oral hygiene and handling of dentures will be
impaired
Difficult impressions due to excessive quantities of
saliva
Pagets Disease
Patients may present enlargement of tuberosities.
Frequent recall program.
Quite rare
Acromegaly
Enlargement of the mandible
Frequent exams to evaluate fit and function of
removable prosthesis
Epilepsy
Removable dentures may be contraindicated if they
are
small and seizures are frequent and severe:
choking
Ifpatient takes phenytoin (common drug to take),
make sure that RPD does not irritate gingival
tissues.
Pemphigus Vulgaris
Common symptoms: oral discomfort and dryness.
Establish smooth and polished borders to reduce soft
tissue harm.
Greater follow up is anticipated.
Transmissible Diseases
Hepatitis
TB
Influenza
HIV
Make sure impressions are disinfected
Infection Control
Recommended infection control practices for dental
treatment.
1)Gloves should be worn in treating all patient
2)Masks should be worn for oral and nasal
mucosa from splatter of blood and saliva
3)Eyes should be protected
4)Sterilization should be maintained
6)Cleanup of instruments and surfaces in the
operatory
5)Contaminated disposable material should be
handled carefully and discarded in plastic bags,
sharp items should be kept in puncture resistant
bags
Examination
Extra-Oral examination
1. Size of face
2. Form and contour of face(ovoid, rectangular or
tapered)
3. Face color and symmetry
4. Profile (Class I,II,III)
5. Facial muscle tone tense or flaccid
6. Lip length and support
7.TMJexamination
Diagnostic Casts
Purpose of diagnostic casts
1) Supplement the oral examination by permitting a view
of
the occlusion from the lingual and buccal aspect.
2)Permit topographic survey of the dental arch
that is to be restored by means of a removable partial
denture.
3)Permit a logical and comprehensive
presentation to the patient of present and
future restorative needs and the hazards of
future neglect.
4) Individual impression trays may be fabricated on the
diagnostic casts, or the diagnostic cast may be used in
selecting and fitting a stock impression tray for the final
impression.
5) Diagnostic casts may be used as a constant reference
as
the work progresses.
6) Unaltered diagnostic casts should become a
permanent
part of the patient record
Objectives of ProsthodonticTreatment
1. Elimination of disease
2. Preservation, restoration, maintenance
3. Selected replacement of lost teeth and restore
esthetics
and functions
Treatment Planning
Prosthodontic treatment for partially edentulous
patient can be divided into
5 separate phases
PhaseI:
evaluation,
immediate treatment,
diagnostic mounting, wax-up, partial design,
referral to other specialties (endo, ortho,
etc.),
patient education (OHI, etc).
Phase II
Removal of caries,
extractions,
perio tx,
occlusal equilibration,
Conclusion:
Although there are similarities between
partially edentulous patients ( such as
classification designations); significant
differences exist making each patient, and
the ultimate treatment, unique.
And a successful treatment plan go hand in
hand with a complete patient interview and,
diagnostic clinical and radiological
examination
References:
McCracken`s Removable Partial
Prosthodontics 11th Edition
Textbook of Prosthodontics -Deepak
Nallaswamy