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Diagnosis :

It is the examination of the physical state , evaluation


of the mental or psychological makeup &
understanding the needs of each patient to ensure a

predictable result.
Treatment Planning :

It means developing a course of action that


encompasses the ramification & sequelae of
treatment to serve the patients needs.
Patient Evaluation :
Patient evaluation is the first step to be carried out in
treating a patient.

Gait :
The dentist should note the way the patients walk into
the clinic. People with neuromuscular disorders show
a different gait. Such patients will have difficulty
in adapting to the denture.

Age :
The decade , which the patients belong to , is important
to predict the outcome of treatment. For eg.
patients belonging to the 4th decade of life will have
good healing abilities & patients above the 6th decade will
Sex :
Male patients are generally busy people who appear
indifferent to the treatment. They are only
bothered about comfort & nothing else.On the other
hand , female patients are more critical about aesthetics &
they usually appear to overrule the dentist in
treatment planning.

Complexion & Personality :


To determine the shade of the teeth. Executives require
smaller teeth.

Mental attitude :
Based on there mental attitude , patients can be grouped
under two classifications,
House’s classification -
Class I : Philosophical
Classification II -
I) Cooperative
II) Apprehensive
- Anxious
- Frightened
- Obsessive
- Chronic
complainers
- Self conscious
III) Uncooperative
History Taking :
It is a systematic procedure for collecting the details of the
patient to do a proper
treatment planning.

Name :
The name should be asked to enter it in the record.

Age :
Some diseases are limited to certain age groups.

Occupation :
Executives & sales representatives require more
idealistic teeth.
While other people who work in places with high
physical exertion require rugged teeth.
Race :
It helps to select the shade of the teeth.

Location :
Some endemic disorders like fluorosis are confined to
certain localities.

Religion & Community :


Gives an idea about the dietary habits & helps to
design the denture accordingly.

Medical History :
The following medical conditions should be ruled out
before beginning the prosthetic treatment.
Debilitating Disease -
Complete denture patients , most of whom are
geriatric, are bound to be suffering from
debilitating diseases like diabetes , blood
dyscrasias & tuberculosis. These patients require specific
instructions on denture /tissue care. Diabetic
patients show excessive rate of bone resorption ,
hence, frequent relining may be necessary.
Disease of the Joints –
The most common disease of the joint in old age
is osteoarthritis.
Disease of the Skin -
Skin disease like Pemphigus have oral manifestations,
which vary from ulcers to bullae.
Neurological Disorders -
Diseases such as Bell’s palsy & Parkinson’s disease can
Oral Malignancies -
Some complete denture patients with oral
malignancies may require radiation
therapy before prosthetic treatment.
Climacteric Conditions -
Like menopause can cause glandular
changes,osteoporosis & psychiatric
changes in the patient.

Dental History :
It is most important part of Diagnosis.
Chief Complaint -
It should be recorded in the patients on words.It
givs idea about the patients on words.
Expectations -
The dentist should evaluate the patient’s
Period of Edentulous ness -
It gives information about the amount & pattern
of bone resorption.

Pre-treatment Records -
It includes information about the previous
denture ,current denture, pre-extractions
records & diagnostic casts.
Clinical Examination :

Extraoral Examination

The patients head & neck region should first be


examined in general for the presence of any pathologic
conditions relating to a nondental or systemic conditions.

Facial Examinations :
It includes the evaluation of facial features, facial form,
facial profile & lower facial height.

Facial features –
The following features on the face should be
noted,
Perioral features :
- Length of the lips
- Lip fullness
- Apparent support of the lips
- Philtrum
- Nasolabial fold
- Mentolabial sulcus
- Labial commissures & modiolus
- Width of the vermilion border
- Size of the oral opening
- Texture of the skin
Facial form -
House & Loop, Frush & Fisher & Williams classified
facial form based on the outline of the face as
square, tapering, square tapering & ovoid. It
helps in teeth selection.
Facial profile -
It determine the jaw relation & occlusion. Angle
classified facial profile as,
Class I : Normal or straight profile
Class II : Retrognathic profile
Class III : Prognathic profile
Lower facial height -
It is important to determine the vertical jaw
relation.

Muscle Tone :
It can affect the stability of the denture. House
classified muscle tone as,
Class I : Normal tension, tone & placement of the
muscle of mastication & facial
expression. No degeneration.
Muscle Development :
People with excessive muscle development have
more biting force.
House classified muscle development as,
Class I : Heavy
Class II : Medium
Class III : Light

Complexion :
The color of the eye, hair & the skin guide the
selection of artificial teeth.

Lip Examination :
Lip support –
Based on the amount of lip support, lips
can be classified as adequately
Lip mobility –
Based on the mobility, lips are classified as
normal , reduced mobility &
paralyzed.
Thickness of the lips –
Thick lips need lesser support from the artificial
teeth & the labial flange. Thus on the other
hand thin lips rely on the appropriate
labiolingual position of the teeth, for their fullness &
support.
Length of the lips –
It is an important determinant in anterior teeth
selection. Based on the length, lips are classified
long, normal or medium & short.
TMJ Examination :
- The movements may be of three types,
1) coordinated
2) jerky
3) restrictive
- The abnormality usually seen is clicking sound, pain of
tendons, deviation to one side & dislocation.

Neuromuscular Examination :
It includes the examination of speech &
neuromuscular coordination.
Speech –
It is classified based on the ability of the
patients to articulate & coordinate
it.
Type I – Normal
Neuromuscular coordination –
It can be classified as,
Class I – Excellent
Class II – Fair
Class III - Poor

Intraoral Examination

Color of the mucosa :


The mucosa should have a healthy pink color.
Any amount of redness indicates an
inflammatory changes. Other color changes
such as white patches should be noted as this might indicate
an area of frictional keratosis.
Saliva :
- The amount & Consistency of saliva will affect the
denture construction process & the quality of the
final product itself.
- The consistency of saliva can range from a thin,
serous type to a thick, ropy consistency. It is best
to work with serous type. Thick ropy saliva alters the
seat of the denture.
- All salivary duct orifices should be examined.

Residual Alveolar Ridge :


Arch size –
a) The size of the maxilla & mandible will
determine the amount of basal seat available
for the denture foundation. The greater the
size, the more the support the larger the contact surface, the
b) Discrepancy b/w the mandibular & maxillary
arch sizes can lead to difficulties in
artificial teeth arrangement & decreases the
stability of the denture resting in the smaller one of the two
arches.
- It can be classified as,
Class I – Large
Class II – Medium
Class III – Small
Arch form -
The arch may be square, ovoid or tapered & opposing
arches may not necessarily have the same form.
Ridge contour -
Ridges can be classified as based on their contour as,
- High ridge with flat crest & parallel sides
- Flat ridge
Ridge relation -
- It is defined as, “ The positional relation of the
mandibular ridge to the maxillary ridge”
- Inter ridge relationship,
Anterior :
Class I – Normal
Class II – Prognathic
Class III – Retrognathic
Posterior :
- Normal
- Cross arch
- Inter arch space,
Class I – Adequate
Class II – Excessive
Class III - Reduced
Redundant tissue :

Any excessive amount of flabby tissue will cause


the denture base to shift & move as force is
applied, this will result in instability &
decreases retention of the denture.

Hard palate :

The shape of the vault of the palate should be


examined. It can be classified as,
- ‘U’ shaped : Ideal for both retention &
stability
Hyperplastic tissue :
The most common hyperplastic lesions are epulis
fissuratum related to a denture border, papillary
hyperplasia or hyperplastic folds under the
denture base.
- ‘V’ shaped : Retention is less, as the peripheral seal is
easily broken
- Flat : Reduced resistance to lateral & rotatory forces

Soft palate :
While examine the soft palate, it is important to
observe the relationship of the soft palate
to the hard palate. This relationship is called
palatal throat form. On this bases, soft palate can be classified
as,
Class I : It is horizontal & demonstrates
little muscular movement
Class II : Soft palate turns downwards at
about a 45. angle to the hard
palate
Class III : Soft palate turns downwards
sharply at about a 70. angle just
Bony undercuts :
- On the maxilla, the undercuts are usually
present on the anterior ridge & lateral to the
tuberosities.
- On the mandibular arch, the only undercut that
can poses a real problem, sharp mylohyoid
ridge.
Tori :
- A torus palatinus & lingual tori are
occasionally present.
- On the maxilla, the torus can range from a
small prominence on the midline to one
that covers the entire hard palate.
- On the mandible, lingual tori can present
lingually to the premoral region.
Muscles & Frenal attachments :
Muscle & Frenal attachments should be examined for
favorable or unfavorable position in relation to the crest
of the ridge.

Tongue :
Wright classified the tongue position as follows,
Class I : The tongue lies in the floor of the
mouth with the tip forward &
slightly below the incisal edges of the
mandibular anterior teeth.
Class II : The tongue is flattened &
brodened but tip is in a normal
position.
Class III : The tongue is retracted &
depressed into the floor of the
Floor Of The Mouth :
The relationship of the floor of the mouth to the
crest of the ridge is crucial in determining
the prognosis of the lower complete denture.

Gag reflex :
- “The gag reflex is a normal defense mechanism
designed to prevent foreign bodies from
entering the trachea.”
- The initiation of gag reflex can be caused by
systemic disorders, psychological factors &
iatrogenic factors.
adiographic Examination :

- Periapical surveys of the edentulous jaws are


acceptable, but panoramic radiographs are faster,
reduce the patient exposure to radiation & image the
entire mandible & maxilla.
- The interpretation of the panoramic radiograph should
follow a five steps analysis as outlined by Chomenko,
1) Screen jaws for defects in structure & reactive
new bone formation, bone enlargement,
displacement of the jaw parts,retained root
fragments, unerupted teeth, rarefaction, sclerosis, cysts,
tumors & TMJ disorders.
2) Describe the apperearance of the lesion as
3) Correlate the radiographic findings with the
clinical, historical & laboratory findings.
4) Perform a differential diagnosis which
includes all the diseases that could explain the
findings.
5) Estimate the growth of the lesions by the
apperearance of jaw structures bordering
the lesion.
The amount of resorption can be classified by Wical &
Swoope,
Class I : Mild
resorption
Class II : Moderate
TREATMENT PLANNING
Treatment planning is the process of matching possible
treatment option with patient needs & systematically
arranging the treatment in order of priority but in keeping
with a logical or technically necessary sequence.

# A primer on treatment option