Diagnosis and treatment planning in complete dentures


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Diagnosis and treatment planning in complete dentures

  2. 2. “The dentist should meet the mind of the patient before he meets the mouth of the patient” De Van - 1942
  3. 3. DIAGNOSIS Familiarity with the patient Principles of perception  Detection  Discrimination  Recognition  Identification  Judgement
  4. 4. S OCIAL INFORMATION Name. Age. Sex. Religion and race. Occupation. Address. Telephone number. Marital Status. Previous dental or denture experience.
  5. 5. M EDICAL STATUS Medical history. Family history. Dental history.
  6. 6. C ONDITIONS OF DEBILITATINGNATURE Senility  Endocrine disorders Diabetes  Menopause Tuberculosis  High basal metabolic rate Joint diseases  Grand climacteric. Blood dyscrasias  In which there is generalized loss of bone through out the body.
  7. 7. D ENTAL HISTORY How many dentures? How long worn? Age of present set? Satisfaction with dentures? Things patient likes - what they want changed
  8. 8. M ENTAL HEALTH A denture always fits better inthe mouth of a satisfied patient
  9. 9. M ENTAL HEALTHAlan Mack classified individuals accordingto their mental attitude. Ectomorph(Worrying type). Endomorph(Care free). Mesomorph(Passive).
  10. 10. M ENTAL HEALTHHouse divided the mental attitude into 4 majorgroups Philosophic or Reasonable Indifferent or passive Critical or Exacting Skeptical or Antagonistic
  11. 11. P HILOSOPHIC OR REASONABLE These are normal ideal. They understand the limitations of an artificial prosthesis. They are ready to play their role in the perseverance and learning phase. They do not unnecessarily criticize the operator. They correctly interpret their problems neither overstating nor under expressing.
  12. 12. I NDIFFERENT OR PASSIVE Patient shows no concern. They are not interested and lack motivation. Pays no attention to the instructions. They are non cooperative. They seek prosthesis at the request of family members or at the advice of the physician.
  13. 13. C RITICAL OR EXACTING The patient is methodical, precise and accurate. At time he is more demanding. Can be managed if handled properly.
  14. 14. S KEPTICAL OR ANTAGONISTIC / HYSTERICAL Emotionally unstable. Excitable, hypertensive. Grumbling even with little things. Patients having family problems or psychological disturbances usually fall into this category.
  15. 15. G ENERAL EXAMINATION General health and constitution Cardiovascular System Disturbances Blood pressure, Angina, Infarction, Rheumatic fever Respiratory System Diseases Tuberculosis, Asthma, Dyspnoea, Edema Gastrointestinal Tract Disturbances Ulcers, Jaundice, Nausea, Vomiting, Diarrhea, Constipation, Cirrhosis
  16. 16. G ENERAL EXAMINATION Endocrine Disturbances Diabetes , Steroids Hematopoetic Disorders Anemia, Bleeding disorders Neurological Disturbances Epilepsy, Convulsions, Paralysis, Psychiatric treatments,, Tranqulizers.
  17. 17. L OCAL EXAMINATION Visual examination Physical examination Digital examination Conditions of occlusion
  18. 18. V ISUAL EXAMINATION Oral Cavity Inflammation, Growth, Cysts, White lesions Character of Enamel Rampant caries, Abrasion, Attrition, Erosion, Abfraction Periodontal Conditions Gingiva, Pockets, Tooth mobility Oral Hygiene habits
  19. 19. C AUSES OF TOOTH LOSS Periodontal disease Caries Trauma Orthodontic indications
  20. 20. C ONSEQUENCES OF TOOTH LOSS Extra load on digestive  TMJ Changes organs  Supra occlusion of Impaired digestion opposing teeth Systemic disturbances  Tilting of adjoining teeth General poor health  Discomfort Impaired phonetics  Loss of confidence
  21. 21. D IGITAL E XAMINATION Sharp bony spicules Torus palatinus Mid-palatal suture Torus mandibularis Ridge form
  22. 22. R ADIOGRAPHIC E XAMINATION Bone Nature, Degree of calcification, Stress bearing quality. Pathology Cysts, Embedded roots, Unerupted teeth
  23. 23. R ADIOGRAPHIC E XAMINATION Foci of infection Remaining teeth, Number and length of roots, Interproximal caries Foraminae - exact position
  25. 25. M AXILLA
  27. 27. E DENTULOUS M AXILLA Foundation of denture bearing area:  Stress Bearing or supporting area  Peripheral or limiting area
  28. 28. E DENTULOUS M AXILLA Supporting structures• Bone• Residual ridge• Mucous membrane
  29. 29. E DENTULOUS M AXILLA Supporting structures• Bone• Residual ridge• Mucous membrane
  30. 30. S UPPORTING STRUCTURES Bone:  Hard Palate:  PRIMARY SUPPORT AND STRESS BEARING AREA  Two maxillary and two palatine bones – Foundation for hard palate  Palatine process of two maxillae joined together at mid palatal suture.
  31. 31. H ARD PALATE Incisive foramenPalatineprocess ofMaxilla Alveolar ridge Palatine Greater bone Palatine foramen
  32. 32. H ARD PALATE Buccal Frenum Mid Palatal suture Hard Palate Maxillary tuberosity
  33. 33. R ESIDUAL RIDGE Alveolar ridges after removal of natural teeth are called residual ridges Size and shape changes. Rapid at first then reduced rate throughout life SECONDARY SUPPORTING OR STRESS BEARING AREA During 1st year of extraction, reduction of residual ridge in Maxilla in midsagittal plane is 2-3 mm. After that, it is reduced to 0.1 to 0.2 mm per year.
  34. 34. M UCOUS MEMBRANE MUCOUS MEMBRANE Mucosa Submucosa Dense Stratified sqamous epithelium Connective tissue Loose areolar tissue Often Keratinized Fat Glandular Masticatory mucosa Transmit nerve and Muscle blood supply to mucosaHard Palate Crest of residual ridge Residual attached gingiva
  35. 35. S HAPE OF SUPPORTING STRUCTURE Various factors depend on the form and size of the supporting bone: 1. Original size and consistency 2. General health of person 3. Forces developed by the surrounding musculature 4. Extent of periodontal disease 5. Effect of wearing dental prosthesis 6. Surgery at the time of extraction 7. Span of being edentulous
  36. 36. I NFLUENCES ON SHAPE OF HARD PALATE AND RIDGEIncisive ForamenMaxillary tuberositySharp Spiny processesTorus Palatinus
  37. 37. E DENTULOUS M AXILLA Limiting structures
  38. 38. E DENTULOUS M AXILLA Limiting structures• Labial Vestibule • Labial frenum• Buccal vestibule • Buccal frenum• Vibrating line
  39. 39. L ABIAL VESTIBULE Divided into right and left by labial frenum Labial frenum contains no muscles Mucous membrane lining the Labial vestibule – thin mucosa. Submucosa thick – loose areolar tissue and elastic fibers. Lining mucosa Orbicualris oris
  40. 40. B UCCAL VESTIBULE Lies opposite to tuberosity and extends from buccal frenum to hamular notch. Buccal frenum – Levator anguli oris, Orbicularis oris (pulls frenum forward), Buccinator (pulls backward) Distal to frenum lies root of zygoma.  Increasing resorption makes it prominent
  41. 41. V IBRATING LINE Imaginary line drawn on soft palate that marks beginning of motion of soft palate. Extends from one hamular notch to other. Ahhh Midline – 2 mm anterior or posterior to Fovea palatinae Vibrating line always on soft palate Anterior and posterior vibrating lines