Treatment planning for partially edentulous patients /fixed orthodontics courses

Diagnosis and Treatment
Planning for Partially Edentulous
Patients
First Appointment
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Keys to a successful Interview
 Dentist’s attitude
 Caring
 Understanding
 Respectful
 Phrasing of
questions
 Open-ended
questions
WE SHOULD MEET THE MIND OF THE PATIENT BEFORE WE MEET
THE MOUTH OF THE PATIENT

Health Questionnaire: Diabetes
 Decrease resistance
to infection
 Patients often
display reduced
salivary output.

Health Questionnaire: 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

Health Questionnaire:
Parkinson’s Disease
 Oral hygiene and
handling of dentures
will be impaired
 Difficult impressions
due to excessive
quantities of saliva

Paget’s Disease
 Patients may present
enlargement of
tuberosities.
 Frequent recall
program.
 Quite rare

Health Questionnaire: Acromegaly
 Enlargement of the
mandible
 Frequent exams to
evaluate fit and
function of
removable
prosthesis

Health Questionnaire: Epilepsy
 Removable dentures
may be contraindicated
if they are small and
seizures are frequent
and severe: choking
 If patient 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.

Treatment for Cancer
 Most common oral
complications:
 Xerostomia
 Irritations
 Bacterial and fungal
infections
 40% of patients who
have cancer outside of
the mouth have
repercussions inside the
mouth.

Cardiovascular Disease
 Require medical
consultation:
 Acute or recent MI
 Angina pectoris
 Congestive Heart
Failure
 Arrhythmia
 Hypertension
 Take blood pressure as
soon as you see patient
(180/110 and you
shouldn’t see patient)

Transmissible Diseases
 Hepatitis
 TB
 Influenza
 HIV
 Make sure
impressions are
disinfected

Effects of drugs on treatment
 Anticoagulants
(coumadin, aspirin)
 Post-surgical bleeding
 Antihypertensive agents
 Orthostatic hypotension
 Xerostomia if patient is
on diuretics
 Endocrine Therapy
 Xerostomia

Structure of the interview
 Dental History
How did he/she
lose his/her teeth?
Caries? Perio?
Gather information
about existing
dentures.
Old x-rays.

 Diet
Frequent usage of
mints, soft drinks,
sugar-containing
products

 Habits
 Bruxism and
clenching
 Tongue thrusting

 Expectations of
treatment, get the
chief complaint
 Questions from
patient

Initial Examination
Problems requiring immediate attention
Evaluation of oral hygiene. Explain:
Signs and symptoms of dental disease
Materials and techniques for home care
Patient’s responsibilities (you can only do
50% of the job, the patient has to do the
other half, i.e. the OH)

Initial Examination
 Eval. of caries
susceptibility
 Oral prophylaxis to
clear things up
 Radiographs (Pan
and FMS)
 Diagnostic
impressions and
casts

Second appointment
Facebow transfer
Take centric relation registration
Take protrusive record
Mount casts

Centric relation record
 Recommended
method
 Recording CR
position
 Occlusal vertical
dimension

Centric relation record:
using wax?
 We can also use elastomeric registration
materials (wax tends to change dimension over
time and can become brittle)

Centric relation record: Using
Record bases
 If patient does not
have enough teeth to
mount lower cast to
upper (i.e. no
posterior teeth),
fabricate record
bases.
 Wax-up, take
relation in centric
relation.

Setting condylar elements
 Protrusive record: with either wax or
elastomeric material.
 Ask patient to put front teeth edge to edge for
practice, then using PVS ask them to repeat.

Setting condylar elements
Too shallow
Correct
inclination
Too steepThe condylar setting is…

Diagnostic Wax-up

Definitive Oral Examination:
Caries and existing restorations
 Countours of
potential abutments
 Occlusion
 Possible extractions.

pulpal tissues
Possible pulp testing in teeth to be used
as abutments that have decay or crowns
or extensive work.
Selection of endodontically treated tooth
as abutments is NOT contraindicated.
Better prognosis with full crown
coverage restoration.

tooth mobility
 Unstable occlusion
 Tooth in traumatic
occlusion
 PA abscess
 Acute pulpitis
 Cracked tooth
syndrome

tooth mobility
 Trauma of occlusion
 Inflammation of
periodontum
 Loss of bone support
Niether is useful as an abuttment
for a partial Useful for an abuttment for
an overdenture

Definitive Oral Examination
 oral mucosa
 hard tissues
abnormalities
 soft tissues
abnormalities
 space for mandibular
major connector

Definitive Oral Examination
 radiographic evaluation of prospective
abutments

Evaluation of mounted diagnostic
casts
 Interarch distance
 Occlusal plane
 Irregular occlusal
plane
 Malpositioned
occlusal plane

Evaluation of mounted diagnostic
casts
 Malrelation of arches
 Tipped or malposed
teeth
 Occlusion
Interferences need to be corrected

To treat or not to treat at centric
relation….that is the question.
We will construct our prosthesis at CR if:
CR=MI
Absence of posterior tooth contacts (tissue-
borne)
Few remaining posterior contacts
Otherwise, we will construct our RPD’s at
maximum intercuspation position. We will
not introduce new interferences by a RPD.

Finally….
 Diagnostic wax-up
 Consultation to other
specialties
 Development of
Treatment plan.

?? $ ?? @ … ? &&!
How do I
develop a
Treatment
Plan????

Developing a sequenced treatment
plan
Phase I:
evaluation,
immediate treatment,
diagnostic mounting, wax-up, partial
design,
referral to other specialties (endo, ortho,
etc.),
patient education (OHI, etc).

plan
Phase II:
Removal of caries,
extractions,
perio tx,
occlusal equilibration,
placement of temporary restorations
(temporary crowns, etc).

plan
Phase III (continuation of Phase II):
 Pre-prosthetic surgeries,
 root canal therapies,
 definitive restoration of teeth,
 RPD mouth preparation, final impressions, metal
try-in, records (if needed).
Phase IV:
 Delivery of RPD,
 Instruction for patient.
Phase V: Periodic recall, reinforcement of
education.

Treatment planning for partially edentulous patients /fixed orthodontics courses

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