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Diagnosis&Treatment Planningin Fpd

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  • 1. DIAGNOSIS & TREATMENT PLANNING
    • Dr shabeel pn
    • Royal Dental College
  • 2. Significance of Replacement
    • Dental arch is not a static entity, it is in state of dynamic equilibrium
    • Tooth loss – loss of structural integrity & a new equilibrium is achieved
    • Pathological drifting of teeth
  • 3. Choices
    • Removable partial denture
    • Conventional tooth-supported FPD
    • Resin Bonded tooth-supported FPD
    • Implant supported FPD
    • No prosthetic replacement
  • 4. Treatment Plan Purpose
      • Formulating a logical sequence of treatment designed to restore the patient’s dentition to good health , with optimal function and appearance
  • 5. What is an Ideal Treatment plan?
    • Treatment plan that achieves the best possible long-term outcomes for the patient, while addressing all patient concerns and active problems, with the minimum necessary intervention
  • 6. Identification of Patient Needs
    • Correction of existing disease
    • Prevention of future disease
    • Restoration of function
    • Improvement of appearance
  • 7. Phase II Disease Control Phase III Restorative Phase IV Maintenance Treatment Plan by Phases Dental & medical history Clinical examination, Radiographic films Dx Casts, Dx photographs Dx Wax-up, Aesthetic evaluation Periodontal Therapy Endodontic Therapy (RCT) Removal of existing restorations Caries control Phase I Diagnosis
      • Crown lengthening/Implant surgery
      • Gnathologic technique
      • Long-term provisional restorations
      • Permanent restorations
    Recall every 6 months Fluoride supplements Reinforce oral hygiene Improve diet
  • 8. Diagnosis & Prognosis
      • Diagnosis :
      • Dental and medical history
      • Clinical examination
      • Diagnostic pictures
      • Diagnostic casts
      • Diagnostic wax-up
      • Radiographic films
      • Prognosis :
      • General factors: age, oral environment, etc.
      • Local factors: occlusion, access for oral hygiene
  • 9. History
    • Patient Expectations can be understood
    • Medical history has Prime importance
    • Diabetes – effects prognosis
    • Rheumatic heart diseases – prophylaxis
    • Infectious diseases – protection to others
    • Pacemaker – electrosurgical dilatation
    • Previous radiation - ORN
  • 10. History
    • Allergies – Even Anaphylaxis
    • Medications – Adverse drug reactions
    • Hypertension – LA without adrenalin
    • Cardiac problems – prophylaxis
    • Epilepsy – short appointments
    • Hypoglycemia – syncope or coma
    • Xerostomia – poor prognosis
  • 11. Clinical examination
    • General examination
    • Extra oral examination
    • - head & neck examination
    • - TMJ evaluation
    • - Muscles of Mastication
    • Intra oral examination
    • - oral hygiene status
    • - nature & quantity of Saliva
    • - examination of teeth
    • - occlusal examination
    • - periodontal examination
  • 12. Radiographic evaluation
    • Complete mouth radiographic series needed (14 IOPA & 4 bitewings)
    • Panoramic Radiographs
    • TMJ Radiographs
    • All of them give information that cannot be detected clinically
  • 13. Radiographic evaluation
    • Remaining bone support & bone quality
    • Root number & morphology
    • Periodontal ligament & TFO
    • Resorption or Furcation involvement
    • Carious lesions
    • Pulpal status
    • Periapical pathologies
    • Retained roots, calcifications, foreign bodies
    • Oral manifestations of systemic diseases
  • 14. Diagnostic Impressions/Casts
    • Dx impressions:
      • Irreversible hydrocolloid (alginate)/stock trays
      • High quality with no voids
      • A clinical instructor must authorize impressions pouring
    • Type III dental stone (buff) is used for Dx-casts pouring
    • Dx casts evaluation criteria:
      • Accurate reproduction of teeth and tissue
      • Base thickness: 15-16 mm
      • Land area width: 3-4 mm
  • 15. Diagnostic Casts * Comprehensive Care Patient Presentations, 2003-04, Dr. Mary Baechle 
  • 16. Diagnostic Casts
    • Provide valuable preliminary information and a comprehensive overview of patient’s needs
    • Treatment procedures can be rehearsed on the stone cast before making any irreversible changes in the patient’s mouth
    • Used for diagnostic wax-up, preliminary RPD design, surgical stent (surgical procedures), etc.
    • Help to explain intended procedure to patient
  • 17. Diagnostic Wax-up
      • Diagnostic Wax-up:
      • Casts/waxing/set-ups (denture teeth) must be completed prior to beginning any reconstructive treatment (castings/prostheses or definitive Periodontal therapy)
  • 18. Diagnostic Wax-up* * Comprehensive Care Patient Presentations, 2003-04, Dr. Mary Baechle 
  • 19.
    • Useful to show proposed treatment to the patient
    • Used for fabrication of provisional restorations
    • Fabrication of final restorations against the diagnostically waxed cast allows establishing optimum contour and occlusion
    • Provides specific information about desired tooth length and form or occlusal arrangement: dentist-lab technician communication
    Diagnostic Wax-up
  • 20. Developing Treatment Options
      • Factors to be considered :
      • Patient’s expectations
      • Systemic & Emotional Health
      • Cost
      • Periodontal Factors
      • Success rate
      • Possible complications
      • Time involved, both total treatment time and number of visits
      • Influence on quality of life
  • 21. Summary
    • The patient should be considered as a human being
    • Successful accomplishment of dental treatment is the result of a multidisciplinary team effort.
    • The key of a successful dental case is the planning of the treatment at the beginning
  • 22.
    • Thank you