Importance of diagnosis and treatment planning in fixed
It should be recorded in patients own
words. The accuracy and significance
of patient’s primary reason /reasons
should be analyzed first. This will
reveal problems and conditions of
which the patient is often unaware.
An accurate and current general medical
history should include any medication the patient
is taking as well as all relevant medical conditions.
a) Any disorders that necessitate the use of
antibiotic premedication, any use of steroids or
anticoagulants and any previous allergic
responses to medication or dental materials
should be recorded.
b) Any conditions affecting the treatment plan
e.g.: various radiation therapy, haemorrahgic
disorders etc. should be recorded
Periodontal, restorative and endodontic history
are first noted.
Orthodontic history should be an integral part of the
assessment of a prosthodontic dentition. Occlusal
adjustment may be needed to promote long term
positional stability of the teeth and reduce or eliminate
parafunctional activity. Restorative treatment can
often be simplified by minor tooth movement. When a
patient is contemplating orthodontic treatment, much
time can often be saved if minor tooth movement for
restorative reasons is incorporated from the start.
TMJ dysfunction history
A history of pain or clicking in the
temporomandibular joints or
neuromuscular symptoms, such as
tenderness to palpation, may be due
to TMJ dysfunction which should be
treated before fixed prosthodontic
Cervical lymph nodes, TMJ and muscles of
mastication are palpated.
The TMJ is palpated bilaterally just anterior to the
auricular tragic while having the patient open and
close his lower jaw.
Tenderness, clicking or pain on movement is
noted. Maximum jaw opening less than 40mm
indicates jaw restriction, because the average
opening is greater than 50mm. Any deviation from
the midline is also recorded. Maximum lateral
movement can be measured (normal is about
Muscles of mastication
A brief palpation of masseter, temporalis,
medial pterygoid, lateral pteregoid, trapezius and
sternocleido mastoid muscles may reveal
tenderness. The patient may demonstrate limited
opening due to spasm of the masseter or
Next, the patient is observed for tooth exposure
during normal and exaggerated smiling. This may
be critical in treatment planning and particularly for
margin placement of metal-ceramic crowns.
- First the patient’s general oral hygiene is
- The presence or absence of inflammation
should be noted along with gingival architecture
and stippling. The existence of pockets should be
entered in the record and their location and depth
- The presence and amount of tooth mobility
should be recorded with special attention paid to
any relationship with occlusal prematurities and to
potential abutment teeth.
- Check for a band of attached gingiva around all the
teeth, particularly around teeth to be restored with
crowns. Mandibular 3rd molars frequently do not have
attached gingiva around the distal segment (30% to
60% of cases).
- The presence and location of caries is noted. The
amount and location of caries, coupled with an
evaluation of plaque retention, can offer some
prognosis for new restorations that will be placed. It
will also help the preparation designs to be used.
- Finally an evaluation should be made of the
occlusion. The amount of slide between the retruded
position and the position of maximum intercuspation
should be noted. Non-working interferences if present,
should be evaluated. The presence or absence of
simultaneous contact on both sides of the mouth
should be observed.
Advantages of diagnostic casts:
1) For diagnosing problems and arriving at a
2) Allow an unobstructed view of the edentulous
spaces and an accurate assessment of the span
length, as well as occlusogingival dimension.
3) Curvature of the arch in the edentulous region
can be determined so that it will be possible to predict
whether the pontic/pontics will act as a lever arm on
the abutment teeth.
4) Length of the abutment teeth can be accurately
gauged to determine which preparation designs will
provide adequate retention and resistance.
5) The true inclination of the abutment teeth will
also became evident, so that the problems in a
common path of insertion can be anticipated.
Diagnosis and treatment
The process of diagnosis and treatment
planning helps us attain a comprehensive
and complete guide to care for any given
patient and their particular situation. It allows
for the care rendered to be logical both in
plan and action
Before a diagnosis is made,through data
collection is necessary.
Articulated diagnostic casts
Medical,social and dental histories
Endodontic vitality tests
Patient expectations of treatment.
Treatment planning is the intergration of
data collection and diagnosis to form an
omniscient and ordered guide of
It can be a very complex and confusing
process if the patient’s needs are great.
So ,having a well-thought-out plan prior
to beginning any treatment is a key to
Order of treatment plans:
1)Disease control phase
4)Maintenance and prophylaxis
FDP treatment plan:
.Crown to root ratio
.Management of destructive forces
.Length of span