Diagnosis and treatment planning in removable partial denture

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diagnosis, treatment planning, intra-oral and abutment evaluation,

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  • The interview, an opportunity to develop rapport with the patient, involves listening to and understanding the patient’s chief complaint or concern about his or her oral health. A fundamental objective of the patient interview, which accompanies the diagnostic examination, is to gain a clear understanding of why the patient is presenting for evaluation;this involves having the patient describe the history related to the chief complaint.
  • Mouth preparation procedures are influenced by the choice of major connectors
    When an RPD is inserted, it is especially important that the patient ’ s remaining natural teeth and tissues receive consistent and meticulous oral hygiene procedures in order for an acceptable degree of oral health to be maintained. The patient ’ s oral hygiene status before prosthodontic treatment provides reliable evidence of the importance that the patient attaches to this critical factor and refl ects if appropriate maintenance and oral hygiene instructions were provided and/or were understood from the prior treatment.
  • Vitality tests should be given particularly to teeth to be used as abutments and those having deep restorations or deep carious lesions.Radio graphic interpretation : Bone density, Periodontal ligaments and the lamina dura, Root configuration, Radiolucent or radiopaque lesions
  • Diagnosis and treatment planning in removable partial denture

    1. 1. Vinay PavanKumar .K II year pg. student Dept of Prosthodontics AECS Maaruti College of Dental Sciences
    2. 2. Patient interview Clinical Examination Treatment planning •Purpose & Uniqueness of Rx •Shared Decision Making •General examination •Oral examination •Interpretation of Examination Data •Development & phases of Rx plan
    3. 3. “Most clinicians also choose an RPD for a partially edentulous patient if they need to restore lost residual ridge, achieve appropriate esthetics, increase masticatory efficiency, and improve phonetics but are unable to do so with dental implants or fixed partial dentures due to financial constraints or patient desires” - Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am 58 (2014) 69–89 “Problems related to RPDs may be associated with errors in diagnosis and treatment planning, including inadequate mouth preparation “ - McCord JF et al Dent Update 2003; 30: 88–97
    4. 4. According to GPT 8  Diagnosis : the determination of the nature of a disease  Treatment plan : the sequence of procedures planned for the treatment of a patient after diagnosis
    5. 5.  The delineation of each patient’s uniqueness occurs through the patient interview and clinical examination process.  The ultimate treatment is individualized to address disease management and the coordinated restorative and prosthetic needs that are unique to the patient.
    6. 6.  understanding the patient’s desires or chief concerns/complaints regarding his or her condition  ascertaining the patient’s dental needs through a clinical examination,  developing a treatment plan that reflects the best management of desires and need  Executing appropriately sequenced treatment with planned follow-up
    7. 7. The dentist should follow a sequence that includes: 1. Chief complaint and its history 2. Medical history review 3. Dental history review, especially related to previous prosthetic experience(s) 4. Patient expectations
    8. 8.  Personal and psychological factors are significant to the success of prosthodontic treatment  House classification - Philosophical - Exacting - Hysterical - Indifferent House classification revisited : - Ideal - Submitter - Reluctant - Indifferent - Resistant
    9. 9.  The process of clinical examination involves two stages : - Medical examination - Oral examination A comprehensive medical history includes : - systemic disorders (Chronic degenerative or dysfunctional diseases) - Medication history - Diet - Habits
    10. 10. Systemic disordes include:  Hypertension  Diabetes  Pernicious anemia  Vitamin or nutritional deficiencies  Osteoporosis  Chronic pulmonary disease (i.e.,emphysema and chronic bronchitis)
    11. 11.  Climacteric (i.e., menopausal changes)  Parkinsonism  Salivary gland disorders  TM disturbances  Post radiation therapy  Bell ’ s palsy  Lichen planus  Fungal infections
    12. 12. An oral examination should be accomplished in the following sequence :  visual examination,  pain relief and temporary restorations,  radiographs,  evaluation of abutment and periodontium,  vitality tests of individual teeth,  determination of the floor of the mouth position,  Oral prophylaxis and impressions of each arch.
    13. 13. This includes : extra oral and intra oral examination. TMJ - tenderness, mouth opening deviation & clicking
    14. 14.  No of teeth present with their clinical evaluation  Malposed teeth  Carious teeth  Existing restoration- sensitivity to percussion  Periodontium  Residual ridges  Saliva  Investing structures  Occlusion and occlusal plane  Oral hygiene index
    15. 15.  to determine the need and management of acute needs and whether a prophylaxis is required to conduct a thorough oral examination.  to relieve discomfort arising from tooth defects  the extent of caries and arrest further caries activity
    16. 16.  areas of infection and other pathologies  the presence of root fragments, foreign objects, bone spicules and irregular ridge formations  the presence and extent of caries and the relation of carious lesions to the pulp and periodontal attachment  evaluation of existing restorations : evidence of recurrent caries, marginal leakage, and overhanging gingival margins
    17. 17.  the presence of root canal fillings  evaluation of periodontal conditions present  to evaluate the alveolar support of abutment teeth, their number, the supporting length and morphology of their roots  the relative amount of alveolar bone loss suffered through pathogenic processes, and the amount of alveolar support remaining
    18. 18.  To locate inferior borders of lingual mandibular major connectors.  oral hygiene status before prosthodontic treatment is important.  The impression for the diagnostic cast is usually made with an irreversible hydrocolloid in a stock (perforated or rim lock) impression tray.
    19. 19. • Anatomic consideration - Root length, size and form • vitality tests • caries evaluation • Periodontal health • Malpositions • Analysis of Occlusal Factors
    20. 20. • Supplements oral examination • Permit a topographic survey of the dental arch • Patient education and motivation • Custom tray fabrication • Constant reference • Patient's record
    21. 21.  verification of appropriate mouth modifications for a removable partial denture.  To determine the most desirable path of placement that will eliminate or minimize interference to placement and removal  To locate and measure areas of the teeth that may be used for retention
    22. 22.  To determine whether tooth and bony areas of interference will need to be eliminated surgically or by selecting a different path of placement  To determine the most suitable path of placement that will permit locating retainers and artificial teeth to the best esthetic advantage.  To permit an accurate charting of the mouth preparation to be made including the preparation of proximal tooth surfaces to provide guiding
    23. 23. • Occlusal plane & relationships • Abutment tooth contours • Rest seat areas • Interarch space • Residual ridge relation • Tissue contours
    24. 24.  The objectives of any prosthodontic treatment may be stated as follows:  the elimination of disease  the preservation, restoration, and maintenance of the health of the remaining teeth and oral tissues  the selected replacement of lost teeth; for the purpose of restoration of function  comfort and in esthetically pleasing manner
    25. 25.  Based on diagnostic findings, The American College of Prosthodontists (ACP) has developed a classification system for partial edentulism  Criteria 1: Location and extent of the edentulous area(s)  Criteria 2: Abutment conditions  Criteria 3: Occlusion  Criteria 4: Residual ridge
    26. 26.  Edentulous area confined to a single arch  Abutment conditions -No preprosthetic therapy is indicated  Occlusal characteristics- Class I molar jaw relationships are seen  Residual bone height of ≥21 mm
    27. 27.  Edentulous area – Both arches  Abutment- Abutments in 1 or 2 sextants have less tooth structure or support intra or extra coronal restorations  Occlusion- Localized adjunctive therapy Class I molar and jaw relationships are seen  Residual bone height of 16 to 20 mm
    28. 28.  Any posterior maxillary or mandibular edentulous area greater than 3 teeth or 2 molars. Any edentulous areas including anterior and posterior areas of 3 or more teeth.  Abutments in 3 sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations.
    29. 29.  Entire occlusion must be reestablished. Class II molar and jaw relationships are seen.  Residual alveolar bone height of 11 to 15 mm
    30. 30.  Any edentulous area or combination of edentulous areas requiring a high level of patient compliance  Abutments in 4 or more sextants have insufficient tooth structure to retain or support intracoronal or extracoronal restorations.
    31. 31.  Entire occlusion must be reestablished, including changes in the occlusal vertical dimension. Class II div 2 and Class III molar and jaw relationships are seen.  Residual vertical bone height of ≤10 mm
    32. 32.  Individual diagnostic criteria are evaluated and the appropriate box is checked. The most advanced finding determines the final classification Classification System for Partial Edentulism, Journal of Prosthodontics Vol. 11, no. 3, 2002: 181 – 193.
    33. 33. 1. Any single criterion of a more complex class places the patient into the more complex class. 2. Consideration of future treatment procedures must not influence the diagnostic level. 3. Initial preprosthetic treatment and/or adjunctive therapy can change the initial classification level.
    34. 34. 4. If there is an esthetic concern/challenge, the classification is increased in complexity by one level in Class I and II patients. 5. In the presence of TMD symptoms, the classification is increased in complexity by one or more levels in Class I and II patients. 6. In the situation where the patient presents with an edentulous mandible opposing a partially edentulous or dentate maxilla, Class IV.
    35. 35.  Implant supported fixed dental prosthesis  Fixed dental prosthesis  Removable partial denture  Complete denture  Combination of the above  No treatment at all
    36. 36.  Distal extension situations  After recent extractions  Long span  Need for cross-arch stabilization  Excessive loss of residual bone  Sound abutment teeth  Abutment with guarded prognosis  Economic considerations
    37. 37.  It is a communication model  a process where the provider and the patient identify together the best course of care.  it addresses the need to fully inform patients about risks and benefits of care options  ensures that patient values and preferences play a prominent role in the process.
    38. 38. Computer-designed polycarbonate RPD framework. Digital partial design and manufacturing: using 3D printing technology to fabricate RPD frameworks
    39. 39. Valplast RPDs with anterior flexible nylon clasps. A cast metal framework with metal clasps and flexible nylon polyamide retentive clasps Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am 2014; 58: 69–89
    40. 40. Mandibular overlay unilateral distal extension RPD with tooth-colored acrylic resin processed to the metal framework Mandibular overlay RPD metal framework Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am 2014; 58: 69–89
    41. 41. Minimize rotation about an axis in a Kennedy Class I or II arch, or any long modification span  direct retainers  rests
    42. 42. Phase I  Collection and evaluation of data  Pain, infection control  Biopsy  Patient motivation Phase II  Removal of deep caries  Extirpation of necrotic pulp  Extraction of non- retainable teeth  Periodontal treatment  Interim prosthesis  Occlusal equilibrium  Patient education
    43. 43. Phase III  Preprosthetic surgical procedures  Definitive endodontic procedures  Definitive restoration of teeth  Fixed partial denture construction  Reinforcement of education and motivation of the patient
    44. 44. Phase IV  Construction of removable partial denture  Reinforcement of education and motivation of patient Phase V  Post insertion care  Periodic recall  Reinforcement of education and motivation of patient.
    45. 45.  The four components of a SOAP note are Subjective, Objective, Assessment, and Plan  The SOAP note format is used to standardize medical evaluation entries made in clinical records. The SOAP note is written to facilitate improved communication among all involved in caring for the patient and to display the assessment, problems and plans in an organized format.
    46. 46.  Plan the amount of time and appointment schedule  Provides information to the patient.  Estimate the professional fees for the treatment.  Coordinate the schedule for dental laboratory procedures  Meet the legal requirements of informed consent
    47. 47.  Carr AB, Brown DT, McCracken’s Removable Partial Prosthodontics, 12th edition, Canada, Elsevier Publishers, 2011, pp:150-184  Stewart, Rudd, Kuebkar, Clinical Removable Partial Prosthodontics, 2nd edition, India, All India Publishers and Distributors, 2001, pp:117-220  Jones DJ,Gracia LT, Removable Partial Dentures : A Clinician’s guide, 1st edition, Singapore, Wiley-Blackwell, 2009, pp : 11-38  Garry TJ, Nimmo A, Skiba JF, Ahlstrom RH, Smith CR, Koumjian JH, Arbree NS, Classification system for partial edentulism, J Prosthodont 2002;11,3:181-193
    48. 48.  McCord JF, Grey JA, Winstanley RB, Johnson A, A Clinical Overview of Removable Prostheses: 1. Factors to Consider in Planning a Removable Partial Denture, Dent Update 2002; 29: 376-381  Bohnenkamp DM Removable Partial Dentures : Clinical Concepts, Dent Clin N Am 2014; 58: 69–89  Gamer et al, M. M. House mental classification revisited: Intersection of particular patient types and particular dentist’s needs, J Prosthet Dent 2003;89:297- 302  Davenport JC, Basker RM, Heath JR, Ralph JP, Glantz PO, The removable partial denture equation, Brit Dent J 2000; 189: 414–424

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