TREATMENT PLANNING FOR AN FPD WOULD REQUIRE A SCRUPLOUS SCRUTINY OF INFORMATION FOR DIAGNOSIS AND OTHER CLINICAL REQUIREMENTS.

2. Diagnosis & Treatment Planning in
FPD
Dr. Vinod Viswanathan
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3. Definition
Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning,
rehabilitation and maintenance of the oral function, comfort, appearance and health of
patients with clinical conditions associated with missing or deficient teeth and/or
maxillofacial tissues using biocompatible substitutes
Fixed Prosthodontics: the branch of prosthodontics concerned with the replacement
and/or restoration of teeth by artificial substitutes that not readily removed from the mouth
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5. Case
History
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Case history is a planned professional conversation
that enables the patient to communicate their
symptoms, feelings and fear complex to the physician

6. Screening questionnaire
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8. Chief Complaint
 Patient’s primary reason or reasons for seeking treatment
 These may be just the obvious features, and careful examination often reveals
problems and disease of which the patient is unaware; nevertheless, the patient
perceives the chief complaint as the major problem
 A comprehensive treatment plan is proposed, special attention must be given to
how the chief complaint can be resolved.
 The inexperienced clinician trying to prescribe an “ideal” treatment plan can lose
sight of the patient’s wishes. The patient may then become frustrated because the
dentist apparently does not understand or does not want to understand the patient’s
point of view.
 Chief complaints usually belong to one of the following four categories:
• Comfort (pain, sensitivity, swelling)
• Function (difficulty in mastication or speech)
• Social (bad taste or odor) or • Appearance (fractured or unattractive teeth or restorations,
discoloration)
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9. Comfort Function Social aspect Appearance
Comfort: Location Character Severity Frequency Precipitating Factors
Localized or Diffuse
Swelling Location Size Consistency Color How long
Increasing or decreasing
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Function: Difficulties in chewing may result from a local problem such as a
fractured cusp or missing teeth; it may also indicate a more generalized
malocclusion or dysfunction
Social aspects: Bad taste or smell indicates compromised oral hygiene and
periodontal disease.
Often social pressures prompt the patient to seek care

10. Appearance: Compromised appearance is a strong motivating factor for patients
to seek advice as to whether improvement is possible.
Such patients may have missing or crowded teeth, or a tooth or restoration may be
fractured.
Teeth may be unattractively shaped, malpositioned, or discolored, or there may be
a developmental defect.

11. MEDICAL HISTORY
• Relevant medical conditions Medication the patient is taking
1. Conditions affecting the treatment methods: Antibiotic premedication, steroids or
anticoagulants, Allergic responses to medication or dental materials, previous
radiation therapy, hemorrhagic disorders, extremes of age, and terminal illness
2. Systemic conditions with oral manifestations. Periodontitis may be modified by
diabetes, menopause, pregnancy, or the use of anticonvulsant drugs
3. Gastroesophageal reflux disease, bulimia, or anorexia nervosa, teeth may be eroded
by regurgitated stomach acid
4. Certain drugs may generate side effects that mimic temporomandibular disorders or
reduce salivary flow
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12. MEDICAL HISTORY
Risk factors to the dentist and auxiliary personnel
Suspected or confirmed carriers of hepatitis B
Acquired immunodeficiency syndrome
Syphilis
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13. Dental History
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Periodontal History: The patient’s oral hygiene is assessed, and current plaque-
control measures are discussed, as are previously received oral hygiene
instructions. The frequency of any previous débridement should be recorded, and
the dates and nature of any previous periodontal surgery should be noted.

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Restorative History: The patient’s restorative history may include only simple
composite resin or dental amalgam fillings, or it may involve crowns and extensive
fixed dental prostheses. The age of existing restorations can help establish the
prognosis and probable longevity of any future fixed prostheses.

15. Endodontic history: Patients often forget which teeth have been endodontically
treated. These can be readily identified with radiographs. The findings should be
reviewed periodically so that periapical health can be monitored, and any recurring
lesions promptly detected
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16. 16
Removable prosthodontic history: The patient’s experiences with removable
prostheses must be carefully evaluated. For example, a partial removable dental
prosthesis may not have been worn for a variety of reasons, and the patient may not
even have mentioned its existence. Careful questioning and examination usually
elicits discussion concerning any such devices. Listening to the patient’s comments
about previously unsuccessful removable prostheses can be very helpful in
assessing whether future treatment will be more successful

17. Oral surgical history: Information about missing teeth and any complications that
may have occurred during tooth removal is obtained. Special evaluation and data
collection procedures are necessary for patients who require prosthodontic care after
orthognathic surgery. Before any treatment is undertaken, the prosthodontic
component of the proposed treatment should be fully coordinated with the surgical
component

18. Radiographic history : A current diagnostic radiographic series is essential and
should be obtained as part of the examination

19. Temporomandibular joint dysfunction history: A history of pain or clicking in the
TMJs or neuromuscular symptoms, such as tenderness to palpation, may be caused
by TMJ dysfunction, which should normally be treated and resolved before fixed
prosthodontic treatment begins. A screening questionnaire efficiently identifies these
problems. The patient should be questioned regarding any previous treatment for
joint dysfunction (e.g., occlusal devices, medications, biofeedback, or physical
therapy exercises)

20. Examination
General examination
Extraoral examination
Intraoral examination
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21. Intraoral examination:
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Periodontal Examination: A periodontal examination should provide
information regarding the status of bacterial accumulation, the response of
the host tissues, and the degree of reversible and irreversible damage.
Because longterm periodontal health is essential for successful fixed
prosthodontics, existing periodontal disease must be corrected before any
definitive prosthodontic treatment is undertaken.

22. Periodontal
examination:
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Gingiva: should be lightly dried before examination so that moisture does not obscure
subtle changes or detail.
Color, texture, size, contour, consistency, and position are noted and recorded. The
gingiva is then carefully palpated to express any exudate or pus that may be present
in the sulcular area.
Healthy gingiva is pink, stippled, and firmly bound to the underlying connective tissue.
The free margin of the gingiva is knife-edged, and sharply pointed papillae fill the
interproximal spaces.
Chronic marginal gingivitis, the gingiva becomes enlarged and bulbous, loss of
stippling occurs, the margins and papillae are blunted, and bleeding and exudate are
observed.

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Periodontium: Periodontal probing
Tooth mobility or malposition
Open or deficient contact areas
Inconsistent marginal ridge heights
Missing or impacted teeth
Areas of inadequate attached keratinized gingiva
Gingival recession
Furcation involvements
Malpositioned frenum attachments

24. Dental charting:
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Presence or absence of teeth
Dental caries
Restorations
Wear faceting
Abrasions
Fractures
Malformations
Erosions

25. Dental charting:
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General alignment: Crowding Rotation Supraeruption Spacing Malocclusion
Teeth adjacent to edentulous spaces often have shifted position slightly. Small amounts of tooth movement can
significantly affect fixed prosthodontic treatment.
Tipped teeth affect tooth preparation design or, in severe cases, may result in a need for minor tooth movement
before restorative treatment.
Supraerupted teeth frequently complicate fixed dental prosthesis design and fabrication
Tooth may have drifted into the space previously occupied by the tooth in need of treatment because a large filling
was previously lost.
Such changes in alignment can seriously complicate or preclude fabrication of a cast restoration for the damaged
tooth and may even necessitate its extraction

26. Radiographic Examination:
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Radiographs provide essential information to supplement the clinical examination. Detailed knowledge of
the extent of bone support and the root structure of each standing tooth is essential for establishing a
comprehensive fixed prosthodontic treatment plan.

27. DIAGNOSIS AND PROGNOSIS :
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 COMPLETELY EDENTULOUS
UPPER AND LOWER ARCH
 PARTIALLY EDENTULOUS
UPPER/LOWER ARCH
Treatment Plan:
• CONVENTIONAL FIXED PARTIAL DENTURES
• CANTILEVER FIXED PARTIAL DENTURES
• SPRING CANTILEVER FIXED PARTIAL DENTURES
• FIXED FIXED PARTIAL DENTURE
• FIXED REMOVABLE PARTIAL DENTURE/ REMOVABLE BRIDGES
• MODIFIED FIXED REMOVABLE PARTIAL DENTURES
• ALL METAL FIXED PARTIAL DENTURES
• ALL CERAMIC FIXED PARTIAL DENTURES
• ALL ACRYLIC FPD
• VENEERS
• SHORT SPAN FPD
• LONG SPAN FPD
• PERMANENT /DEFINITIVE PROSTHESIS
• LONG TERM TEMPORARY BRIDGES
• FIXED PARTIAL DENTURE SPLINTS
• FIBER REINFORCED COMPOSITE RESIN BRIDGES
• RESIN-BONDED FPD

28. Conventional Fixed prosthesis

29. CANTILEVER FIXED PARTIAL DENTURES

30. SPRING CANTILEVER FIXED PARTIAL DENTURES

31. MODIFIED FIXED REMOVABLE PARTIAL DENTURES

32. FIXED removable PARTIAL DENTURE

33. VENEERS
RESIN-BONDED FPD

34. ALL CERAMIC FIXED PARTIAL DENTURES
ALL METAL FIXED PARTIAL DENTURES

35. FIBER REINFORCED COMPOSITE FPD