Diagnosis and treatment planning for complete dentures by dr brajendra singh tomar

1. Diagnosis and treatment planning in
complete denture therapy
Presented by:
Dr. Brajendra Singh Tomar
1
Guided by:
Dr. G. S. Chandu

2. Diagnosis and treatment planning in
complete denture therapy
LECTURE BY:
Dr. BRAJENDRASINGHTOMAR
MDS
ASSOCIATEPROFESSOR
PROSTHODONTICS& IMPLANTOLOGY
2

3. content
• INTRODUCTION
• PERSONAL INFORMATION
• CHIEF COMPLAINT
• HISTORY OF PRESENT
ILLNESS
• CLINICAL EVALUATION –
• EXTRAORAL EXAMINATION
• FACE
• SKIN
• EYES
• LIPS
• MUSCLES OF MASTICATION
• MUSCLES OF FACIAL
EXPRESSIONS
• TEMPOROMANDIBULAR JOINT
• LYMPH NODES
• NEUROMUSCULAR ACTIVITY
• PATHOLOGY
• INTRAORAL EXAMINATION
• ARCH SIZE
• ARCH FORM
3
• RIDGE FORM
• RIDGE PARALLELISM
• RIDGE RELATIONSHIP
• HARD PALATE
• SOFT PALATE
• FLOOR OF MOUTH
• TONGUE
• FRENUM ATTACHMENT
• BORDER ATTACHMENT
• MUCOSA
• PALATAL THROAT FORM
• LATERAL THROAT FORM
• ANY SOFT/HARD TISSUE
ABNORMALITY
• SALIVA
• GAG REFLEX
• LOCALIZED LESION
• DIAGNOSTIC AIDS
• TREAMENT PLAN
• SUMMARY
• REFERENCES

4. introduction
The complete denture more than any other dental
treatment depends for its success not only on the oral
cavity of the patient but also on patient’s general health
and attitude. Complete denture rehabilitation involves
treating the patient and not just the oral cavity. Hence, the
physical and psychological status of the patient along with
oral health should be thoroughly assessed.
4

5. Diagnosis
5

6. definitions
1. The determination of the nature of a disease. (GPT8)
2. The act or process of deciding the nature of a diseased
condition by examination. ( Heart well 4th edition.)
3. A careful investigation of the facts to determine the nature of
a thing.( Heart well 4th edition.)
6

7. • Success in complete denture depends
on the three factors:
1.The patient’s attitude to dentures and
his / her ability to learn to use them.
2.The condition of the mouth
3.The skill of the operator who must
acquire all the information, in order to
anticipate difficulties which may arise
and select the technique best suited to
overcome them.
7

8. personal information
• Name.
• Age.
• Sex.
• Religion and race.
• Occupation.
• Address.
• Telephone number.
• Marital Status.
• Previous dental or denture
experience.
8

9. Name :
• Significance of name: it helps in
identification of patient and brings
confidence and psychological security
in patients.
• Addressing the patient by his/her name
gives a rather personal touch to the
dentist patient relationship
9

10. Age10
Indicates patient ability to wear and to use denture.
Fourth decade of life-tissues heal rapidly ,
relatively resilient ,
esthetics of paramount importance.
individuals adapt more readily
with age :
oral cancer & pre cancerous lesions more
common
age related diseases – hypertension
cardiac problems
quality of bone decreases – osteoporosis
hypo-salivation
malnourishment

11. Sex
• Appearance is a higher priority for women.
• males may be more concerned about comfort
and function.
• Sex related disorders – osteoporosis
especially post menopausal and its
associated hormonal and behavioral changes
are a concern with women.
• Sex Is also an Important consideration in the
selection of teeth and arrangement of artificial
teeth.
11

12. occupation
• A patient's job and social standing often
determine the value he or she places on oral
health, as well as the esthetics.
• Executives in high stress jobs may exhibits
bruxism.
• People who work in places with high physical
exertion and factories where abrasive dust
abounds require rugged teeth, which do not
wear easily.
• For professionals like teachers, lecturers,
stage performers immediate denture can be
planned.
12

13. Race
• Race can be a critical factor in the
characterization of dentures .
• (i.e., choice of denture base shade,
shade and size selection of teeth
placement of denture base stains,
etc.).
13

14. Chief complaint
• Must determine the reason the patient is
seeking prosthodontic treatment.
 To asses whether patients expectations are
realistic or attainable.
 Response provides information regarding
patients psychology.
14

15. History of present illness
• It is the course of patient’s chief complaint .
• When and how it began ?
• What exacerbates and what ameliorates the complaint?
• If and how the complaint has been treated ?
• What was the result of such treatment ?
• What diagnostic tests have been performed ? Etc.
15

16. PAST DENTAL HISTORY
• Number of visit to dentist
• Previous dental treatment and outcome of
such treatment.
• Years of edentulousness max/mand.
Bone resorption patterns
• Reason for tooth loss: bone loss, trauma,
caries, pathology etc.
• Previous denture: number and type of
denture , reason for replacement
16

17. • Denture success: esthetics and functioning of denture
• Localized lesions and habits:
DENTURE STOMATITIS
TISSUE GROWTHS
FUNGAL INFECTIONS : CANDIDIASIS
NICOTINIC STOMATITIS – H/o smoking
LEUKOPLAKIA-
ORAL SUBMUCOUS FIBROSIS- Habits
ORAL LICHEN PLANUS- Stress
ORAL INFECTIONS
• It is important to inform and educate patient about such
lesions and to treat these before proceeding to fabricate
a prosthesis.
17

18. Medical history
• It is an information gathering process for assessing
patient’s health status.
Serious or significant illness
Hospitalizations
Transfusions
Allergies
Medications
18

19. Significant illness
• ANEMIA
• PLUMMER WINSON SYNDROME
• DISEASES OF JOINTS : ARTHRITIS
• NEUROLOGICAL DISORDERS : BELL’S PALSY
PARKINSON’S DISEASE
• CARCINOMAS
• DIABETES
• DISEASES OF SKIN : PEMPHIGUS
LUPUS ERYTHEMATOSIS
• PAGETS DISEASE
• SCLERODERMA
• DEBILITATING DISEASES : TUBERCULOSIS
BLOODY DYSCRSIAS
• RENAL DISORDERS
• PATIENTS ON STEROIDS
• THERAPIES LEADING TO XEROSTOMIA
19

20. SIGNIFICANCE :
DIABETES : multiple small oral abscesses,
poor tissue tone,
decreased resistance to infection,
decreased salivary flow,
decreased ability to wear prosthesis
ARTHRITIS : making of jaw relation records difficult
( painful mandibular movements )
( reduced ability to open jaws )
Changes in occlusion.
20

21. PAGET’S DISEASE :
Enlarged maxillary tuberosities ,
Changes in fit and occlusion of prosthesis varies with
time
PARKINSON’S DISEASE :
Rhythmic contraction of
musculature, and excessive salivation ,interferes with
impression procedure , and jaw relation recording is
difficult
21

22. MALIGNANCY :
• chemotherapy and irradiation causes
xerostomia ,mucosal irritation
Radiation therapist consultation is required
to proceed for treatment.
Denture use on limited time basis is
advised.
22

23. • ACROMEGALY : Enlargement of mandible
Causes Frequent
change in prosthesis
• CARDIOVASCULAR DISEASE :
Medical consultation is needed
• Debilitating diseases
Diabetes ,Tuberculosis , Bloody dyscrasias
require extra oral hygiene instructions , eating
habits and tissue rest.
23

24. Family history
• Serious medical problems in immediate family
members
• Disorders of genetic or environmental basis:
Allergies
Hypertension
Cardiovascular diseases
Diabetes mellitus
Bleeding disorders – Haemophilia
Asthma
24

25. PSYCHOLOGICAL EVALUATION
25
DE VAN
‘THE DENTIST SHOULD MEET THE MIND OF
PATIENT
BEFORE HE MEETS THE MOUTH OF THE PATIENT’’
ACCORDING TO HOUSE : 1937
PHILOSOPHICAL
EXACTING
HYSTERICAL
INDIFFERENT

26. PHILOSOPHICAL PATIENT
• well adjusted
• cooperative
• confidence in dentist
• excellent prognosis
26

27. exacting
• Above average in intelligence
• dissatisfied with past treatment
• doubt dentist ability
• once satisfied becomes dentist’s greatest
supporter
27

28. HYSTERICAL
• negative attitude
• often in poor health
• poorly adjusted
• poor prognosis
28

29. INDIFFERENT
• Often go without dentures for years
• do not adapt well
• Unfavourable prognosis
• Pays no attention to instructions.
29

30. Blum (1960)30
REASONABLE UNREASONABLE
REALISTIC UNREALISTIC

31. Clinical evaluation31
GENERAL HEAD AND NECK
GAIT
APPEARANCE
PHYSICAL DEFORMITY
VITAL SIGNS
BLOOD PRESSURE
TEMPERATURE
PULSE
RESPIRATORY RATE

32. GAIT : Should be observed as patient walks inside .
Neuromuscular coordination can be evaluated.
APPEARANCE : Weak &
Malnourished
Poor Economic condition
PHYSICAL ABNORMALITY : Special consideration
Hygiene maintenance difficult
VITAL SIGNS : BLOOD PRESSURE
PULSE RATE
RESPIRATORY RATE
TEMPERATURE
Abnormal vital signs are indicators of systemic diseases so
it is important to take informed consent from concerned
specialist.
32

33. HEAD AND NECK
EXTRAORAL INTRAORAL
INSPECTION PALPATION
AUSCULTATION
&
PERCUSSION
33

34. Extra oral examination
1. Facial profile : classify according to Angle: profile
is obtained by joining the two reference lines, line
joining the forehead and the deepest point in
curvature of upper lip (A).
2. Line joining point A & most anterior point of the chin
(B)
34
Class
1
Class
3
Class
2
RETROGNATHICNORMAL PROGNATHIC

35. • Facial form: classify according to House and
Loop, Frush and Fisher and Williams:
35
Square Tapering Square – tapering Ovoid

36. • Facial symmetry:
• it is examined to determine disproportions in
transverse and vertical plane. In most patient, the
right and left sides are not identical which is also
termed as normal asymmetry. Some degree of
asymmetry is accepted as normal whereas gross
asymmetries are recorded.
• Gross asymmetries can be due to:
1. Congenital defect
2. Hemifacial atrophy
3. Unilateral condylar ankylosis and hyperplasia
36

37. • Complexion:
• Hair, eye, and skin color provide useful
guides in shade selection. Skin color also
can reveal underlying disease and
pathology.
• Patients with significant sun damage
warrant referral to a dermatologist. Pale,
anemic-looking patients may have
underlying systemic diseases and may
require longer adjustment periods.
37

38. • Heavy wrinkles at the commissures and
nasolabial fold usually suggest decreased
Vertical Dimension of Occlusion (VDO) or
poor support of facial musculature by the
denture.
38

39. Muscle tone
ACCORDING TO HOUSE
• class 1: Normal tension ,tone and
placement of muscles of mastication and
facial expression.
no degenerative changes apparent.
• class 2: Approximately normal function ,
slightly impaired tone.
• class 3: Greatly impaired muscle tone and
function.
39

40. MUSCLE DEVELOPMENT :
ACCORDING TO HOUSE
• class 1: Heavy
• class 2: Medium
• class 3: Light
40

41. lip
LIP CONTOUR:
Adequately supported
Unsupported.
• Amount of vermillion border seen.
41

42. LIP LENGTH –
long
normal or medium
short
• long lip reveal very little anterior teeth.
• short lip allows display of denture base.
• critical factors: mold selection and denture charecterization.
Normal lip Short liplong lip
42

43. • Lip thickness: thick
Thin
medium
• LIP MOBILITY :
class 1 –Normal
class 2 –Reduced mobility
class 3- Paralysis
• LIP COMPETENCY:
COMPETENT I
COMPETENT INCOMPETENT
43

44. Temporomandibular joint
• Clinical examination of the temporomandibular joint:
• The examination should include the auscultation and
palapation of the TMJ and the musculature
associated with mandibular movements as well as
fuctional analysis of the mandibular movements.
• Palpation:
• lateral palpation ,
• posterior palpation
44

45. • Lateral palpation:
• Exert slight pressure on the
condyloid process with the
index fingers,, palpate both
sides simultaneously,
register any tenderness to
palpation of joint and any
irregularities in condyloid
movement during opening
and closing meneuvers.
The co-ordination of action
between the left and right
condylar heads should be
assessed at the same time
45

46. • Posterior palpation:
• Position the little finger
in the external auditory
meatus and palpate the
posterior surface of the
condyle during opening
and closing movements
of the mandible,
palpation should be
carried out in such a
way that the condyle
displaces the little
finger when closing.
46

47. Movements of the mandible
• Opening movements
• Closing
• Protrusive
• Retrusive
• Lateral
• All these are examined as part of the
functional analysis. The amount and direction
of these actions are recorded during the
clinical examination.
• Deviation in speed can only be registered
with electronic devices e.g. Kinesiograph.
47

48. Intra oral examination
• Arch size: House Classify arch size
as follows:
• Class 1: Large (best for retention
and stability)
• Class 2: Medium (good retention
and stability but not ideal)
• Class 3: Small (difficult to achieve
good retention and stability)
•
48

49. Arch form:
• classify according to house
49
Class 1 square Class 3 ovoidClass 2 tapered

50. Ridge form
• Maxillary ridge and vault form
should be classified as follows:
50
CLASS 1: SQUARE TO GENTLY
ROUNDED
Class 2 ‘V’ SHAPED Class 3 FLAT

51. Rounded
flat
V’
shaped
51

52. • Mandibular Ridge Form: Mandibular
ridge form is classified as follows:
52
Class 1: Inverted "U" shaped
(parallel walls from medium to tall
with broad crest)
Class 2: Inverted "U"
shaped
Short with flat crest
Class 3: unfavorable
Inverted "W" Short inverted "V" Tall & Thin inverted "V"

53. Tori:
• Class 1- absent or minimal in size , do not interfere
with denture construction.
• Class 2 - moderate size , mild difficulties in denture
construction and use.
• Class 3 - large tori are present. Require surgical
recontouring or removal .
53
INTERFERE WITH SPEECH
ADVERSLY AFFECT POSTERIOR
PALATAL SEAL
DENTURE STABILITY HAMPER

54. Interarch Space
• Class 1: Ideal interach space to accommodate the
artificial teeth.
54
 Class 2- Excessive interarch
space.
 Class 3: Insufficient interarch space to
accommodate the artificial teeth.

55. insufficientexcessive
ideal
55

56. Ridge Parallelism:
• Classify ridge parallelism as follows
56
 Class 3: The maxillary ridge is divergent from the occlusal
pladne anteriorly or both ridges are divergent anteriorly
 Class 1: Both ridges are parallel
to the occlusal plane.
 Class 2: The mandibular ridge is
divergent from the occlusal plane
anteriorly

57. Ridge Relationship:
• Classify according to Angle:
57
 Class 1: Normal  Class 3:
Prognathic
 Class 2:
Retrognathic

58. Lateral Throat Form
• Classify according to Neil:
58
 Class 1
 Class 3
 Class 2

59. Palatal Throat Form
HOUSE59
Class 1: Large and normal in form, with a relatively
immovable band of resilient tissue 5 to 12 mm distal to a line
drawn across the distal edge of the tuberosities.
Class 2: Medium size and normal
in form, with a relatively
immovable resilient band of
tissue 3 to 5 mm distal to a line
drawn across the distal edge of
the tuberosities.
Class 3: Usually accompanies a
small maxilla. The curtain of
soft tissue turns down abruptly
3 to 5 mm anterior to a line
drawn across the palate at the
distal edge of the tuberosities

60. Palatal Sensitivity
• Class 1: Normal
• Class 2: Subnormal (hyposensitive)
• Class 3: Supernormal (hypersensitive)
60

61. SOFT PALATE
 CLASS 1 – HORIZANTAL
Little muscular
movement
MOST FAVOURABLE
 Class 2 – soft palate turns downward at about 45
degree
to hard palate
potential tissue coverage less than class 1 for
posterior palatal seal
 Class 3 - soft palate turns downward sharply at 70
degree just posterior to hard palate
minimum potential space for posterior palatal seal
61

62. Floor of mouth
• Presents wide variation in anatomical and functional
relation to ridge crest
• If near ridge crest denture stability and retention is
poor.
62

63. Mucosa Thickness
• Classify thickness according to House:
Class 1:
Normal uniform density of mucosal tissue
(approximately 1-mm thick). Investing membrane is
firm but not tense and forms an ideal cushion for the
basal seat of a denture.
Class 2:
• (a) Soft tissues have thin investing membranes and
are highly susceptible to irritation under pressure
• (b) Soft tissues have mucous membranes twice the
normal thickness.
Class 3:
• Soft tissues have excessively thick investing
membranes filled with redundant tissues. At the very
least, this requires tissue treatment. Such conditions
may require surgical correction
63

64. Mucosa Condition:
• Classified according to House:
1.Class 1: Healthy
2.Class 2: Irritated
3.Class 3:'Pathologic
64

65. Border Attachments:
• Attachments should be classified according to
House:
1. Class 1: Attachments are high in maxilla or low in
mandible with relation to ridge crest (0.5 inches
or more between level of attachment and crest of
ridge).
2. Class 2: Attachment height in relation to the crest
of the ridge is between 0.25 and 0.50 inches.
3. Class 3: Attachment height is less than 0.25
inches from the ridge crest.
65

66. Frenum Attachments:
• Classify according to House (classified
in same manner as border attachments):
1. Class 1: High in the maxilla or low in the
mandible with respect to the crest of the
ridge.
2. Class 2: Medium
3. Class 3: Freni encroach on the crest of
the ridge and may interfere with tile
denture seal. Surgical correction may be
required. All lingual tissues of the
mandible are classified as muscle
attachments.
66

67. Saliva:
• Classify saliva as follows:
1.Class 1: Normal quality and quantity of
saliva. Cohesive and adhesive
properties of saliva are ideal.
2.Class 2: Excessive saliva; contains
much mucus.
3.Class 3: Xerostomia; remaining saliva
is mucinous.
67

68. XEROSTOMIA
PATIENT EDUCATION
Chewing
Candies or citrus sweet drinks
Consultation with physician regarding substitution of
offending drug
Increased cool water intake
Milk with meals
Pilocarpine 5 to 10 mg , 3 to 4 times/day , 30 min before
meals
SALIVA SUBSTITUTES : Oral balance gel
Salivart spray
Dentures soaked in water overnight
68
( Ref. JPD sep.2002 , vol. 88 ,no. 3

69. Tongue:
• Classify tongue according to House:
1. Class 1: Normal in size, development, and
function. Sufficient teeth are present to
maintain normal form and function.
2. Class 2: Teeth have been absent long
enough to permit a change in the form and
function of the tongue.
3. Class 3: Excessively large tongue. All teeth
have been absent for an extended period of
time, allowing for abnormal development of
the size of the tongue. Inefficient dentures
sometimes can lead to the development of a
class 3 tongue.
69
Problem in impression making
Decreased denture stability

70. Tongue Position:
WRIGHT
• Normal: The tongue
fills the floor of the
mouth and is confined
by the mandibular
teeth. The lateral
borders rest on the
occlusal surfaces of
the posterior teeth and
the apex rests on the
incisal edges of the
anterior teeth. There
is, no aberration in
tongue size or activity.
70

71. • Class 1: Retracted:
The tongue is
retracted. The floor
of the mouth pulled
downward is
exposed back to the
molar area. The
lateral borders are
raised above the
occlusal plane and
the apex is pulled
down into the floor
of the mouth.
71

72. • Class 2: Retracted:
The tongue is very
tense and pulled
backward and upward.
The apex is pulled
back into the body of
the tongue and almost
disappears. The lateral
borders rest above the
mandibular occlusal
plane. The floor of the
mouth is raised and
tense.
72

73. GAG REFLEX
• NORMAL DEFENCE MECHANISM
• Prosthodontic treatment may be compromised
• Causes : systemic disorders
• psychological factors
• Physiologic factors
• Iatrogenic
• Careful handling and constant reassurance .
73

74. ACUPRESSURE TECHNIQUE to control gag reflex
during maxillary impression procedures
Chengjiang ( REN 24) point. Apply light finger
pressure with index finger. Procedure should start 5
min before impression making and continued till
removal of impression from mouth
74
Amornpong Vachiramon, Acupressure technique to
control gag reflex during maxillary impression
proceduresJPD 2002 , VOL. 88 NO. 2 :236)

75. HYPERPLASTIC TISSUE
75
 Often present in relation to ill fitting denture
 Epulis fissuratum – Denture border
 Papillary hyperplasia
 Hyperplastic folds Denture base

76. REDUNDANT TISSUE
• Excessive amount of flabby tissue
76

77. Localized lesions
• White and red lesions
• Carcinoma
• Benign tumour
• Oral manifestations of systemic
disorders
• Oral infections
77

78. LEUKOPLAKIA
78
CANDIDAL INFECTION
Nutritional Deficiency
Related Angular cheilitis

79. palpation
• Sensitive finger with light touch
• But patient response to pressure may be helpful
EXTRAORAL : LYMPH NODES
MUSCLES OF MASTICATION
TEMPOROMANDIBULAR JOINT
PAROTID SALIVARY GLAND
INTRAORAL : LIPS
CHEEKS
DENTURE SUPPORTING AREA
FLOOR OF THE MOUTH
TONGUE
PATENCY OF WHARTONS DUCT
PRODUCTION OF SALIVA BY
SUBMANDIBULAR GLAND
79

80. EXTRA ORAL
LYMPH NODES80

81. MUSCLES OF
MASTICATION
• MASSETER: is
palpated bilaterally
and simultaneously
with firm and gentle
pressure.
• TEMPORALIS: is
palpated while asking
the patient to clench
and unclench the jaw
81

82. • MEDIAL
PTERYGOID: is
palpated with
thumb placed
outside and
index finger
placed inside
angle of ramus
82

83. Intraoral palpation
• FLOOR OF MOUTH: is
palpated bimanually by
placing index finger
inside mouth and fingers
of other hand outside in
submandibular region.
• TONGUE: can be
palpated by holding its
tip with a gauze piece
and asking the patient to
protrude the tongue and
move side to side.
83

84. • RIDGE: can be
palpated with
the back of
handle of
mouth mirror.
84

85. DIAGNOSTIC AIDS
• RADIOGRAPHS
• DIAGNOSTIC CAST
• PRE EXTRACTION RECORDS
• EXISTING DENTURE
85

86. RADIOGRAPHS
• RECOMMENDED RADIOGRAPHS – OPG
INTRA ORAL
OCCLUSAL
INDICATIONS
• SUBMUCOSAL CONDITIONS
• NORMAL ANATOMICAL LANDMARKS
• BONE DENSITY
• BONE PATHOLOGY
• SYSTEMIC DISORDERS
• RESORPTION PATTERNS
86

87. Submucosal conditions
• Foreign bodies
• Retained tooth roots
• Unerupted teeth
• Various pathosis of inflammatory
,developmental or neoplastic origin
• Relative thickness of submucosa covering the
bone in edentulous regions
• Location of mandibular canal and mental
foramina in relation to basal seat for denture
• Sharp spicules of bone on ridge crest and spiny
ridges
87

88. RETAINED ROOT PIECE88 RESORPTION PATTERN
TUMOURS
ACROMEGAL
Y

89. NORMAL ANATOMICAL
LANDMARKS89
Edentulous Panoramic X-Ray
1. Nasal Cavity
2. Maxillary Sinus
3. Zygomatic Arch
4. Head of the Condyle
5. Cornoid Process
6. Soft Palate
7. Maxillary Tuberosity
8. Hard Palate
9. Tongue Shadow
10.Mandible
11.Mental Foramen
12.Submandibular Fossa
13.Inferior Alveolar Canal

90. AMOUNT OF BONE RESORPTION
BY WICAL AND SWOOP
1974CLASS I
CLASS 2
CLASS 3
TWO THIRDS OF
MANDIBULAR
ALVEOLAR BONE
PRESENT
ONE THIRD TO TWO
THIRDS OF
MANDIBULAR
ALVEOLAR BONE
PRESENT ONE THIRD OR LESS
X 3
90
Wical KE, Swoope CC: Studies of residual ridge resorption. Part I. Use of panoramic radiographs for evaluation and classification of
mandibular resorption: JPD 1974;32:7-12

91. CALCULATION –
by WICAL AND SWOOP
• They found that lower edge of mental foramen divides
mandible into thirds in normal dentulous panoramic
radiographs.
• If distance is measured from inferior border of mandible
to inferior margin of mental foramen and then multiplied
by three , resulting product is reliable estimate of
original alveolar ridge crest height
91

92. EXTENT OF BONE RESORPTION
BY – CAWOOD AND HOWELL 1988
92

93. MISH - BONE DENSITY
CLASSIFICATION
93

94. Bone Quality : LEKHOLM AND ZARB
198594
For anterior region
Of jaws

95. PRE EXTRACTION
RECORDS :
• PHOTOGRAPHS – Tooth selection and arrangement
Measurements of teeth
Jaw relation
• OLD RADIOGRAPHS – Tooth size and bony changes
95

96. Diagnostic cast
• Evaluation of anatomy relationships in absence of
patient
• Three dimensional information on tooth size and
arrangement
• Arch size and symmetry
• Arch concentricity
• Articulator mounted cast – jaw relationship
interarch tooth relationship
• Undercuts
• Soft tissue disease
96

97. EXISTING DENTURES
• - Anterior Tooth Shade, Mold, and
Material
• Posterior Tooth Shade, Mold, and
Material:
• Existing dentures should be evaluated
to determine physical, esthetic, and
anatomic characteristics. Shade, mold,
and material should be recorded for
both anterior and posterior teeth. If the
mold cannot be determined, the
general shape of the teeth should be
recorded (e.g., square, square-
tapering, tapering, ovoid, etc.).
97

98. • Esthetics, phonetics, retention, stability,
extensions, and contours:
• Existing esthetics, phonetics,
retention,, stability, extensions, and
contours should be evaluated. These
attributes should be rated
• (1) good,
• (2) fair, and
• (3) poor.
98

99. • Centric Relation and Vertical Dimension of
Occlusion:
• Centric relation and vertical dimension
of occlusion should be assessed and
rated "acceptable" or "unacceptable,"
• If unacceptable, it should be noted
whether the existing VDO is
"inadequate" or "excessive."
99

100. • Occlusal Plane Orientation:
• The orientation of the occlusal plane should be
noted. Improper orientation as a result of tooth
setting or changes in bony architecture often
creates a "reverse smile line." This condition is
characterized by teeth that slope downward as
one progresses posteriorly. Consequently, the
anterior teeth assume a curvature that does not
follow the arc of the lower lip.
100
REVERSE SMILE LINE DESIRED SMILE LINE

101. • Palate:
• The palate of the existing maxillary denture should
be examined.
• The denture base material and thickness should be
noted. Anatomic features should be assessed.
• The practitioner should note the presence or
absence of rugae on the cameo surface of the
denture base.
• Denture wearers may have become accustomed to
a particular palatal form, and may resist change.
• The practitioner should listen to speech patterns,
and determine whether appropriate "valving" is
taking place. Placement of rugae or a change in
thickness may affect pronunciation.
101

102. • Post dam: The posterior border of the
maxillary denture should be examined.
Likewise, soft tissues in the vicinity of the
"vibrating line" should be observed.
• The seal of the existing maxillary denture
should be evaluated clinically. Often,
deficiencies in retention of the maxillary
denture may be traced to improper post-
damming. The post dam should be rated
"acceptable" or "unacceptable."
102

103. • Base Adaptation:
• The fit of maxillary and mandibular
bases should be assessed using an
appropriate disclosing medium,
Adaptation should be rated
"acceptable" or "unacceptable."
103

104. • Midline:
• Maxillary and mandibular midlines should be observed.
• Discrepancies in midline placement create noticeable
facial disharmonies.
• The existing maxillary midline should be evaluated
using intraoral (e.g., incisive papilla) and extraoral
landmarks (e.g., nasion, filtrum, middle of the chin).
• The midline should be rated "acceptable" or
"unacceptable.' Deviations of the maxillary midline
should be recorded by direction and amount (e.g.,
maxillary midline 2 mm to the right of the facial midline).
104

105. • Buccal Vestibule:
• The buccal vestibule is an important
esthetic and functional component in
complete denture service.
• Consequently, this space should be
assessed carefully. The buccal vestibule
should be judged "acceptable" or
"unacceptable." Corrective actions
should be proposed.
•
105

106. • Crossbite:
• The presence of a unilateral or
bilateral crossbite often presents a
challenging situation.
• Crossbites should be noted and their
effects on tooth placement anticipated.
This information may be entered into
the diagnostic record using the
categories "none “, “ unilateral," or
"bilateral."
106

107. • Characterization:
• Characterization or staining of existing
denture bases should be evaluated and
recorded.
• Existing denture bases may be
classified as "characterized" or '
'uncharacterized."
107

108. • Comfort:
• The patient should be questioned
regarding the comfort of maxillary and
mandibular dentures.
• Comfort for the respective arches
should be classified as "acceptable" or
"unacceptable."
• Patients who experience discomfort
should be questioned to determine the
nature and source of the discomfort.
108

109. • Hygiene:
• The patient's ability and motivation to clean
the dentures should be assessed during the
clinical evaluation.
• The patient also should be questioned about
his or her denture cleansing regimen.
• These factors may affect denture-base
contouring (e.g, closed interdental contours
versus open interdental contours) and tooth
arrangement (e.g., presence or absence of
diastemata).
• Hygiene should be classified as (1) good, (2)
fair, or (3) poor.
109

110. • Wear:
• Wear often is an indicator of
parafunctional habits or an abrasive
diet. The wear process must be
assessed with respect to time.
• With these factors in mind, wear
should be classified as (1) minimal, (2)
moderate, or (3) severe.
110

111. • Attachments and Hardware:
• Attachments and hardware usually are
limited to overdenture situations.
• When working under these constraints,
it is important to know the specific
system in use and the availability of
components
111

112. TREATMENT
PLANNING
112

113. 113
Treatment planning
It addresses patient’s needs
List specific treatment needs.
Enables patient to
informed consent
regarding
Treatment time
And fees
Enables dentist to
estimate
Operating time
Laboratory time
And fees

114. TREATMENT OPTIONS
• ADJUNCTIVE CARE :
• Elimination of infection
• Elimination of pathosis
• Surgical improvement of denture support and space
• Tissue conditioning
• Nutritional counselling
114

115. • PROSTHODONTIC CARE :
• Complete denture : : immediate or conventional
: definitive or interim
: tooth , implant or soft tissue
supported
115

116. Complete denture:
• Tooth selection : shade
mold
material
• Denture base material ,shade
• Anatomic palate
• Charecterization of denture
• Inadequacies of existing denture to be
improved
116

117. TISSUE CONDITIONING
• Traumatized denture bearing area
• Oral mucosa
Hypertrophic
Irritated
Hyperemic
bruxism
poorly occluding dentures
• Lining old dentures improve stability , relieves and
equalizes pressure immediately
• Patient need not be without dentures for tissue recovery
• Recording correct jaw relation
117

118. NUTRITIONAL COUNSELLING
• Teach about components of diet that will
support
oral mucosa
bone health
body health
• More intake of vitamins
minerals
calcium
proteins
• DIETARY COUNSELLING – 24 HOURS diet record for
two or more days
118

119. PRE PROSTHETIC SURGERIES
• ALVEOLOPLASTY
• VESTIBULOPLASTY
• FRENECTOMY
• EXCISION OF FLABBY TISSUE
• EXCISION OF TORI
• REDUCTION OF ENLARGED TUBEROSITIES
• RIDGE AUGMENTATION PROCEDURES
119

120. FRENECTOMY
EXCISION OF FLABBY TISSUE
SINUS LIFT PROCEDURE
120

121. IMMEDIATE DENTURES121
CONVENTIONAL OR
CLASSIC
 Only anterior teeth
 Few posterior teeth
remaining that do not
support existing RPD
 When patient can
function without
posterior teeth for
approximately 3
months
INTERIM
 Multiple anterior and
posterior teeth
remaining
 Full arch extractions
 High esthetic
concerns

122. OVERDENTURES
• Young patients
• Old patients unable to undergo
treatment procedures
• If complete dentures opposed by
retained
mandibular anterior teeth
122

123. Implant supported dentures
• Patient desire
• Systemic health status ,
which permits a
minor surgical procedure
• Sufficient bone quantity to
accommodate
prescribed implant dimensions
• Patient willingness and ability
to maintain oral health status
123

124. PROGNOSIS
• After treatment plan prognosis should
be evaluated
• Give the prognosis and reasons for it .
• Prognosis should be evaluated
keeping in
mind the consequences of
treatment &
no treatment , as to how such an
action can change the prognosis .
124

125. SUMMARY
• Intelligent effective treatment will meet the specific
need of individual patient. However , in order to meet
these needs first they must be identified . Some
patients pose greater problems than others , some can
be minimized , some can be eliminated , to varying
achievement level. The treatment plan developed for a
patient should reflect the dentists best efforts at
interpreting the diagnostic findings and addressing the
patients needs in keeping with their appreciation for
dentistry and their ability to accept the proposed
treatment.
125

126. REFERENCES
• ZARB – BOLENDER,PROSTHDONTIC TREATMENT FOR EDENTULOUS PATIENTS
12TH EDITION , PAGE 73-99
• SHELDON WINKLER,ESSENTIALS OF COMPLETE DENTURE PROSTHODONTICS
2ND EDITION , PAGE 39-55
• CHARLES M . HEARTWELL,JR, SYLLABUS OF COMPLETE DENTURES
4TH EDITION ,PAGE 106-142
• H.R.B. FENN, CLINICAL DENTAL PROSTHETICS, 2ND EDITION ,PAGE 54-75
• LEVIN BERNARD,COMPLETE DENTURE PROSTHODONTICS ,QUINTESSENCE PUBLISHING,CHICAGO,2002,17TH
ED:PAGE:11-24
• THE DENTAL CLINICS OF NORTH AMERICA , JAN 1996,VOL.40,NO.1
• GREENBERG . GLICK, BURKET’S WICAL KE, SWOOPE CC: STUDIES OF RESIDUAL RIDGE RESORPTION. PART I.
USE OF PANORAMIC RADIOGRAPHS FOR EVALUATION AND CLASSIFICATION OF MANDIBULAR RESORPTION: JPD
1974;32:7-12
• AMORNPONG VACHIRAMON, ACUPRESSURE TECHNIQUE TO CONTROL GAG REFLEX DURING MAXILLARY
IMPRESSION PROCEDURES, JPD 2002 , VOL. 88 NO. 2 :236)
• BISSASU ET AL, PRE-EXTRACTION RECORDS FOR COMPLETE DENTURE FABRICATION: A LITERATURE
REVIEW;JPD :JAN 2004:VOL 91:NO1;PAGE55-57
• ARNOLD, ET AL, THE IMPACT OF SALIVA ON PATIENT CARE: A LITERATURE REVIEW JPD SEPT .2002,V
OL.88,NO.3:337-343
126

127. 127