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Diagnosis and treatment planning in completely endntulous arches/dental courses


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Diagnosis and treatment planning in completely endntulous arches/dental courses

  2. 2. CONTENTS Introduction Definition Of Diagnosis & Treatment Planning General Introduction Of the Patient&Evaluation Diagnostic Procedures Clinical history taking Clinical examination—Intra oral -Extra oral Examination of existing dentures.
  3. 3. Specific Investigations— Radiographs. Diagnostic cast. Pre-extraction record. Other investigation for systemic disease . Treatment planning. Summary&Conclusion. References.
  4. 4. INTRODUCTION Diagnosis Comprises of evaluation of patients health with respect to his/her physical,mental&social health, and these diagnostic findings decide treatment plan. Treatment planning is the most important milestone which depends on the diagnosis.So accurate diagnosis plays a very important role in ensuring predictable results of the treatment.prognosis depends on both diagnosis and treatment planning.
  5. 5. Definition of diagnosis & treatment planning • Diagnosis is defind as determination of nature of disease. • Treatment planning is defind as the sequence of procedures planned for the treatment of a patient after diagnosis • Boucher –diagnosis consists of planned observation to determine & evaluate the existing conditions, which lead to decision making based on the condition observed. • Treatment plans should be developed to best serve the needs of each individual patient. •GPT—
  6. 6. Winkler— Defines diagnosis is the examination of physical status, evaluation of mental or psychological make up, &understanding of needs of each pt to ensure a predictable result. Treatment planning means developing sequence of procedures planned for the treatment of a patient after diagnosis.
  7. 7. General introduction of the patient & Evaluation The first appointment imp for the development of mutual understanding, trust b/n pt dentist. Pt should be addressed by name Dentist should verify the personnel information collected by the receptionist. Patient Evaluation— Observation of the patients motor skills,level of co- ordination steadiness while walking. Unusual gait –Parkinson`s disease, neurological disorder, disease of the joint. .
  8. 8. EVALUATION OF MENTAL ATTITUDE The successful prosthodontic treatment depends on both technical skill &p mgt according to mental attitude. Neurosis– chr. Anxiety state at phy .State --increases alters neuromuscular co ordination. Dr. M .M. House cl of mental attitudes 1. Philosophical-ideal, co-operative, optimistic .Prognosis good. 2. Indifferent- least concerned about their oral health not co-operative, avoid treatment. Prognosis poor. 3. Critical-not satisfied with previous dentures &dentist. 4. Skeptical—poor gen health, unfavorable biomechanical condition,pessimistic. Pt motivation & education. 5. Hysterical-poor health, nervous, unrealistic expectation, poor prognosis education & motivation.
  9. 9. CLINICAL HISTORY TAKING Diagnosis & treatment planning depends upon accurate data collection & record maintenance. Information collection—Questionnaire. --Direct interrogation. --Combination. Name:patient identification, for addressing. Sex: patient expectations in the denture differ with sex. AGE:diseases related to age,as age advances decrease in adaptability &neuromuscular co- ordination,learning ability. Oral&facial tissues loose elasticity &resiliency.
  10. 10. Address: Telephone. No: Religion : Family history: Socio-economic status : Physician
  11. 11. Chief complaint:difficulty in speech mastication, appearance Dental history >Cause for the tooth loss >Period of edentulousness >Problems with existing denture >expectations in new denture
  12. 12. MEDICAL HISTORY: Hospitalization. Previous medical records. Date & reason for the last visit to physician. Physician tel .ph no. H/o systemic diseases.
  13. 13. DIABETES MELLITUS • -Impaired carbohydrate metabolism because of insulin deficiency or resistance. • Pt should be for the h/o DM, rule out for DM. • Drug history Insulin,OADA,diet • Pt suffering from DM will show-- 1)Osteoporosis. 2) Residual alv bone resorption . 3)Delayed wound healing. 4)Prone infection. . • Patient education regarding maintenance of denture cleanliness oral hygiene. Need for regular check up • Appointment scheduling. • Mucostatic impression technique. Avoid surgical intervention.
  14. 14. CARDIOVASCULAR SYSTEM Angina pectoris: it is a severe ischeamic pain aggravates on exertion relieved with rest. Avoid anxiety, exertion Physician consultation . Emergency drugs. Hypertensions: Myocardial infarction: Pt with h/o MI avoid treatment for 6 mts. Physician consultation & reassurance of pt to reduce anxiety. Infective bacterial endocarditis: Pt with artificial heart valves, valvular heart disease prone to develop. Prophylactic Ab therapy prior to surgical procedures.
  15. 15. BLOOD DYSCRASIAS Anaemia:level of Hb in the blood below normal.(14- 16%) Types of Anaemia: Iron def. Anaemia:increased loss of iron, increased physiological requirement, malabsorbtion of iron as in hypochlorhydria. Oral Manifestations:atrophic mucous membrane, loss of normal keratinization. Megaloblastic anaemia: deficiency of vit B-12 & folic acid. Oral Manifestations:angular chelitis Pernicious anaemia:It is autoimmune disorder.atrophic gastric mucosa with loss of parietal cells so def of IF,decreased vitB-12 absorption
  16. 16. Oral manifestations Bald tongue atrophy of papilla Glossitis Burning sensation in the mouth. Sickel cell anaemia.:hereditary type of chr. Hemolytic anemia transmitted as non sex linked dominant factor. Radiographic features reveal-mild to sever gen osteoporosis, loss trabaculation of jaw bones with large irregular marrow spaces, coarse trabaculaton.
  17. 17. DISEASE INVOLVING WBC`S Leukopenia:decrease in no. WBC`s. Agranulocytosis: serious disease with decrease in number of granulocytes. Oral manifestations: necrotizing ulcers, excessive salivation. Leukemias:characterized by progressive over production of WBC`s, appear in circulating blood in immature form. Cl. As—acute -myeloid ` -chronic. -lymphoid -monocytic O.m—petechiae, ulceration of mucosa, purpuric lesions.
  18. 18. DISEASES OF PLATELETS Thrombocytopenic purpura:decrease in circulating blood platelets autoimmune disorder. Thrombocythemia: increase in circulating blood platelets. Oral manifestations: petechiae on the oral mucosa,bleeding tendencies.
  19. 19. INFECTIOUS DISEASES Bacterial, Viral,Fungal Tuberculosis Syphilis Herpes simplex Hepatitis A&B Infectious mononucleosis HIV Candidiasis Precautions: Prevent cross contamination Self precaution &protection of assistant Disposable instruments Disinfections of
  20. 20. DISEASES OF BONE & JOINTS Osteoarthritis:Osteoarthritis: Affects elderlyAffects elderly aboveabove 45 yrs of age M:F ratio 2:1(age45 yrs of age M:F ratio 2:1(age related degenerative joint disease less frequentlyrelated degenerative joint disease less frequently affects TMJ),weight bearing jointsaffects TMJ),weight bearing joints Characterized by deteriorations of articular cartilageCharacterized by deteriorations of articular cartilage remodeling of underlying bone.remodeling of underlying bone. C/f:-C/f:-pain &crepitaion during mandibularpain &crepitaion during mandibular -- restricted movementsrestricted movements -- muscles of mastication tender.muscles of mastication tender. -- -- Advanced stage jt disability & atrophy ofAdvanced stage jt disability & atrophy of associated muscles.associated muscles. Difficulty in wearing and cleaning of denture.Difficulty in wearing and cleaning of denture. Impression making,jaw relation recording difficult.Impression making,jaw relation recording difficult. Frequent occlusal corrections should be made.Frequent occlusal corrections should be
  21. 21. Rheumatoid arthritis Inflammatory disease affecting joints. C/f –Affects small joints of hands,feet symmetrically first followed by wrists, elbows, ankles,knees. TMJ-pain ,crepitations, limited movements, stiffness, anterior open bite, vertical facial height increased.
  22. 22. Paget`s disease C/f— chronic disease,pt above 40 yr & older age group - bone pain ,head ache, deafness compression of cochlear n,blindness involvement of optic n, dizziness , facial paralysis, weakness & mental disturbance. O/m-maxilla>mandible 2.3:1. - -maxilla progressive enlargement,alv ridge widened, palate flattened. Ed pt c/o inability to wear dentures.
  23. 23. Achondroplasia Disturbance of endochondral bone formation resulting in dwarfism. Hereditary condition transmitted as autosomal dominant character. C/f dwarf below 1.4mt,brachycephalic skull,bowed legs,small hands ,stubby fingers, lumbar lordosis. O/m—Retruded maxilla with relative mandibular prognathism resulting in jaw discrepancies in size & malocclusion
  24. 24. Emotional disturbances: Mild anxiety to anxiety neurosis, depression,phobias,disoriented. Severe cases psychiatric consultation. Patient motivation & reassurance. Require longer appointments Epilepsy: drug history ,h/o last attack, precipitating factors, frequency, duration of . In such pts avoid flickering lights ,instruments which can cause harm. CENTRAL NERVOUS SYSTEM
  25. 25. Bell`s palsy Facial .n palsy because of cold,trauma, injection of L.A drugs,nerve impingement ,injury of the n during the parotid gl surgery. C/f :-unilat facial paralysis. -Mask like face,drooping of mouth corner. -inability to close eyes. -loss of forehead wrinkles . Difficulty in making impression . Difficulty in eating & speech. To avoid cheek biting over contouring denture base on the affected side. Excessive horizontal overlap in posteriors.
  26. 26. Parkinson`s disease It is a degenerating disease affecting basal ganglia, decreased dopaminergic output so inhibitory action on sub thalamic nucleus decreased. C/f –expressionless face with staring look -soft rapid speech,fixed posture,impaired balance,altered gait,muscle rigidity,impaired fine movements,tremors in mandible,tongue, fingers, hands. Difficulty in making impression , jaw relation recording Pt should be educated about the difficulty in eating,speech &retaining mandibular denture.
  27. 27. Trigeminal neuralgia Disease involving the ns supplying the face,teeth,jaws &associated structures. C/f –searing,stabbing ,lancinating type of pain initiated on touching trigger zone. In such pts prosthodontic treatment becomes difficult. Pts should be first treated for Trigeminal neuralgia then continued with prosthodontic treatment
  28. 28. Climacteric Change in bodily functions occurs during specific periods Affects both male& females In females menopause is the period Post menopausal syndrome: Gen osteoporosis, inability to adjust, burning tongue& tendency to gag
  29. 29. DISEASES OF SKIN WITH ORAL MANIFESTATIONS Lichen planus: O.m:white or grey velvety thread like papules in a leniar,annular, retiform arrangement forming typical lacy,reticular patches, rings , streakes over the buccal mucosa, lesser extent on tongue &palate(Wickham’ s striae) Erosive (premalignant), vesicular or bullous forms also causes burning sensation
  30. 30. Erythema multiformae:concentric ring like vesiculo bullos lesions(bull’s eye) O.m: Pain, discomfort Hyperemic macules,papules,vesicles become eroded or ulcerated bleed freely Tongue, palate, buccal mucosa ,gingiva commonly affected Lip may show ulceration/bloody crusting
  31. 31. Pemphigus: auto immune disease Intercellular antibodies in epithelium of skin,oral mucosa. Serious chr disease appearance of vesicles, bullae,& blisters. Oral manifestations: Isolated vesiculo bullos lesions ruptures to leave ulcers Oral lesions with rugged borders covered by white blood tinged exudate follows by crusting Severe pain,burning sensation. Inability to eat Pt informed about existing condition and advised not to wear the dentures continuously.
  32. 32. Systemic sclerosis Characterized by indurations of skin & fixation of epidermis to the deeper subcutaneous tissue Types Diffuse Localized O/m:mucosa thin ,pale due to loss of vascularity and elasticity. Tongue stiff board like, restricted movements. Lips thin rigid partially fixed Decrease in mouth opening Distortion of buccal and labial vestibules Difficulty in impression making & jaw relation recording Post insertion probs: soreness, ulceration require constant adjustments & even remaking
  33. 33. Sjogren`s syndrome: Auto immune disease characterized by keratoconjunctivitis sicca, xerostomia, rheumatoid arthritis. O/m-xerostomia, burning sensation in the mouth. Contact dermatitis-Lesions occur on skin &mucous membrane at a localized site after a repeated contact with causative agent. Patch test.
  34. 34. DRUG HISTORY Indicate systemic disease,adverse reaction affecting oral conditions. Drugs- antihistamines,antihypertensive, antiparkinson`s,antidepressants, atropine cause xerostomia. Sialorrhoea-- cholinesterase,epinephrine,sialogouges. Orthostatic hypertension— antihypertensives,antidepressants,centrally acting skeletal muscle relaxants. Drug induced Parkinson like syndrome by tricyclic antidepressants,phenothiazine. Hypoglycemic shock-Insulin. Behavioral changes &confusion- antidepressants,corticosteroids,antiparkinson`s, antihistaminic,digitalis.
  36. 36. CONTENTS Introduction Definition Of Diagnosis & Treatment Planning General Introduction Of the Patient&Evaluation Diagnostic Procedures Clinical history taking Clinical examination—Intra oral -Extra oral Examination of existing dentures.
  37. 37. Specific Investigations— Radiographs. Diagnostic cast. Pre-extraction record. Other investigation for systemic disease . Treatment planning. Summary&Conclusion. References.
  39. 39. LOCAL EXAMINATION EXTRA ORAL Examination of the head & neck for pathological lesions Facial examination. 1)Facial Form: -Square -Ovoid -Tapering -Square tapering. 2)Facial symmetry : -Symmetrical -Asymmetrical -swellings, hemi facial hypertrophy. 3)Facial profile : -Acc to angle –Class |-Normal -Class||-Retrognathic -Class|||-Prognathic
  40. 40.
  41. 41.
  42. 42. TONE FACIAL TISSUES It depends on the age & health of the patient Acc to house classified-- -ClassI—Normal tone & placement of facial muscles of mastication & expression. -ClassII_ Displays normal function but slightly decreased tone. -ClassIII_ Decreased muscle tone function. Muscle development: Acc to house classified-Heavy -Medium -Light Muscle tone for denture retention. Normal tone &development required for ease of manipulation.
  43. 43. COMPLEXION: Skin of face—Dark __Medium __Fair Hair color__ Black, brown, blond. Eyes __Blue ,gray, brown, Black. The color of the skin guides in shade selection of the teeth .
  44. 44. LIP EXAMINATION Lips examined for cracks , fissures, ulcers Lip supportcontour: Adequate support is achieved by proper positioning of upper anterior tooth Un supported-collapsed appearance, wrinkles around lip. Lip thickness: Thick Thin
  45. 45. Lip mobility: Normal Limited Paralysis Lip length: Long—hides denture & most of tooth Medium Short---teeth& denture base exposed. Vertical face length: Normal Decreased vertical dimension---Collapsed appearance with wrinkles ,false prognathic relation. Increased vertical dimension—taut ,
  46. 46.
  47. 47. TMJ EXAMINATION Pain on opening/ closing movements of mandible. Tenderness Clicking sound, crepitations Deviation of mandible on opening Muscle tenderness Limitation of mandibular movement The centric relation depends upon structural & functional harmony of osseous structures ,the intra articular tissues , capsular ligaments.
  48. 48. NEUROMUSCULAR EVALUATION Neuromuscular co-ordination-Excellent -fair -poor Poor neuromuscular co-ordination affects impression recording & jaw relation recording. Advise for tongue & mouth exercises. Jaw movements. Speech Evaluation-affected - normal
  49. 49. Examination of the lymphnodes
  50. 50. Intra oral examination Oral mucous membrane: Examined for inflammatory lesions , pathological lesions like precancerous lesions ,oral malignancies ,papillary hyperplasia ,epulis fissuratum,ulcers. Evaluation of residual alveolar ridge: Arch size: The size of the maxilla &mandible determines the amount denture bearing available. Discrepancy in jaw size. Arch size –Large - ideal _Medium-good _Small- poor
  51. 51. Disharmony in jaw size Maxillary may be larger than mandibular or reverse because of the resorption pattern, disturbance in growth & development,genetic factor. Occlusion should be planned similar to disharmony. Arch form: According to house cl---Square ---Ovoid ----Tapering
  52. 52.
  53. 53. RESIDUAL RIDGE FORM Classified as-- High with parallel ridge slopes & well rounded ,broad in width. High in height & average in width. High in height & thin in width. Because of resorption ridge assumes. Average height broad in width. Average height & width. Low in height & broad in width. In severe resorption the ridge assumes V shape Unfavorable for retention. – High V shaped . – Average V shaped. – Low V shaped.
  54. 54. In severe resorption ridge becomes knife edge shaped. High knife edge. Average knife edge. Low knife edge Ridge can be classified as. High well rounded Low well rounded Knife edge. Flat ridge.
  55. 55.
  56. 56.
  57. 57.
  58. 58. High well rounded ridge favorable With flat crest & parallel sides . Knife edge &V shaped ridge selective pressure impression technique. Ridge relationship: GPT—The positional relation of the mandibular ridge & maxillary ridge. Angle classified:Class I —Normal -Class II_Retrognathic _Class III_Prognathic
  59. 59.
  60. 60. RIDGE PARALLELISM Refers to relative parallelism between planes of the ridge. Class I-Both ridges are parallel to occlusal plane. Class II-Mandibular plane diverts from the occlusal plane anteriorly. Class III-Either the maxillary ridge diverts from occlusalplane anterioly or both ridges divert.
  61. 61. INTER ARCH SPACE Normally 16-20mm adequate for the accommodation of artificial teeth. Excessive inter arch space –increased resorption. -Poor stability. Inadequate space
  62. 62.
  63. 63. SAGITTAL PROFILE OF RESIDUAL ALVEOLAR RIDGE It is important to locate from where the mandibular ridge slopes up towards retromolar pad & ramus because occlusal contacts immediately above the the incline at the back part of the residual alveolar ridge will cause denture to slide forward.
  64. 64. BONY UNDERCUTS The bony undercuts do not play any role in retention of the denture. Bony irregularities– presence of sharp bony spicules , rounded smooth elevations. Retained root pieces.
  65. 65. SOFT TISSUE EXAMINATION Mucosal thickness: According to house classified as. ClassI—Normal uniform thickness approximately 1mm. Class II—Soft tissue with thin investing membrane & mucous membrane maybe twice the normal thickness. ClassIII—Soft tissue with excessively thick investing membrane with redundant tissue. Muscle & Frenal attachments: Examined in relation to the crest of the ridge because it can interfere with denture extension &border seal. House cl border attachments-ClassI-At least 0.5inches distance between attachment & ridge crest.s -ClassII- distance between attachment & ridge crest 0.25 to 0.5inches. -ClassIII-below 0.25inches
  66. 66.
  67. 67.
  68. 68. Frenal attachments: Away from the crest. Nearer to the crest. At the crest. Floor of the mouth: Lingual frenum. Genial tubercles. Plica.
  69. 69. RETROMYLOHYOID SPACE Neil cl as ClassI-Deep ClassII-Moderate ClassIII-Shallow
  70. 70. EXAMINATION OF THE TONGUE Tongue size: House classified.—ClassI-Normal ,development ,function. __ClassII-Change in form & function. __ClassIII-Excessively large. Tongue size can be ---Hypertrophic. __Atrophic. __Normal. Tongue position:Wrights classified as ClassI—the tongue lies in the floor of the mouth with tip forward &slightly below the incisal edgsse of mandibular anterior teeth. ClassII—The tongue flattened & broadened but tip is a normal position. Class III-retracted depressed into floor of mouth with the tip curled upward into the body of the
  71. 71. Class I position is ideal with floor of mouth at an adequate height , so lingual border contacts it & maintains the seal. In class II &III floor of the mouth is low.
  72. 72. SALIVA Thin serous normal quantity-favorable for retention. Thick ropy/mucous saliva—decreases retention & stability. Xerostomia.
  73. 73. GAG REFLEX Normal defense mechanism designed to prevent foreign bodies from entering the trachea.Mild chocking to retching . Causes – anatomical variation ,psychological, systemic disorder,alcoholism. Management—clinical -Prosthodontic -pharmacological -psychological reassurance.
  74. 74. HARD & SOFT TISSUES IN THE MAXILLARYHARD & SOFT TISSUES IN THE MAXILLARY BASAL SEATBASAL SEAT Soft tissue covering RAR & palate: Ideally uniform thickness,quite firm, resilient. Hyperplasic/flabby ridge. Fibrous enlargement of maxillary tuberosity. Papillry hyperplasia of the palate. Epulis fissuratum Incisive papilla. Palatine rugae. Compressibility.
  75. 75.
  76. 76.
  77. 77. PALATAL VAULT U shaped –Parallel ridge slopes & broad base. Flat palate with broad base & lower ridge slopes . The V shaped vault with greater vertical than horizontal area.
  78. 78.
  79. 79.  Soft classified  Cl I-Horizontal favorable ,more tissue coverage for pps area.  Cl II-Soft palate turns down at 45 degree  Cl III-Soft palate turns down at 70 degree angle just posterior to hard palate. SOFT PALATE
  80. 80. TORUS PALATINUS Bony enlargement at the midline of the hard palate. Size- small pea nut,enlarges till occlusal plane. Covered by thin less resilient tissue Surgical removal advised if it extends near to vibrating line about 2to 3mm short.
  81. 81. Absence of tuberosity & loss of pterygomaxillary notch.  Advanced RAR resorption.  Excessive surgical reduction of tuberosity.  Inadequate pps of maxillary denture.
  82. 82. HARD & SOFT AREA IN MANDIBULAR BASAL SEAT Soft tissue- fibrous cord like soft tissue ridge in severely resorbed ridges,epulis fissuratum.
  83. 83.
  84. 84.
  85. 85. MANDIBULAR TORI Bony protuberance on lingual aspect of the mandible in the premolar region. Genial tubercles . Mental foramen. Mylohyoid ridge.
  86. 86. EXAMINATION OF EXISTING DENTURES Mucosa examined for pathological changes. As per the study conducted by Ostlund in 1953 it was reported that in 77% of the denture wearing patients there will be presence histological changes even though he mucosa appears clinically normal. Evaluation of Denture cleanliness. C R & CO, premature contacts ,sliding. Vertical dimension. Denture extensions. Type of teeth. Retention ,stability. Esthetics. Phonetics.
  87. 87. SPECIFIC INVESTIGATIONS Radiographs: Panoramic radiographs play an important role in diagnosis &treatment planning in completely edentulous patients. Study was conducted by Syropoulos N.D,Patsaks A.J in 1931.
  88. 88. Study the residual alveolar ridge resorption. Mandibular RAR resorption can be classified. Class I—Upto 1/3rd of original vertical height lost Class II-From 1/3rd to 2/3rd of original vertical height lost. ClassIII-2/3rd or more of original vertical height lost. Radiographic examination of the bone density by Misch. Dense cortical bone . Porous cortical bone. Coarse trabacular bone. Fine trabacular bone. Study the location of anatomic structures.
  89. 89.
  90. 90.
  91. 91.
  92. 92.
  93. 93. RADIOGRAPHIC EXAMINATION TMJ Panoramic projection– bilateral view of condyle& fosssa relation, oblique posterior ,anterior view of the joint . To rule out gross intra osseous defects. Transcranial projection—lateral view of TMJ.Spicules &erosions of lateral surface Transorbital projection---medial & lateral surface. Submento vertex view---the surface of condyles
  94. 94.
  95. 95. Tomography:Specialized technique that allows detailed images of structures in a predetermined plane ,while blurring the unwanted structures. Classic tomography: Several exposures of selected area at orbitrary intervals or section.Lateral, medial, central parts of joint as separate images. Computed tomography: Scanning of well defined area. -The computer analyses X-ray absorption at many different points & converts them into an image on a video screen. -Gross determination of condyle disk relation Arthrography: Magnetic resonance imaging: Bone scintigraphy: .
  96. 96.
  97. 97. Diagnostic casts Aids in the evaluation of anatomy & relationships in absence of patients. Evaluation of following Ridge relationship Diagnose missed findings Conform clinical findings Measuring & determining relation to other structures Decision about preprosthetic surgery Undercut surveying. Pre extraction records: Photographs showing natural teeth. Old radiographs. Diagnostic casts & radiographs obtained from other dentist.
  98. 98.
  99. 99. EXISTING DENTURES Using the patient`s existing dentures impression made & diagnostic casts made. With tentative CR & face record mount the maxillary cast on to the adjustable articulator ,orient the mandibular casts with CR. Check vertical dimension ,CR &CO.
  100. 100. OTHER INVESTIGATIVE PROCEDERES To Rule Out DM RBS FBS PPBS Patient’s BP should be recorded. BT CT Prothrombine time Hb gm%. If any Intra or Extra Oral lesion advise for Biopsy Histopathological Examination .
  101. 101. TREATMENT PLAN The treatment plan should specify regarding the treatment procedures,operating time,laboratory time,calender time & fees such that patient informed consent regarding the same can be obtained. Treatment plan for completely edentulous patients includes: Adjunctive care---Pt education &motivation. ----Elimination of infection. ----Elimination of pathoses. ----Treatment of abused tissues. ----Tissue conditioning. ----Nutritional counseling. Prosthodontic care –Conventional complete denture. --implant supported complete denture.
  102. 102. ADJUNCTIVE CARE Patient education: Information about their dental health &it`s effect on the treatment outcome. Limitation of complete denture. Problems associated with complete denture initially. Importance of oral &denture hygiene. Need for regular check up. Convincing about the Rx procedure,need for the surgical Rx, time required, fees. Motivation of the patient. Diet counseling:Diet rich in proteins,calcium, vitamins, minerals,low calorie diet. If required referred to dietician, physician.
  103. 103. NON SURGICAL METHODS OF TREATING THE ABUSED TISSUES Resting the denture supporting tissues. Regular massaging. Occlusal correction , establishing vertical height Refitting the dentures. Drugs to eliminate infection. Nutritional supplements. Advise for jaw exercise.
  104. 104. SURGICAL METHOD 1)Correction of hyperplastic ridge tissue ,epulis fissuratum, papillomatosis ,hyperplastic pendulous tuberosity. Indication—no response to nonsurgical Rx procedures. --interferes with stability . Excision of the tissues with vestibuloplasty.Electro surgery. 2)Frenal attachments-maxillary labial frenum broad fibrous band,lingual tongue tie,prominent buccal freni Indications—near to crest of ridge. Frenectomy. 3)papillary hyperplasia-Small lesion with sharp curettes electro surgery. -Large lesion split thickness supra periosteal flap. 4)Vestibuloplasty-Restores the ridge height by lowering the muscle attachments & attached mucosa.
  105. 105.
  106. 106. OSSEOUS ABNORMALITIES Ridge undercuts. Prominent mylohyoid &Internal oblique ridge-surgical recontouring repositioning of muscle attachment. Prominent genial tubercle-surgically removed & genioglossus muscle sutured to geniohyoid muscle. Bony tuberosities. Residual ridge sharp, spiny. Torus palatinus. Torus mandibularis. Discrepancies in jaw size. Mental foramen with sharp extended margins. Ridge augmentation.
  107. 107.
  108. 108. FABRICATION OF COMPLETE DENTURE Conventional complete denture. Implant supported. Previous h/o failures with conventional complete dentures Good health,affordable. Patient with compromised motor skills, advanced residual ridge resorption. If dose not like to wear dentures.
  109. 109. SUMMERY&CONCLUSION It encompasses history taking which includes past dental history &medical history,patients expectation & studying the mental attitude of the patients Diagnosis involve examination of the patient’s right from he enters the clinic,beginning from the collection of personnel in formations of the patient.and then examination of extra&intra oral hard&soft tissues structures. Subjecting the patients to required investigations,to confirm the diagnostic findings ,and Referring patients to other specialist on requirement. On the basis of Diagnostic findings the Rx plan is framed.
  110. 110. Conclusion Diagnosis and Rx planning form the first important milestone for the successful accomplishment of the Rx &favorable prognosis as the potential problems are identified & treatment plan is framed accordingly.
  111. 111. REFERENCES BOCHER ‘S Proshtodontics Rx for edentulous patients 11th edition. Prosthodontics Rx for edentetious patients by Zarb Bolender 12th edition Essentials of complete denture prosthodontics by Winkler Syllabus of complete dentures by Heartwell.4th edition . Complete Denture prosthodontics by Jhon Joy Mannapali. Color atlas of common oral diseases by Craig .S .Miller. The temepomandibular Joint & Related oeofacial disorder by Francis .M.Bush. A text book of oral pathology by shafer 4th edition Davidson’s principles & practice of Medicine. DCNA 1977 complete denture. BDJ volume 188,No.7:April:8:2000.Complete denture an introduction.
  112. 112. Diagnostic factors in the choice of impression materials & methods by George.A.Buckly D.D.S in JPD March:1995:5:2. Dr.Robert.H.Spring. Diagnostic procedures ---the patients existing dentures.JPD 1983:49:2:153. Study conducted by syropoulos ND, Patsuks AJ,in 1981.Finding from radiology of Jaw of edentulous patients oral surgery Oral medicine:oral pathology.1981:52:455:459. JPD July 1974:32:1:7-12studies of residual alveolar-ridge resorptionpart1 use of Panoramic radiographs for evaluation & collection of mandibular resorption by Kinneth.I.Wical.Chaclese.Sweope.