Treatment planning for partially edentulous patients /fixed orthodontics courses


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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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Treatment planning for partially edentulous patients /fixed orthodontics courses

  1. 1. Diagnosis and Treatment Planning for Partially Edentulous Patients First Appointment INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Keys to a successful Interview  Dentist’s attitude  Caring  Understanding  Respectful  Phrasing of questions  Open-ended questions WE SHOULD MEET THE MIND OF THE PATIENT BEFORE WE MEET THE MOUTH OF THE PATIENT
  3. 3. Health Questionnaire: Diabetes  Decrease resistance to infection  Patients often display reduced salivary output.
  4. 4.
  5. 5. Health Questionnaire: Arthritis  If it is in TMJs, may produce changes in occlusion  Very rare in TMJ, and if it is in TMJ it is usually a secondary site
  6. 6. Health Questionnaire: Parkinson’s Disease  Oral hygiene and handling of dentures will be impaired  Difficult impressions due to excessive quantities of saliva
  7. 7. Health Questionnaire: Paget’s Disease  Patients may present enlargement of tuberosities.  Frequent recall program.  Quite rare
  8. 8. Health Questionnaire: Acromegaly  Enlargement of the mandible  Frequent exams to evaluate fit and function of removable prosthesis
  9. 9. Health Questionnaire: Epilepsy  Removable dentures may be contraindicated if they are small and seizures are frequent and severe: choking  If patient takes phenytoin (common drug to take), make sure that RPD does not irritate gingival tissues.
  10. 10. Health Questionnaire: Pemphigus Vulgaris  Common symptoms: oral discomfort and dryness.  Establish smooth and polished borders to reduce soft tissue harm.  Greater follow up is anticipated.
  11. 11. Health Questionnaire: Treatment for Cancer  Most common oral complications:  Xerostomia  Irritations  Bacterial and fungal infections  40% of patients who have cancer outside of the mouth have repercussions inside the mouth.
  12. 12. Cardiovascular Disease  Require medical consultation:  Acute or recent MI  Angina pectoris  Congestive Heart Failure  Arrhythmia  Hypertension  Take blood pressure as soon as you see patient (180/110 and you shouldn’t see patient)
  13. 13. Health Questionnaire: Transmissible Diseases  Hepatitis  TB  Influenza  HIV  Make sure impressions are disinfected
  14. 14. Effects of drugs on treatment  Anticoagulants (coumadin, aspirin)  Post-surgical bleeding  Antihypertensive agents  Orthostatic hypotension  Xerostomia if patient is on diuretics  Endocrine Therapy  Xerostomia
  15. 15. Structure of the interview  Dental History How did he/she lose his/her teeth? Caries? Perio? Gather information about existing dentures. Old x-rays.
  16. 16. Structure of the interview  Diet Frequent usage of mints, soft drinks, sugar-containing products
  17. 17. Structure of the interview  Habits  Bruxism and clenching  Tongue thrusting
  18. 18. Structure of the interview  Expectations of treatment, get the chief complaint  Questions from patient
  19. 19. Initial Examination Problems requiring immediate attention Evaluation of oral hygiene. Explain: Signs and symptoms of dental disease Materials and techniques for home care Patient’s responsibilities (you can only do 50% of the job, the patient has to do the other half, i.e. the OH)
  20. 20. Initial Examination  Eval. of caries susceptibility  Oral prophylaxis to clear things up  Radiographs (Pan and FMS)  Diagnostic impressions and casts
  21. 21. Second appointment Facebow transfer Take centric relation registration Take protrusive record Mount casts
  22. 22. Centric relation record  Recommended method  Recording CR position  Occlusal vertical dimension
  23. 23. Centric relation record: using wax?  We can also use elastomeric registration materials (wax tends to change dimension over time and can become brittle)
  24. 24. Centric relation record: Using Record bases  If patient does not have enough teeth to mount lower cast to upper (i.e. no posterior teeth), fabricate record bases.  Wax-up, take relation in centric relation.
  25. 25. Setting condylar elements  Protrusive record: with either wax or elastomeric material.  Ask patient to put front teeth edge to edge for practice, then using PVS ask them to repeat.
  26. 26. Setting condylar elements Too shallow Correct inclination Too steepThe condylar setting is…
  27. 27. Diagnostic Wax-up
  28. 28. Definitive Oral Examination: Caries and existing restorations  Countours of potential abutments  Occlusion  Possible extractions.
  29. 29. Definitive Oral Examination: pulpal tissues Possible pulp testing in teeth to be used as abutments that have decay or crowns or extensive work. Selection of endodontically treated tooth as abutments is NOT contraindicated. Better prognosis with full crown coverage restoration.
  30. 30. Definitive Oral Examination: tooth mobility  Unstable occlusion  Tooth in traumatic occlusion  PA abscess  Acute pulpitis  Cracked tooth syndrome
  31. 31. Definitive Oral Examination: tooth mobility  Trauma of occlusion  Inflammation of periodontum  Loss of bone support Niether is useful as an abuttment for a partial Useful for an abuttment for an overdenture
  32. 32. Definitive Oral Examination  oral mucosa  hard tissues abnormalities  soft tissues abnormalities  space for mandibular major connector
  33. 33. Definitive Oral Examination  radiographic evaluation of prospective abutments
  34. 34. Evaluation of mounted diagnostic casts  Interarch distance  Occlusal plane  Irregular occlusal plane  Malpositioned occlusal plane
  35. 35. Evaluation of mounted diagnostic casts  Malrelation of arches  Tipped or malposed teeth  Occlusion Interferences need to be corrected
  36. 36. To treat or not to treat at centric relation….that is the question. We will construct our prosthesis at CR if: CR=MI Absence of posterior tooth contacts (tissue- borne) Few remaining posterior contacts Otherwise, we will construct our RPD’s at maximum intercuspation position. We will not introduce new interferences by a RPD.
  37. 37. Finally….  Diagnostic wax-up  Consultation to other specialties  Development of Treatment plan.
  38. 38. ?? $ ?? @ … ? &&! How do I develop a Treatment Plan????
  39. 39. Developing a sequenced treatment plan Phase I: evaluation, immediate treatment, diagnostic mounting, wax-up, partial design, referral to other specialties (endo, ortho, etc.), patient education (OHI, etc).
  40. 40. Developing a sequenced treatment plan Phase II: Removal of caries, extractions, perio tx, occlusal equilibration, placement of temporary restorations (temporary crowns, etc).
  41. 41. Developing a sequenced treatment plan Phase III (continuation of Phase II):  Pre-prosthetic surgeries,  root canal therapies,  definitive restoration of teeth,  RPD mouth preparation, final impressions, metal try-in, records (if needed). Phase IV:  Delivery of RPD,  Instruction for patient. Phase V: Periodic recall, reinforcement of education.
  42. 42.