PERIO

1. It is the examination of the physical state , evaluation of the mental
or psychological makeup & understanding the needs of each patient
to ensure a predictable result.
It means developing a course of action that encompasses the
ramification & sequelae of treatment to serve the patients needs.
Diagnosis :
Treatment Planning :

2. Patient evaluation is the first step to be carried out in treating a patient.
Gait :
The dentist should note the way the patients walk into the clinic.
People with neuromuscular disorders show a different gait. Such
patients will have difficulty in adapting to the denture.
Age :
The decade , which the patients belong to , is important to predict the
outcome of treatment. For eg. patients belonging to the 4th
decade of life will have good healing abilities & patients above the
6th decade will have compromised healing.
Patient Evaluation :

3. Sex :
Male patients are generally busy people who appear indifferent to the
treatment. They are only bothered about comfort & nothing
else.On the other hand , female patients are more critical about
aesthetics & they usually appear to overrule the dentist in
treatment planning.
Complexion & Personality :
To determine the shade of the teeth. Executives require smaller teeth.
Mental attitude :
Based on there mental attitude , patients can be grouped under two
classifications,
House’s classification -
Class I : Philosophical
Class II : Exacting
Class III : Hysterical
Class IV : Indifferent

4. Classification II -
I) Cooperative
II) Apprehensive
- Anxious
- Frightened
- Obsessive
- Chronic
complainers
- Self conscious
III) Uncooperative

5. It is a systematic procedure for collecting the details of the patient to do a
proper
treatment planning.
Name :
The name should be asked to enter it in the record.
Age :
Some diseases are limited to certain age groups.
Occupation :
Executives & sales representatives require more idealistic teeth.
While other people who work in places with high physical exertion
require rugged teeth.
History Taking :

6. Race :
It helps to select the shade of the teeth.
Location :
Some endemic disorders like fluorosis are confined to certain
localities.
Religion & Community :
Gives an idea about the dietary habits & helps to design the
denture accordingly.
Medical History :
The following medical conditions should be ruled out before
beginning the prosthetic treatment.

7. Debilitating Disease -
Complete denture patients , most of whom are geriatric, are
bound to be suffering from debilitating diseases like diabetes
, blood dyscrasias & tuberculosis. These patients
require specific instructions on denture /tissue care.
Diabetic patients show excessive rate of bone resorption ,
hence, frequent relining may be necessary.
Disease of the Joints –
The most common disease of the joint in old age is
osteoarthritis.
Disease of the Skin -
Skin disease like Pemphigus have oral manifestations, which vary
from ulcers to bullae.
Neurological Disorders -
Diseases such as Bell’s palsy & Parkinson’s disease can influence
denture retention & jaw relation records.

8. Oral Malignancies -
Some complete denture patients with oral malignancies may
require radiation therapy before prosthetic treatment.
Climacteric Conditions -
Like menopause can cause glandular changes,osteoporosis &
psychiatric changes in the patient.
Dental History :
It is most important part of Diagnosis.
Chief Complaint -
It should be recorded in the patients on words.It givs idea
about the patients on words.
Expectations -
The dentist should evaluate the patient’s expectations &
classify them as realistic or attainable & unrealistic.

9. Period of Edentulous ness -
It gives information about the amount & pattern of bone
resorption.
Pre-treatment Records -
It includes information about the previous denture ,current
denture, pre-extractions records & diagnostic casts.

10. The patients head & neck region should first be examined in general for
the presence of any pathologic conditions relating to a nondental or systemic
conditions.
Facial Examinations :
It includes the evaluation of facial features, facial form, facial profile &
lower facial height.
Facial features –
The following features on the face should be noted,
Clinical Examination :
Extraoral Examination

11. Perioral features :
- Length of the lips
- Lip fullness
- Apparent support of the lips
- Philtrum
- Nasolabial fold
- Mentolabial sulcus
- Labial commissures & modiolus
- Width of the vermilion border
- Size of the oral opening
- Texture of the skin
Facial form -
House & Loop, Frush & Fisher & Williams classified facial form
based on the outline of the face as square, tapering, square
tapering & ovoid. It helps in teeth selection.

12. Facial profile -
It determine the jaw relation & occlusion. Angle classified
facial profile as,
Class I : Normal or straight profile
Class II : Retrognathic profile
Class III : Prognathic profile
Lower facial height -
It is important to determine the vertical jaw relation.
Muscle Tone :
It can affect the stability of the denture. House classified muscle
tone as,
Class I : Normal tension, tone & placement of the muscle of
mastication & facial expression. No
degeneration.
Class II : Normal muscle function but slightly decreased muscle tone.

13. Muscle Development :
People with excessive muscle development have more biting
force.
House classified muscle development as,
Class I : Heavy
Class II : Medium
Class III : Light
Complexion :
The color of the eye, hair & the skin guide the selection of
artificial teeth.
Lip Examination :
Lip support –
Based on the amount of lip support, lips can be
classified as adequately supported or unsupported.

14. Lip mobility –
Based on the mobility, lips are classified as normal ,
reduced mobility & paralyzed.
Thickness of the lips –
Thick lips need lesser support from the artificial teeth & the
labial flange. Thus on the other hand thin lips rely on the
appropriate labiolingual position of the teeth, for their
fullness & support.
Length of the lips –
It is an important determinant in anterior teeth selection. Based
on the length, lips are classified long, normal or medium & short.
Health of the lips –
The lips are examined for fissures, cracks or ulcers at the corners
of the mouth.

15. TMJ Examination :
- The movements may be of three types,
1) coordinated
2) jerky
3) restrictive
- The abnormality usually seen is clicking sound, pain of tendons,
deviation to one side & dislocation.
Neuromuscular Examination :
It includes the examination of speech & neuromuscular
coordination.
Speech –
It is classified based on the ability of the patients to
articulate & coordinate it.
Type I – Normal
Type II – Affected

16. Neuromuscular coordination –
It can be classified as,
Class I – Excellent
Class II – Fair
Class III - Poor
Intraoral Examination
Color of the mucosa :
The mucosa should have a healthy pink color. Any amount
of redness indicates an inflammatory changes. Other
color changes such as white patches should be noted as
this might indicate an area of frictional keratosis.

17. Saliva :
- The amount & Consistency of saliva will affect the denture
construction process & the quality of the final product itself.
- The consistency of saliva can range from a thin, serous type to
a thick, ropy consistency. It is best to work with serous type. Thick
ropy saliva alters the seat of the denture.
- All salivary duct orifices should be examined.
Residual Alveolar Ridge :
Arch size –
a) The size of the maxilla & mandible will determine the
amount of basal seat available for the denture foundation. The
greater the size, the more the support the larger the
contact surface, the greater the retention.

18. b) Discrepancy b/w the mandibular & maxillary arch sizes can
lead to difficulties in artificial teeth arrangement &
decreases the stability of the denture resting in the smaller
one of the two arches.
- It can be classified as,
Class I – Large
Class II – Medium
Class III – Small
Arch form -
The arch may be square, ovoid or tapered & opposing arches may not
necessarily have the same form.
Ridge contour -
Ridges can be classified as based on their contour as,
- High ridge with flat crest & parallel sides
- Flat ridge
- Knife edged or ‘v’ shaped ridge

19. Ridge relation -
- It is defined as, “ The positional relation of the mandibular
ridge to the maxillary ridge”
- Inter ridge relationship,
Anterior :
Class I – Normal
Class II – Prognathic
Class III – Retrognathic
Posterior :
- Normal
- Cross arch
- Inter arch space,
Class I – Adequate
Class II – Excessive
Class III - Reduced

20. Redundant tissue :
Any excessive amount of flabby tissue will cause the denture
base to shift & move as force is applied, this will result in
instability & decreases retention of the denture.
Hard palate :
The shape of the vault of the palate should be examined. It
can be classified as,
- ‘U’ shaped : Ideal for both retention & stability

21. Hyperplastic tissue :
The most common hyperplastic lesions are epulis fissuratum
related to a denture border, papillary hyperplasia or
hyperplastic folds under the denture base.

22. - ‘V’ shaped : Retention is less, as the peripheral seal is
easily broken
- Flat : Reduced resistance to lateral & rotatory forces
Soft palate :
While examine the soft palate, it is important to observe the
relationship of the soft palate to the hard palate. This
relationship is called palatal throat form. On this bases, soft
palate can be classified as,
Class I : It is horizontal & demonstrates little muscular
movement
Class II : Soft palate turns downwards at about a 45.
angle to the hard palate
Class III : Soft palate turns downwards sharply at
about a 70. angle just posterior to the hard
palate

23. Bony undercuts :
- On the maxilla, the undercuts are usually present on the
anterior ridge & lateral to the tuberosities.
- On the mandibular arch, the only undercut that can poses a
real problem, sharp mylohyoid ridge.

24. Tori :
- A torus palatinus & lingual tori are occasionally present.
- On the maxilla, the torus can range from a small
prominence on the midline to one that covers the entire
hard palate.
- On the mandible, lingual tori can present lingually to the
premoral region.

25. Muscles & Frenal attachments :
Muscle & Frenal attachments should be examined for favorable or
unfavorable position in relation to the crest of the ridge.
Tongue :
Wright classified the tongue position as follows,
Class I : The tongue lies in the floor of the mouth with
the tip forward & slightly below the incisal edges
of the mandibular anterior teeth.
Class II : The tongue is flattened & brodened but tip is
in a normal position.
Class III : The tongue is retracted & depressed into
the floor of the mouth with the tip
curled upward, downward or
assimilated into the body of the tongue.

26. Floor Of The Mouth :
The relationship of the floor of the mouth to the crest of the
ridge is crucial in determining the prognosis of the lower
complete denture.
Gag reflex :
- “The gag reflex is a normal defense mechanism designed to
prevent foreign bodies from entering the trachea.”
- The initiation of gag reflex can be caused by systemic
disorders, psychological factors & iatrogenic factors.

27. - Periapical surveys of the edentulous jaws are acceptable, but panoramic
radiographs are faster, reduce the patient exposure to radiation & image
the entire mandible & maxilla.
- The interpretation of the panoramic radiograph should follow a five
steps analysis as outlined by Chomenko,
1) Screen jaws for defects in structure & reactive new bone
formation, bone enlargement, displacement of the jaw
parts,retained root fragments, unerupted teeth, rarefaction,
sclerosis, cysts, tumors & TMJ disorders.
2) Describe the apperearance of the lesion as well as any bone
changes adjoining the lesion.
Radiographic Examination :

28. 3) Correlate the radiographic findings with the clinical,
historical & laboratory findings.
4) Perform a differential diagnosis which includes all the
diseases that could explain the findings.
5) Estimate the growth of the lesions by the apperearance of
jaw structures bordering the lesion.
The amount of resorption can be classified by Wical & Swoope,
Class I : Mild resorption
Class II : Moderate
resorption
Class III : Severe resorption

29. TREATMENT PLANNING
Treatment planning is the process of matching possible treatment option with
patient needs & systematically arranging the treatment in order of priority but
in keeping with a logical or technically necessary sequence.
# A primer on treatment option