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Diagnosis&Treatment Planningin Fpd


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Diagnosis&Treatment Planningin Fpd

  1. 1. DIAGNOSIS & TREATMENT PLANNING <ul><li>Dr shabeel pn </li></ul><ul><li>Royal Dental College </li></ul>
  2. 2. Significance of Replacement <ul><li>Dental arch is not a static entity, it is in state of dynamic equilibrium </li></ul><ul><li>Tooth loss – loss of structural integrity & a new equilibrium is achieved </li></ul><ul><li>Pathological drifting of teeth </li></ul>
  3. 3. Choices <ul><li>Removable partial denture </li></ul><ul><li>Conventional tooth-supported FPD </li></ul><ul><li>Resin Bonded tooth-supported FPD </li></ul><ul><li>Implant supported FPD </li></ul><ul><li>No prosthetic replacement </li></ul>
  4. 4. Treatment Plan Purpose <ul><ul><li>Formulating a logical sequence of treatment designed to restore the patient’s dentition to good health , with optimal function and appearance </li></ul></ul>
  5. 5. What is an Ideal Treatment plan? <ul><li>Treatment plan that achieves the best possible long-term outcomes for the patient, while addressing all patient concerns and active problems, with the minimum necessary intervention </li></ul>
  6. 6. Identification of Patient Needs <ul><li>Correction of existing disease </li></ul><ul><li>Prevention of future disease </li></ul><ul><li>Restoration of function </li></ul><ul><li>Improvement of appearance </li></ul>
  7. 7. Phase II Disease Control Phase III Restorative Phase IV Maintenance Treatment Plan by Phases Dental & medical history Clinical examination, Radiographic films Dx Casts, Dx photographs Dx Wax-up, Aesthetic evaluation Periodontal Therapy Endodontic Therapy (RCT) Removal of existing restorations Caries control Phase I Diagnosis <ul><ul><li>Crown lengthening/Implant surgery </li></ul></ul><ul><ul><li>Gnathologic technique </li></ul></ul><ul><ul><li>Long-term provisional restorations </li></ul></ul><ul><ul><li>Permanent restorations </li></ul></ul>Recall every 6 months Fluoride supplements Reinforce oral hygiene Improve diet
  8. 8. Diagnosis & Prognosis <ul><ul><li>Diagnosis : </li></ul></ul><ul><ul><li>Dental and medical history </li></ul></ul><ul><ul><li>Clinical examination </li></ul></ul><ul><ul><li>Diagnostic pictures </li></ul></ul><ul><ul><li>Diagnostic casts </li></ul></ul><ul><ul><li>Diagnostic wax-up </li></ul></ul><ul><ul><li>Radiographic films </li></ul></ul><ul><ul><li>Prognosis : </li></ul></ul><ul><ul><li>General factors: age, oral environment, etc. </li></ul></ul><ul><ul><li>Local factors: occlusion, access for oral hygiene </li></ul></ul>
  9. 9. History <ul><li>Patient Expectations can be understood </li></ul><ul><li>Medical history has Prime importance </li></ul><ul><li>Diabetes – effects prognosis </li></ul><ul><li>Rheumatic heart diseases – prophylaxis </li></ul><ul><li>Infectious diseases – protection to others </li></ul><ul><li>Pacemaker – electrosurgical dilatation </li></ul><ul><li>Previous radiation - ORN </li></ul>
  10. 10. History <ul><li>Allergies – Even Anaphylaxis </li></ul><ul><li>Medications – Adverse drug reactions </li></ul><ul><li>Hypertension – LA without adrenalin </li></ul><ul><li>Cardiac problems – prophylaxis </li></ul><ul><li>Epilepsy – short appointments </li></ul><ul><li>Hypoglycemia – syncope or coma </li></ul><ul><li>Xerostomia – poor prognosis </li></ul>
  11. 11. Clinical examination <ul><li>General examination </li></ul><ul><li>Extra oral examination </li></ul><ul><li>- head & neck examination </li></ul><ul><li>- TMJ evaluation </li></ul><ul><li>- Muscles of Mastication </li></ul><ul><li>Intra oral examination </li></ul><ul><li>- oral hygiene status </li></ul><ul><li>- nature & quantity of Saliva </li></ul><ul><li>- examination of teeth </li></ul><ul><li>- occlusal examination </li></ul><ul><li>- periodontal examination </li></ul>
  12. 12. Radiographic evaluation <ul><li>Complete mouth radiographic series needed (14 IOPA & 4 bitewings) </li></ul><ul><li>Panoramic Radiographs </li></ul><ul><li>TMJ Radiographs </li></ul><ul><li>All of them give information that cannot be detected clinically </li></ul>
  13. 13. Radiographic evaluation <ul><li>Remaining bone support & bone quality </li></ul><ul><li>Root number & morphology </li></ul><ul><li>Periodontal ligament & TFO </li></ul><ul><li>Resorption or Furcation involvement </li></ul><ul><li>Carious lesions </li></ul><ul><li>Pulpal status </li></ul><ul><li>Periapical pathologies </li></ul><ul><li>Retained roots, calcifications, foreign bodies </li></ul><ul><li>Oral manifestations of systemic diseases </li></ul>
  14. 14. Diagnostic Impressions/Casts <ul><li>Dx impressions: </li></ul><ul><ul><li>Irreversible hydrocolloid (alginate)/stock trays </li></ul></ul><ul><ul><li>High quality with no voids </li></ul></ul><ul><ul><li>A clinical instructor must authorize impressions pouring </li></ul></ul><ul><li>Type III dental stone (buff) is used for Dx-casts pouring </li></ul><ul><li>Dx casts evaluation criteria: </li></ul><ul><ul><li>Accurate reproduction of teeth and tissue </li></ul></ul><ul><ul><li>Base thickness: 15-16 mm </li></ul></ul><ul><ul><li>Land area width: 3-4 mm </li></ul></ul>
  15. 15. Diagnostic Casts * Comprehensive Care Patient Presentations, 2003-04, Dr. Mary Baechle 
  16. 16. Diagnostic Casts <ul><li>Provide valuable preliminary information and a comprehensive overview of patient’s needs </li></ul><ul><li>Treatment procedures can be rehearsed on the stone cast before making any irreversible changes in the patient’s mouth </li></ul><ul><li>Used for diagnostic wax-up, preliminary RPD design, surgical stent (surgical procedures), etc. </li></ul><ul><li>Help to explain intended procedure to patient </li></ul>
  17. 17. Diagnostic Wax-up <ul><ul><li>Diagnostic Wax-up: </li></ul></ul><ul><ul><li>Casts/waxing/set-ups (denture teeth) must be completed prior to beginning any reconstructive treatment (castings/prostheses or definitive Periodontal therapy) </li></ul></ul>
  18. 18. Diagnostic Wax-up* * Comprehensive Care Patient Presentations, 2003-04, Dr. Mary Baechle 
  19. 19. <ul><li>Useful to show proposed treatment to the patient </li></ul><ul><li>Used for fabrication of provisional restorations </li></ul><ul><li>Fabrication of final restorations against the diagnostically waxed cast allows establishing optimum contour and occlusion </li></ul><ul><li>Provides specific information about desired tooth length and form or occlusal arrangement: dentist-lab technician communication </li></ul>Diagnostic Wax-up
  20. 20. Developing Treatment Options <ul><ul><li>Factors to be considered : </li></ul></ul><ul><ul><li>Patient’s expectations </li></ul></ul><ul><ul><li>Systemic & Emotional Health </li></ul></ul><ul><ul><li>Cost </li></ul></ul><ul><ul><li>Periodontal Factors </li></ul></ul><ul><ul><li>Success rate </li></ul></ul><ul><ul><li>Possible complications </li></ul></ul><ul><ul><li>Time involved, both total treatment time and number of visits </li></ul></ul><ul><ul><li>Influence on quality of life </li></ul></ul>
  21. 21. Summary <ul><li>The patient should be considered as a human being </li></ul><ul><li>Successful accomplishment of dental treatment is the result of a multidisciplinary team effort. </li></ul><ul><li>The key of a successful dental case is the planning of the treatment at the beginning </li></ul>
  22. 22. <ul><li>Thank you </li></ul>