Diagnosis in rpd

2. ESSENTIAL DIAGNOSTIC DATA
 Patient interview
 Radiographs
 Mounted and surveyed diagnostic cast
 A definitive oral examination including periodontal
probing, percussion, vitality test.
 Consultation with medical and dental specialist

3. PATIENT INTERVIEW
 Establish rapport with the patient
 Gain insight into the psychological makeup of the
patient
 Explore any physical condition that may effect the
treatment
 Ascertain the patient expectations of treatment

4. ESTABLISHING A RAPPORT
 De Van (1961) stated that we should meet the
mind of the patient before we meet the mouth of the patient.
 According to Boucher (1970) first 5mins spend
with the patient or most important period the dentist spend
with the patient.

5. GAINING INSIGHT INTO PSYCHOLOGICAL MAKEUP
OF THE PATIENT
 In 1950 Dr.M.M.House classified patient into
following four psychological types
1. The Philosophical
2. Exacting
3. Hysterical
4. Indifferent

6. EVALUATING EFFECT OF THE PHYSICAL PROBLEM ON THE
TREATMENT
 Systemic disturbances that have significant effect on the
treatment of patient includes the following :
- Diabetes - Pemphigus vulgaris
- Arthritis - Epilepsy
- Pagets disease - Cardiovascular disease
- Acromegaly - Cancer
- Parkinson’s disease - Transmissible disease
- High risk for Hepatitis

7. EVALUATING EFFECT OF DRUGS ON TREATMENT
 Some of the frequently prescribed drug that can effect
prosthodontic treatment are :
- Anticoagulants
- Antihypertensive agents
- Endocrine therapy

8. ASCERTAINING PATIENT EXPECTATIONS OF
TREATMENT
 Any removable partial denture will complicate
- Oral hygiene procedure
- Occupy space in the oral cavity
- Necessitate a learning and adaptation period
 If the patient expectations are such that these
inconvenience are not acceptable, chances for successful
treatment are extremely limited.

9. STRUCTURE OF INTERVIEW
Dental history - In the dental history it is important to find
out why teeth have been lost.
If lost by caries If lost by
periodontal
disease
Presence of removal partial
Dentures will increase the
possibility of further carious
activity
Every effort must be made to
discover and eliminate its cause

10. DIET
 The patient diet should be evaluated
 If the patient have sugar containing diet a change
must be effected.
 The problem caused by the sugar is compounded by
the wear of removal partial dentures because the prosthesis
shield the microorganism from the cleansing and buffering
action of patient saliva.

11. HABITS
 Patient habit should be evaluated to determine
whether the effect the prognosis of the treatment.
 Bruxism and clenching
 Tongue thrusting

12. PATIENT’S PHYSICAL CHARACTERISTICS
 Speech
 Poor coordination
 Length and mobility of the patient lip
 Facial changes
 Patient cosmetic index

13. CURSORY EXAMINATION
Detection of problems requiring immediate attention
 It is essential that a superficial examination be
performed at the first appointment to detect problem that need
immediate attention like
- Teeth with large carious lesion
- Oral condition caused by ill-fitting denture

14. EVALUATION OF ORAL HYGIENE
 It is critical to the prognosis of the patient treatment
 Inadequate oral hygiene must be recognized early in
the diagnostic procedure so that a preventive dentistry
programme can be evaluated.

15. EVALUATION OF CARIES SUSCEPTIBILITY
 The presence of large number of restored teeth
 Sign of recurrent caries
 Evidence of decalcification

16. ORAL PROPHYLAXIS
 Supragingival calculus should be removed and oral
prophylaxis should be performed
 The diagnostic cast and definitive intraoral examination
will be more accurate if teeth are cleaned

17. RADIOGRAPH
 Complete series of periapical and a full mouth
radiograph is essential for definitive examination of partially
edentulous patient
 Full mouth radiograph is ideal for screening for
pathological condition

18.  Periapical radiographs helps in determining
1. Crown root ratio of remaining teeth
2. Status of periodontal ligament space
3. Lamina dura of abutment teeth
4. Quantity of bone on the residual ridge in
edentulous area

19. DIAGNOSTIC IMPRESSION AND CAST
 A diagnostic procedure for a partially edentulous
patient must be considered incomplete unless it includes the
evaluation of accurate diagnostic cast.

20. MOUNTED DIAGNOSTIC CAST
Uses includes the following :
 Extruded teeth, low hanging tuberosities, lack of inter
arch space, malposed teeth and defective restoration are
readily apparent.
 They provide a detail analysis of patient occlusion
 Aid in the education of the patient and in presentation
of the treatment planning.
 They provide a permanent dental record of the patient
condition before treatment.

21. BONE TO BONE RELATION
RECORDED
REPEATEDLY AND VERIFIED
BEST REFERENCE POINT
Centric jaw relation record

22. Methods of determining centric jaw relation
 Conventional method
 Bilateral manipulation of the mandible
 Alteration of protrusion and retrusion

25. Media for recording centric jaw relation
 Wax
 Impression pastes
 Plaster of paris
 Dental stone
 Acrylic resin
 Modeling plastic
waxes
Soft wax
Hard wax

29. Definitive oral examination
 Evaluation of caries and existing restoration

30.  Evaluation of sensitivity to percussion
• Tooth movement caused by-prosthesis or occlusion
• Traumatic occlusion
• Periapical or pulpal abscesses
• Acute pulpitis
• Gingivitis or periodontitis
• Cracked tooth syndrome

31. Evaluation of mobile teeth
 Traumatic occlusion
 Inflammatory changes in periodontal ligament
 Loss of alveolar bone support

33. Splinting of abutment teeth
 Indications
• Remaining teeth have reduced support-periodontal disease
• Teeth with short ,tapered roots
• Presence of two or three widely spaced retainable teeth

35. Redundant tissue

36. Evaluation of periodontium
 Pocket depth in excess of 3mm
 Furcation involvement
 Deviation from normal color and contour of gingiva
 Marginal exudate
 Abutment teeth have less than 2mm of attached gingiva
Treatment
 Root scaling and planning
 Gingivectomy
 Periodontal flap procedures
 Free gingival grafts

38. Evaluation of hard tissue abnormalities
 Torus palatinus
 Torus mandibularis
 Exostosis and undercuts
 Mandibular tuberosity

41. Evaluation of soft tissue abnormalities
 Labial frenum
 Hypertrophic lingual frenum
 Unsupported and hypermobile gingiva

45. Evaluation of space for mandibular major connector

46. Evaluation of radiographic survey
 Caries
 Existing restorations
 Root fragments and other foreign bodies
 Unerupted third molars
 Abutment teeth
• Root length,size ,form
• Crown/root ratio
• Lamina dura
• Periodontal ligament space
• Bone index areas

48. Evaluation of mounted diagnostic casts
 Interarch distance
 Occlusal plane

49.  Occlusal plane
Irregular occlusal plane
• Enameloplasty
• Extracoronal cast metallic restorations
• Extraction

51. Malposed occlusal plane

52. Tipped and malposed teeth

53. occlusion
Occlusal interferences
• Bruxism
• Excessive wear of teeth
• Chipping or fracture
• Increased mobility
• Tooth migration
• Injury to TMJ-muscle spasm,pain and joint symptoms

55. Occlusal equilibration
 Selective grinding or coronal reshaping of tooth with the
intent of equalizing occlusal stress

56. Treat at centric relation or centric occlusion?
 Coincidence of centric relation or centric occlusion
 Absence of posterior tooth contacts
 Situation in which all posterior tooth contacts are to be restored with
cast restorations
 Only a few posterior contacts
 Clinical symptoms of occlusal trauma

57. Diagnostic wax-up
 Provide a guide for tooth preparation
 Indicate problems that may be encountered during
treatment

58. Development of treatment plan
 Phase1
Collection and evaluation of diagnostic data
Immediate treatment to control pain and infection
Biopsy or referral of patient
Development of treatment plan
Education and motivation of patient

59.  Phase 2
• Removal of deep caries followed by temporary
restoration
• Extripation of inflamed pulp
• Removal of nonretainable teeth
• Periodontal treatment
• Occlusal equilibration

60.  Phase 3
• Preprosthetic surgical procedures
• Definitive endodontic procedures
• Fixed partial denture construction

61.  Phase 4
• Removal partial denture
• Reinforcement of education and motivation

62.  Phase 5
• Postinsertion care
• Periodic recall

63. Case selection
 Longer edentulous span
 Patients under 17 yrs age and old age
 No posterior tooth for support
 Periodontal support of remaining teeth is poor
 Cross arch stabilization
 Immediate replacement after extraction
 Extensive bone loss in edentulous area
 Emotional problems
 Medically compromised
 Patient desire
 Economic reasons

64. References
Rodney d phoenix, David R Cagna, Charles F ;
Stewrt’s Clinical Removablle Prosthodontics- 4th
edition
Text book of Dental lab procedures-RPD; Rudd &
Morrow, 3rd edition
Text book of Removable Partial Prosthodontics by
Mc-cracken- RPD ;12th edition
Bohnenkamp DM Removable Partial Dentures:
Clinical ConceptsDCNA 2014, ; 58; 69-89