This document provides guidance on the examination, diagnosis, and treatment planning process for complete denture prosthodontics. It outlines the various components of patient history taking and clinical examination that are important to assess, including medical history, extraoral examination, intraoral soft tissue and residual ridge examination, radiographs, and mental attitude assessment. Factors such as age, gender, occupation, chief complaint, systemic diseases, neuromuscular function, saliva, arch size and shape, interarch relationship, and existing dentures are evaluated. The results of this process inform the treatment plan, which is discussed with the patient, and prognosis is determined.

1. Clinical Removable Prosthodontics (Complete
Denture) /4th year
Examination, Diagnosis and Treatment
planning
References:
1. Clinical Complete Denture Prosthodontics.
by Dr Mustafa A. Hassaballa.
2. Boucher’s Prosthodontics Treatment for Edentulous Patients, by George Zarb.
Dr Ali Hmud
BDS, MSc, ADCC
College of Dentistry, KFU, Dammam
Sunday 1/3/2009 G, 4/3/1430 H

2. History taking:
It consists of talking
with the patient in
order to obtain
essential personal
details including
health information.

3. A logical approach to
diagnosis begins with:
1. History taking (medical &
dental history).
2. Extraoral & intraoral
examination .
3. Radiographic examination.

4. Patient data:
These data are important records from a
medicolegal point of view and provide
information that will be useful in the
treatment plan.
A. Name, address and telephone
number:
These must be recorded so that correct
naming can be made and the patient can
be contacted as required.

5. B. Age:
The age of the patient
gives an indication of
his/her ability to use
dentures.
Young patients are adaptable to
change, i.e. their tissues heal
rapidly & have good resistance.

6. Old patients found to be
difficult to adapt to new
situations.
Also:
Tissue repair is often slow,& in
many cases they show
more bone resorption in
their alveolar ridges.

7. C. Sex/Gender:
Esthetic is first priority for
women than men,
however, younger men
are also concerned about
esthetics.

8. D. Occupation
Teeth are more important
to some people than to
other.
The higher the social
position, the more
demanding the patient is
about the esthetics.

9. Chief complaint:
The patient’s reason for seeking
dentures should be determined.
The patient should describe the
complaints as they see them, this will
enable the dentist to know what
concerns the patient.
Also it gives an idea about the patient
personality.

10. Medical and Dental History:
Notes should be made of a
patient past &present medical
history related to future dental
treatment.
During diagnostic phase a
thorough & accurate medical
history must be obtained.

11. The patient past medical
history& current medical
states must be reviewed
with particular attention to
allergies, drug reaction,
medications, and
hemorrhagic tendencies.

12. Some systemic diseases
have local oral
manifestations, others have
both local & systemic
manifestations which bear a
direct relationship to the
successful wearing of
complete dentures.

13. These systemic diseases can be
broadly divided into (3) types:
1. Diseases which affect the
shape of the ridges:
e.g. Fibro-osseous dysplasia,
such as Paget’s disease,
Acromegally or
hyperparathyroidism.

14. 2. Diseases which affect
the shape of the oral
mucosa:
They include blood dyscrasias such
as anaemias, skin diseases such
as Pemphigoid lesions, Lichen
Planus, Erythema Mutilforme, and
Aphthous Stomatitis.

15. 3. Diseases which affect the
shape of the patient’s
physical capacity to control
dentures.
These include Parkinson’s disease,
facial paralysis, epilepsy and so on.

16. Questions under medical
history help to alert the
dentist to possible
medical problems.

17. The medical history
examination chart must
be filled by the patients
themselves and then
reviewed by the
dentist.

18. Extra Oral examination:
Head & neck region should first
be examined for the presence of
any pathologic conditions.
The face & neck are palpated for
any mass or enlarged nodes.

19. Lymph nodes:
Any palpable or tender
lymph nodes about the
face, joints or neck should
be noted and their cause
determined.

20. Neuromuscular ability or
coordination:
This can be seen in how
a patient walks, moves &
handles him/herself.

21. Patient with good
neuromuscular coordination
can be expected to learn to
manipulate dentures quickly
& adapt easily to new
dentures.

22. Parafunctional &
uncontrolled jaw
movements complicate
the recording of the
maxillomandibular
relations.

23. Muscle tone:
If the facial muscles are too
tense, manipulation will be
difficult, if too loose, the lips
& cheeks may be easily
displaced by dentures.

24. A face that has poor
tissue tone, with loose or
wrinkled tissues can not
be made to appear
youngful by new
dentures.

25. Excessive facial
muscle droopiness
(flabbiness or
slackness) affects on
both esthetics & the
patient’s ability to
control dentures.

26. TMJ:
They should be observed &
examined.
Any asymmetry during
opening & lateral
movements of jaws should
be noticed.

27. Check if the pain &
tenderness during opening
& closing is present.
Any sounds during condylar
movements, any limitations
of movements.

28. Digital examination (manual) of
the area over TMJ should me
made.
Place your finger over each joint&
ask patient to open & close.
Any sign present must be treated
before new dentures are made.

29. Any clicking in the joints or
crepitus (cracking sound
caused by the rubbing
together of dry synovial
surfaces of the joint) must
be checked & treated.

30. Gagging:
(retching, sick, vomit ,throw-up)
The involuntary contraction of the
muscles of the soft palate that
result in retching.
If it is an active one, it can
compromise the dental treatment
plane.

31. •It can upset & annoy both
the dentist & patient.
•A thorough history & oral
examination will reveal the
presence of such reflex early
in the patient-dentist
relationship phase.

32. 1.
2.
3.
4.
5.
It Could be due to:
Iatrogenic factors (caused by ill-fit old
denture).
Organic disturbances (e.g. visual,
auditory, olfactory stimuli).
Anatomic anomalies (narrow vaults,
retracted tongue) .
Biomechanical inadequacies of
existing prosthesis.
Psychological factors.

33. Reassurance & kind
handling of the patient
proved to be useful.
Patients who show
severe gagging should
be seen by a specialist.

34. Intraoral examination
Color of the mucosa:
The color varies from pink in healthy
mucosa to red in inflamed tissues.
Some tissues will recover with simple
rest (by keeping the denture out)
others require tissue conditioning
resins, while others require surgery.

35. Arch size:
It might be:
1. Large.
2. Average.
3. Small.
The larger the arch, the
greater the advantage for
retention, stability and
support.

36. Arch form:
Generally, they are
classified into:
1. Square
2. Tapering
3. Ovoid.
Square arch is the
best form to prevent
rotational movements.

37. Residual ridge contour:
It varies between upper & lower arches &
from one area of the arch to another
arch.
It can be divided into:
1. Normal ridge.
2. Flat ridge (resorbed ridge)
3. Knife-edge ridge (narrow V-shaped)
4. Irregular or undercut ridge (bulbous).

39. Mucosa condition:
Membranes covering lips,
cheeks, floor of the mouth,
tongue, hard and soft
palates, tonsillar areas, the
jaws and residual alveolar
ridges should carefully
examination.
It is classified into:
1. Healthy
2. Irritated
3. Pathologic.

40. End of 1 lecture
st

41. Tongue:
It plays a major role in the retention of the
mandibular denture.
Tongue position:
Might be normal, subnormal and abnormal.
Normal tongue is in a correct position.
The tip is relaxed where it rests in the area of the
lingual surfaces of the lower anterior teeth.

42. Tongue size:
Large tongue occurs when all
teeth lost for a long period of
time.
Impression making is difficult
with this type of tongue and
denture stability is difficult too.

43. Class I:
Tongue is of adequate size & does not over
fill the floor of the mouth so there is
enough room for the denture.
Class II:
Tongue slightly overfills the floor of the
mouth.
Class III:
Tongue completely fills the floor of the
mouth & covers the alveolar ridge.

44. Residual Ridge
Relationship:
It could be:
1. Normal.
2. Retrognathic.
3. Prognathic.

45. 1. Normal:

when upper
ridge is directly
above the lower
ridge crest.
Arrangement of
teeth will be
conventional.
As in fig. (A)

46. 2. Retrognathic:
Lower jaw is smaller
than upper jaw.
Arrangement
requires that the
vertical & horizontal
overlap will be
increased with the
reduction or
elimination of lower
first premolar.
As in Fig. B

47. 3. Prognathic:
The lower jaw is
larger than
upper jaw & lies
outside the crest
of the upper
ridge.
As in Fig. C

48. Residual Ridge Parallelism:
1. Parallel Residual Ridge: when
upper& lower ridges are parallel
to each other while patient is in
rest position.
2. Divergent Residual Ridge: upper
& lower jaws diverge forward with
inter-ridge distance greater in
anterior than in posterior.

49. Palatal throat form:
Is the width of area between
the distal border of the hard
palate & the anterior border
of the movable tissues of the
soft palate.

50. A wide posterior
palatal seal is most
favorable because a
large seal can be
placed.
There are 3 classes:
1. Class I Soft palate.
2. Class II soft palate.
3. Class III soft palate.

51. Inter-arch Space (Inter-ridge distance):
The vertical distance between
ridge crests may be:
1. Favorable inter-ridge space.
2. Limited inter-ridge space.
3. Excessive inter-ridge space.

52. Saliva:
Class I:
Normal in amount & consistency, where
cohesive and adhesive properties of saliva
are ideal.
Class II:
Excessive saliva. It complicates impression
procedure & minimizes retention.
Class III:
Insufficient saliva, which reduces retentive
qualities of the dentures.

53. Consistency of saliva:
1.Thin- watery saliva.
2.Thick-ropy saliva
(causes less retention)&
difficulty in impression
taking.

54. Tori:
Bony protuberance,
found along the
median palatal suture
(Torus Palatinus) or
on the lingual side of
the mandible at
premolar area (Torus
Mandibularis).

55. Tori are classified as:
1. None.
2. Small (does not interfere
with denture construction).
3. Large (demands surgical
removal).

56. Lips:
Lip length might be:
1.Short lips, will expose all upper
anterior teeth & much of labial
flange of the denture base.
2.Long lips, make it difficult to show
sufficient tooth and usually they
hide upper anterior teeth& denture
base.

57. Form of lip, might be:
1. Thick lip, they give the
appearance of adequate
support when no teeth are
present.
2. Thin lip.

58. Radiographic examination
Radiographs are valuable aids as
they reveal embedded teeth,
retained roots, residual cysts,
foreign bodies, developmental
abnormalities, inflammatory and
neoplastic pathologies.

59. Radiographic landmarks

Edentulous patients
1. Nasal Cavity
2. Maxillary Sinus
3. Zygomatic Arch
4. Head of the Condyle
5. Cornoid Process
6. Soft Palate
7. Maxillary Tuberosity
8. Hard Palate
9. Tongue Shadow
10.Mandible
11.Mental Foramen
12.Submandibular Fossa
13.Inferior Alveolar Canal

60. Radiograph can show the relative
thickness of submucosa covering
bone, location of mandibular
canal & mental foramen in relation
to basal seat for mandibular
denture.
Sharp spicules of bone on ridge
crest can also be seen.

61. Mental attitude
Dr House classified patient’s mental
attitudes into 4 classes:
Class I, Philosophic patients:
Those patients are willing to accept the adjustment
of their dentists without question.
They accept their oral situation & know that their
dentist will do the best that can be done.
They are easy going, mentally well-adjusted &
cooperative.
Prognosis is excellent.

62. Class II, Exacting (demanding) patients:
They are precise, not
satisfied with past
treatment, doubt the
ability of the dentist to
satisfy him, and asks for
written guarantee or
remake at no additional
charge.

63. Class III, Hysterical patients:
Unstable personality, excitable,
apprehensive & hypersensitive.
Have negative attitude, often have poor
health, have failed in the past to wear
dentures, ask for esthetic & function equal
to natural teeth
A medical consultation is always advisable
for them before starting.
Prognosis is unfavorable.

64. Class IV, Indifferent:





Not concerned with appearance.
They go without dentures for years.
Have little appreciation for the efforts of
their dentists & often seek treatment
because of the insistence of their
families.
They discontinue easily if problems are
encountered with their new teeth.
Prognosis is uncertain or unfavorable.

65. Assessment of the existing denture
After examination oral
anatomy, a detailed &
systemic intra & extra oral
examination of the patient’s
existing denture should be
made by the dentist.

66. This examination should
include examination of the
tissue surface, occlusal and
polished surfaces of the
existing denture.
All patients should mention in their
records if they own old dentures:
Length of time dentures have been
worn.

67. How many sets have been
made since the teeth were
extracted.
The success of the existing
old dentures.
The attitude of the patient to
their appearance.

68. Pre-extraction records
Include:
1. Diagnostic casts ( from old treatment).
2. Close-up photograph.
 It must be explained to the patient that the
information is to be used as a guide and
that it is rarely possible to return to the
exact appearance shown in the
photograph.

69. Treatment planning
The dentist can usually
direct his patients to the
most favorable treatment
plan by proper education
since they know very little
about the treatment options.

70. Patient education should begin during
diagnosis & continues throughout the
treatment.
The more information a patient is given
the more he or she will accept that
treatment.
Usually a more highly motivated patient
has a significant positive effect on a
successful prognosis.

71. Prognosis
The degree of success the proposed line of
treatment is likely to achieve.
The overall picture including the patient’s
expectations, understanding and mental
attitude.
If problems are expected, they should be
explained to the patient before treatment
proceeds.
The patient is then more likely to cope with
the unavoidable limitations of the new
dentures.