it describes how to evaluate a patient before any treatment and then provide a suitable treatment to the patient according to the needs.......

1. Engelmeier RL, Phoenix RD.DCNA 1996;40(1)
1

2.  Introduction
 Patient evaluation
 History: The Patient’s Story
o Personal Data
o Dental History
o Medical History
 Examination: Dentist’s Observations
o Extraoral
o Intraoral
o Existing Denture
o Radiographic
o Study Casts
2

3.  Treatment planning
o Preliminary Phase
o Surgical/ Restorative Phase
o Rehabilitation Phase
o Maintenance Phase
3

4.  All the patients seeking dental services have some
degree of experience and understanding which
should be recognized by the dentist and address it
in the treatment planning.
 First visit is very important because explanations
given to the patient at this appointment form the
implicit agreement between the dentist and the
patient:
“Seeds of Success and Failures are Sown”
4

5.  The collection of medical and dental histories and
their careful analysis, coupled with a thorough
orofacial examination are the essential and integral
part of the prosthodontic management as these are
necessary for the selection of the optimal treatment
protocol.
5

6.  A health questionnaire is a convenient
method of collecting the basic information
and personal data which can be sent to the
patient before the appointment or
administered in the reception, dentist then
review and clarify the information provided
in the private operatory which is comfortably
equipped, tastefully decorated, free of
distractions so as to provide the patient with
the sense of security and privacy that will
allow them to communicate honestly and
completely.
6

7.  Data collected should be well documented.
 A logical method to accomplish this is to use a checklist.
7

8.  Name
 Age
 Sex
 Race
 Occupation
 Contact details
 Cosmetic Index
 Personality and Mental Attitude
 Socio-economic Status
 Oral hygiene habits
 Other habits
8

9. Conversing with the patient
addressing him with his name is
a good way of gaining the
patients confidence. The patient
feels he is dealing with a friend
and not a stranger and It is easy
to get information concerning
his medical and dental histories.
9

10. A. Adaptability and physiological Condition of Supporting
Structures
Younger: Adapt rapidly and high esthetic requirements
Beyond fifth decade: Doesn’t adapt readily
B. Mental Attitude
Postmenopausal women: hysterical or exacting with high esthetic
requirements
Men at this age: Preoccupied with their career – indifferent –
concerned only with comfort or function
10

11. Females: more concerned with appearance
Males: though young male are concerned with
appearance but they grow indifferent to their
appearance and shift focus to comfort and health.
Lack of Oestrogen in postmenopausal women
creates Osteoporosis as oestrogen have anti-
absorptive effect on bone. HRT is given.
11

12. The occupation of an individual may demand
special consideration in denture construction
from the standpoint of esthetics, phonetics, or
function or other special qualities in dentures.
12

13.  Critical factor in the characterization of dentures (i.e.,
choice of denture base shade, placement of denture
base stains, etc.)
13

14.  Classify the patient as
class 1: high cosmetic index
class 2: average cosmetic index
class 3: low cosmetic index
 Patients with high cosmetic indices, though often
exacting, usually are appreciative and cooperative.
Conversely, patients with low cosmetic indices
often are indifferent, uncooperative, and place
little value on the efforts of the prosthodontist.
14

15.  Dentist should assess it all the way during history
taking and examination.
 Much of this can be revealed through the
discussion of the chief complaint, reason of teeth
loss, importance of any remaining teeth and the
patient’s experience with the dentistry especially
with the previous denture.
15

16. Personality difficulties become exaggerated under
the influence of ill health, old age, menopause or
flair up because of unfavorable social or business
environment or the state of dominating or being
dominated by others.
16

17.  Danger lurks at both the ends of positive negative
spectrum. Overly optimistic may have unrealistic
expectations and on the other end the patients
who expect nothing more than another failure.
 In any case dentist must strive to bring the patient
to the reality.
“Complete Denture is not the replacement of teeth
but it is the replacement of NO TEETH”
17

18.  It is an general agreement that the complete
denture success or failure is not exclusively
determined by the patient’s oral anatomy or the
efforts of the dental team but also on the patient’s
attitude towards the prosthesis.
18

19.  Loss of teeth in both the general groups, weather
they are morphologically or emotionally
maladaptive, is an obstacle they cannot surmount
easily despite provision of excellent prosthetic
replacements.
 So, there are many critical element to be
considered in managing all the patients, the two
most important are the behavior of the doctor and
a thorough patient interview both of which involve
the skillful handling of verbal and nonverbal
communication
19

20.  The interview can comprise four parts:
i. The recognition and acknowledgement of the
problem
ii. Its identification and exploration
iii. Its interpretation and explanation
iv. The offering of a solution to the problem
20

21.  This iatrosedative interview creates indispensable
trusting relationship in the process of determining
the factors responsible for the problem and seeks
to offer a solution.
 Dentists tend to very rapidly become masters in
technical skills and adept at providing quick
solution to problems, however many clinical
challenges require significant commitment to
“patience with patients”
21

22.  There are some who have significant psychological
problems the require professional help.
 These patient should be referred to the
appropriate professionals. Because of sensitive
nature of such referrals, it usually is best to start
with the patient’s physician.
22

23. Philosophical
Exacting
Hysterical
Indifferent
23

24.  Philosophic: Those patients are
• easygoing,
• congenial,
• mentally well-adjusted,
• cooperative, and
• confident in the dentist
 Prognosis is excellent
24

25.  Exacting: These patients are
• precise,
• above average in intelligence,
• immaculate in dress and appearance,
• often dissatisfied with past treatment, doubt the ability
of the practitioner to satisfy him or her, and
• often want written guarantees or remakes at no
additional charge
 Once satisfied, an exacting patient may become
the practitioner's greatest supporter
25

26.  Hysterical: These patients
• submit to treatment as a last resort,
• have a negative attitude,
• are often in poor health,
• are poorly adjusted,
• often appear "exacting" but with unfounded complaints,
• have failed at past attempts to wear dentures, and
• have unrealistic expectations (hysterical patients often demand
esthetics and function equal to or greater than natural teeth).
 Prognosis is poor.
26

27.  Indifferent: These patients are
• not concerned with appearance,
• often go without dentures for years (or wear poor or
worn-out dentures far beyond serviceability),
• do not persevere, and
• do not adapt well.
• Such patients have no desire to wear dentures and do
not value the efforts or skills of the dentist.
27

28. 28

29.  Anupama
MS, Nair
KC.
Graphoanal
ysis: an aid
in patient
evaluation.
KDJ. 2009;
32: 14-9
29

30.  Determined by
Occupation
Income
Education
30

31.  Method and frequency of oral hygiene should be
asked by the patient.
 These factors may affect denture-base contouring
(e.g, closed interdental contours versus open
interdental contours) and tooth arrangement (e.g.,
presence or absence of diastemata).
 Hygiene should be classified as (1) good, (2) fair, or
(3) poor
31

32.  Other potentially unfavorable habits
• Tobacco smoking and alcohol consumption
• Patient should be informed about their systemic effects,
potential local impacts e.g. detrimental effect on wound
healing, soft tissue health, or the durability of tissue
conditioners
 Parafunctional habits
• Like bruxism and clenching
• Must be considered and their presence must be
considered while forming a treatment protocol
32

33.  Chief Complaint
 Reason of teeth loss
 Duration of complete edentulousness
 Weather a previous denture wearer
Patients comments on present dentures
Present dentures evaluation
 Patient’s expectations with the new dentures
33

34.  According to DeVan, "The dentist should meet the
mind of the patient before he meets the mouth of
the patient."
 Hence, the dentist must determine the reason the
patient is seeking prosthodontic treatment. The
patient should be questioned regarding his or her
chief complaint.
34

35.  There are several reasons for seeking this
information.
 First, if this is not done, the chief complaint may be
overlooked during therapy.
 Second, the response allows the practitioner to
assess whether the patient's expectations are
"realistic" or "attainable."
 And finally, the response provides information
regarding the patient's psychological classification
(for House's personality classification scheme).
35

36.  Provide insight into their appreciation of the
dentistry and contribute to the prognosis for
prosthodontic success.
 Patients who lost their teeth in an accident might
be more unhappy about their edentulous state
than those who lost teeth as a consequence of
decay resulting from neglect.
36

37.  Expectations for the remaining alveolar bone
would be great for the patients with a history of
rapid teeth loss from decay than for the patients
with the long history of progressive periodontal
diseases.
37

38.  Provide information regarding the resorption
pattern.
 Large, rapid changes occurs in the alveolar ridge
morphology during the first year after extraction.
 A “green ridge” may have bony spicules remaining
from extraction sites or bony undercuts with a thin
mucosal covering.
38

39.  The patient should be questioned regarding the
number and types of previous dentures.
 A patient with a history of several dentures over a
short period of time is a poor prosthodontic risk.
 If the patient is old denture wearer it is wise to
know the weather the patient is satisfied with the
old denture and dentist is dealing with the hostile
or receptive attitude.
39

40.  Patient should be questioned about the duration,
chewing efficiency, comfort, esthetics, speech
related to the present denture.
 Comments of the patient should be noted down as
1) Good 2) Fair 3) Poor
40

41.  Teeth shade, mold and material
 Esthetic, phonetics, retention, stability,
extensions, contours
 Centric relation and vertical dimension of
occlusion
 Occlusal plane orentation
 Palate
 Postdam
 Base Adaptation
41

42.  Midline
 Buccal vestibule
 Crossbite
 Characterization
 Wear
 Attachment and hardware
 Denture base extension
 Arch form
42

43.  All the properties should be graded as
1) Good, Fair and Poor
2) Acceptable and unacceptable
3) Adequate and inadequate
43

44. Dentist should be aware of each patient’s general
health as they are responsible for their well being
Knowledge of medications that patient is taking is
important to avoid any conflict in the therapy.
44

45.  Much can be learned from watching the patient
entering the operatory and sitting in the dental
chair.
45

46.  Cardiovascular disease
 Anaemia
 Respiratory Disorder
 Bleeding disorders
 Diabetes
 Asthma
 Allergy
 Tuberculosis
46

47.  Rheumatoid Arthritis/Bone disorders
 Jaundice
 Neurological disorder
 Radiotherapy
 Palsy
 Drug history
 Epilepsy
 Skin disorders
47

48. The patient must have this condition under proper medical control.
This is important, for the success of dentures.
The operator should use an impression technique that will produce
maximum physiologic compatibility of the denture base with the
supporting tissues
Careful occlusal corrections should be accomplished to remove all
interferences.
The food table should be small and the patient should be given
detailed instructions on eating habits and oral hygiene.
Frequent evaluation of the dentures is necessary.
48

49. The limited movement of the mandible during impression
making may necessitate special trays and procedures.
It may be difficult to get proper registrations. Generally, the
tactile method is the most satisfactory.
Occlusal corrections must be made often because of arthritic
changes in the temporomandibular joint.
49

50. Retention is often hard to achieve, and an adhesive may be
necessary.
The patient should be educated for mastication and oral
hygiene.
50

51. Control of the patient during fabrication of the denture can
be accomplished with sedatives.
Retention is difficult, and an adhesive may be necessary.
It may be wise to remove dentures when they are not in use.
This will add to the comfort of the patient and eliminate
the danger of swallowing them.
51

52. If dentures are to be made, it in imperative that no
abrasion or irritation be present on the supporting
tissues.
An open lesion may be the start of a serious condition,
namely osteoradionecrosis.
It is best not to use dentures at all over irradiated tissues,
but if dentures are necessary, they should not be used
until at least two years after radiotherapy.
52

53. Extraoral
Intraoral
Existing Denture
Radiographic
Study Casts
53
CLINICAL EXAMINATION: DENTIST’S
OBSERVATIONS

54.  Facial symmetry
 Facial form (Frontal)
 Facial form (Profile)
 Facial features
 Skin color
 Lip
• Length
• Thickness
• Tonicity
• Lip contact
 Appearance
• Cheeks
• Lips
• skin
54

55.  Nose
• Symmetry
• Tip
• Nasolabial fold
 Philtrum
 Chin
 TMJ
 Neuromuscular Control
 Speech
 Lymph Node Examination
55

56. FACIAL SYMMETRY
Symmetrical
Asymmetrical
56

57. FACE FORM (Frontal)
(House and Loop, Frush and Fisher and Williams)
1. Square: in this case the face is about equally wide in the
temporal region, the area of the zygomatic arch and the
angles of the jaw.
57

58. FACE FORM
2. Tapering: A decrease in width is generally found in these
types as one progresses from forehead to chin.
58

59. FACE FORM
3. Square tapering: a combination of the square and
tapering forms.
59

60. FACE FORM
4. Ovoid: the area of the zygomatic arch is widest in
this case.
60

61. FACIAL PROFILE
(Angle)
Class 1, Normal: that is
the Nasion, Point A,
Point B are in the
same line.
61

62. FACIAL PROFILE
(Angle)
Class 2, Retrognathic:
that is Point B is
placed posteriorly
compared to Class 1
62

63. FACIAL PROFILE
(Angle)
Class 3, Prognathic:
that is point B is
placed anteriorly
compared to Class 1
63

64. Rugged
Delicate
Average
64
Facial Appearance:

65. Complexion
Hair, eye, and skin color provide
useful guides in shade selection.
65

66. Complexion
Skin color also can reveal underlying disease and
pathology.
Patients with significant sun damage warrant
referral to a dermatologist.
Pale, anemic-looking patients may have
underlying systemic diseases and may require
longer adjustment periods.
66

67. LIP
Contour
• Adequately
supported
• Unsupported
67

68. LIP
Mobility
Class 1: Normal
class 2: Reduced Mobility
Class 3: Paralysis
Patients with minimal lip mobility show very little of
the anterior teeth.
68

69. LIP
Mobility
Some stroke victims may have paralysis of half
the lip, leading to unilateral mouth droop and
facial asymmetry.
Patients must be counselled regarding treatment
limitations when dealing with such physical
challenges. Otherwise, patients may have
unrealistic expectations regarding functional
and esthetic results.
69

70. LIP
Length
Classify lip lengths as long, normal or medium, and
short.
A long lip reveals little of the anterior teeth, whereas a
very short lip allows the display of the denture base.
Mold selection and denture characterization can be
critical factors in these cases.
70

71. Cheeks, Lips, Skin: Appearance
Full/ Thin
71

72. Nose
Symmetry: Present/ Absent
Tip: Prominent/ Depressed
Nasolabial Fold: Deepened/ Normal
72

73. Philtrum
Normal/ Obliterated/ Deepened
73

74. CHIN
• Prominent/ Not prominent
• Deviated/ Undeviated
74

75. Labiomental Sulcus
Normal/Obliterated/
Deepened
75

76. TMJ
• Tenderness/Discomfo
rt
• Crepitus
• Deviation of
mandible in
movement
76

77. Mandibular
Movements
Normal/Deviated/Re
stricted
77

78. Mouth Opening
Normal/Reduced
78

79. Neuromuscular Coordination
Class 1: Excellent
Class 2: Fair
Class 3: Poor
Patients with good neuromuscular control
expected to learn to manipulate dentures
relatively quickly
79

80. Muscular Tone
(House)
Class 1: the patient exhibits normal tension, tone,
and placement of muscles of mastication
and facial expression.
Majority of edentulous patients have experienced
some degree of degeneration.
Usually present only in immediate denture patients.
80

81. Muscular Tone
(House)
Class 2: the patient usually exhibits normal tension
but impaired tone
81

82. Muscular Tone
(House)
Class 3: the patient exhibits greatly impaired tone
and tension.
This impairment is usually coupled with poor
health, inefficient dentures, and loss of vertical
dimension, wrinkles, decreased biting force and
drooping commissure.
82

83. Muscular Development
(House)
Class 1: Heavy
Class 2: Medium
Class 3: Light
83

84. Speech
Normal / Affected
Patients with speech impediments or those who
cannot articulate optimally with their existing
dentures require special attention when the
dentist places the anterior teeth and forms the
palatal portions of the denture base.
84

85. Lymph Node Examination
(Submandibular, Submental,
Cervical, Preauricular,
Mastoid)
-Palpable/Non palpable
-Tender/Non tender
-Movable/Fixed
85

86. 86

87.  Mucosa
 Tongue
• Mucosa
• Size
• Position
 Residual Ridge
• Frenal Attachment
• Arch Form
• Vestibule
87

88.  Palate
• Incisive Papilla
• Ruage
• Compressibility
• Fovea
• Maxillary Tuberosity
• Palatal Throat Form
• Soft Palate
 Floor of mouth
• Lateral Throat Form
 Mylohyoid Ridge
88

89. Ridge Relationship
Interarch Space
Saliva
Torus
89

90. MUCOSA : COLOR
From healthy pink to angry red.
Redness indicate: inflammation
Ill-fitting denture, underlying infection, a systemic
disease such as diabetes or chronic smoking.
Determine the cause and remove the irritant for success
of denture.
90

91. MUCOSA : THICKNESSS
(House)
Class 1: Normal uniform density of mucosal tissue
(approximately 1-mm thick).
Investing membrane is firm but not tense and forms
an ideal cushion for the basal seat of a denture.
91

92. MUCOSA : THICKNESSS
(House)
Class 2:
(a) Soft tissues have thin investing membranes and
are highly susceptible to irritation under pressure
(b) Soft tissues have mucous membranes twice the
normal thickness.
92

93. MUCOSA : THICKNESSS
(House)
Class 3: Soft tissues have excessively thick investing
membranes filled with redundant tissues.
At the very least, this requires tissue treatment such
as surgical correction.
93

94. MUCOSA : THICKNESSS
(House)
Uneven thickness because of different timings of
extraction.
Extremely thin: teeth have been missing for a long time
Normal: Teeth removed recently.
Other areas may be excessively thick with localized
regions of redundant tissue.
Such variations make it difficult to equalize pressure
under the denture and to avoid soreness.
94

95. MUCOSA : CONDITION
(House)
Class 1: Healthy
Class 2: Irritated
Class3: Pathologic
If class 2 or 3 is present, remove the cause of irritation
and pathology.
95

96. TONGUE POSITION
(Wright)
Normal: The tongue fills the floor of the mouth
and is confined by the mandibular teeth.
Lateral surface rest on the occlusal surface of
posterior teeth.
Most favourable prognosis.
The floor of the mouth will be high enough to
cover the lingual flange of the denture
producing a border seal.
96

97. TONGUE POSITION
(Wright)
Class 1: Retracted: The tongue is retracted.
The floor of the mouth pulled downward.
The lateral borders are raised above the occlusal
plane and the apex is pulled down into the floor
of the mouth.
97

98. TONGUE POSITION
(Wright)
Class 2: Retracted: The tongue is very tense and
pulled backward and upward.
The apex is pulled back into the body of the
tongue and almost disappears.
The lateral borders rest above the mandibular
occlusal plane.
The floor of the mouth is raised and tense.
98

99. ARCH FORM
( House)
SQURARE
TAPERING
OVOID
99

100. RIDGE FORM
Height: Retention
Parallel walls: Stability as lateral movements ate
limited by this even if vertical displacement
occurs
Also, retention ∝ Surface Area
100

101. RIDGE FORM
(Maxillary)
Class 1: square to gently rounded
Ideal for retention and stability
101

102. RIDGE FORM
(Maxillary)
Class 2: Tapering and V-shaped
Results from bone loss in both width and height,
so poor in both retention and stability
102

103. RIDGE FORM
(Maxillary)
Class 3: Flat
103

104. RIDGE FORM
(Mandibular)
Class 1: Inverted "U" shaped
(Parallel walls from medium to tall with broad
crest)
104

105. RIDGE FORM
(Mandibular)
Class 2: Inverted "U" shaped
(short with flat crest)
105

106. RIDGE FORM
(Mandibular)
Inverted “W” short inverted “V” tall, thin inverted “V”
Class3: Unfavorable
106

107. RIDGE FORM
(Mandibular)
Undercut
107

108. RIDGE FORM
Defects: Ridge defects, such as exostoses or
divots, may pose problems for complete-
denture patients or may warrant preprosthetic
surgery.
108

109. MUSCLE or BORDER ATTACHMENTS
(House)
Class 1: High in the maxilla or low in the mandible
with respect to the crest of the ridge. ≥ 0.5 inches
Class 2: Medium. 0.25-0.5 inches
Class 3: ≤ 0.25 inches
109

110. FRENUM ATTACHMENTS
(House)
Class 1: High in the maxilla or low in the mandible
with respect to the crest of the ridge.
Class 2: Medium
Class 3: Encroach on the crest of ridge and may
interfere with the denture seal. Surgical correction
required.
110

111. FRENUM ATTACHMENTS
(House)
Especially in case of mandible, if freni are present at
both labial and lingual sides of the residual
anterior mandibular ridge, surgical reposition of
the freni is must because denture will be weaker in
these area and fracture may result.
111

112. INCISIVE PAPILLA
• Normal
• Tender
• Prominent
112

113. PALATAL RUGAE
• Normal
• Prominent
• Faint
113

114. PALATAL COMPRESSIBILITY
• Median area
o Rigid
o compressible
• Lateral area
o Rigid
o compressible
114

115. FOVEA PALATINI
• Prominent
• Non prominent
115

116. MAXILLARY TUBEROSITY
• Bulbous
• Pendulous
• Undercuts
o Unilateral
o Bilateral
116

117. SOFT PALATE
Class 1 – soft palate is rather
horizontal and demonstrates
little muscular movement. It is
the most favourable condition
because it allows for more tissue
coverage for the palatal seal.
Class 2 – soft palate turns
downward at about a 45 angle to
the hard palate and the amount
of the potential tissue coverage
for the palatal seal is less than
that of the class1.
117

118. SOFT PALATE
Class 3 – A class 3 soft
palate turns downward
at about a 70 angle just
posteriorly to the hard
palate. Therefore this is
the least favourable form
of soft palate.
118

119. PALATAL THROAT FORM
Class 1: Large and normal in form, with a relatively
immovable band of resilient tissue 5 to 12 mm distal
to a line drawn across the distal edge of the
tuberosities.
119

120. PALATAL THROAT FORM
Class 2: Medium size and normal in form, with a
relatively immovable resilient band of tissue 3 to 5
mm distal to a line drawn across the distal edge of the
tuberosities.
120

121. PALATAL THROAT FORM
Class 3: Usually accompanies a small maxilla. The
curtain of soft tissue turns down abruptly 3 to 5 mm
anterior to a line drawn across the palate at the distal
edge of the tuberosities.
121

122. PALATAL SENSITIVITY
(House)
Class 1: Normal
Class 2: Subnormal (hyposensitive)
Class 3: Supernormal (hypersensitive)
122

123. THROAT FORM
LATERAL THROAT FORM
Class I Low - 1/2 inch or more from the mylohyoid ridge
to the bottom of the retro-mylohyoid fold, visible
when the tongue is in a slightly protruded position.
Most favorable.
Class II Medium - Less than 1/2 inch under the same
conditions as above.
Class III High - Retro-mylohyoid fold at same level as
mylohyoid ridge. Least favorable.
123

124. THROAT FORM
124
Class 1 Class 2
Class 3

125. MYLOHYOID RIDGE
• Normal
• Resorbed
• Sharp
125

126. INTERMAXILLARY RELATIONSHIP
If both the ridges are large, part the
lips gently while the patient
maintains a rest position and note
if there is sufficient space for
teeth.
If the space is limited remember to
use very thin denture base over the
ridges and use acrylic resin teeth.
126

127. INTERMAXILLARY RELATIONSHIP
A large intermaxillary space is also
unfavorable because the teeth are
present so far above the ridge that
undesirable forces may be created
on the ridges and also denture will
be heavy.
127

128. RIDGE PARALLELISM
Class 1: Both ridges are
parallel to the occlusal
plane.
Class 2: The mandibular
ridge is divergent from the
occlusal plane anteriorly.
Class 3: The maxillary ridge
is divergent from the
occlusal plane anteriorly
or both ridges are
divergent anteriorly.
128

129. RIDGE RELATION
Class 1, Normal,The lower ridge
crest is very slightly to the
inside of the upper ridge crest
Class 2, Retrusive,The lower arch
is smaller than the upper and
the lower ridge crest is inside
the upper ridge crest
considerably more than in the
normal.
Class 3, Protrusive,The lower arch
is larger all around than the
upper; hence the upper ridge
crest is inside of the lower ridge
crest. 129

130. SALIVA
Class 1: Normal quality and quantity of saliva. Mixed
Saliva.
Cohesive and adhesive properties of saliva are ideal.
Class 2: Excessive saliva; contains much mucus.
Class 3: Xerostomia; remaining saliva is mucinous.
130

131. SALIVA
Thin watery saliva may affect retention.
Thick ropy saliva complicates impression making and
is annoying to the patient as it clings to the denture.
Abundant saliva is common when the denture is first
inserted but usually improves with time.
131

132. TORI
Class 1: Tori are absent or minimal
in size. Existing tori do not
interfere with denture
construction.
132

133. TORI
Class 2: Clinical examination
reveals tori of moderate size.
Such tori offer mild difficulties in
denture construction and use.
Surgery is not required.
133

134. TORI
Class 3: Large tori are present.
These tori compromise the
fabrication and function of
dentures. Such tori usually
require surgical recontouring or
removal.
134

135. TORI
Does not require surgical intervention
unless large and bulbous.
The mucosa over tori is usually thin
and unyielding.
Do not use arbitrary relief at the site
of the torus. The correct relief can
be obtained by a special impression
procedure or with pressure
indicator paste in the finished
denture.
135

136. TORI
Mandibular Tori usually more of a
problem as they interfere with the
lingual border seal and restrict the
tongue space. If prominent,
especially if undercut, surgical
correction is indicated.
136

137. OPG should be advised.
Check for:
• Root pieces
• Foreign bodies
• Impacted/Embedded teeth
• Rarefaction of bone
• TMJ-Findings
137

138. TREATMENT PLAN
Treatment planning is the process of matching possible
treatment options with patient needs and systemically
arranging the treatment in order of priority but
keeping with logical or technically necessary sequence.
The dentist must resist the natural tendency to include
in a treatment plan the treatment that the dentist feels
competent to deliver. Treatment plan must have a
parallel process of developing a prognosis.
Treatment is driven by the diagnosis must take other
factors like prognosis, patient health and attitudes into
account
138

139. 1. ZARB,PROSTHODONTIC TREATMENT FOR
EDENTULOUS PATIENTS 12TH EDITION
PAGES 73-99.
2. WINKLER S.,ESSENTIALS OF COMPLETE
SENTURE PROSTHDONTICS,2ND EDITION
,Pg39-55.
3. ENGELMEIER R.L.,D.C.N.A.,VOLUME 40;1:18
4. WWW.CPMCNETCHAPTER 1 PATIENT
HISTORY.HTM
139