this lecture covers the history and examination and treatment planning section for complete denture patients

2. Final year
BDS
3rd year
BDS
Curriculum
Prosthodontics
Removable
Partial dentures
Removable
Partial Dentures
Complete
Dentures
Fixed dental
prosthesis

3. CLINICAL ROTATION
CLINICAL QUOTA:
• ACRYLIC PARTIAL DENTURES: 10
• CAST PARTIAL DENTURES: 02
• COMPLETE DENTURES: 06
• CROWN PREPARATIONS: 00

4. STUDY GUIDE
• COMPLETE DENTURES:
• PROSTHODONTIC TREATMENT FOR EDENTULOUS PATIENTS, 1ST SOUTH ASIAN EDITION BY ZARB
• COMPLETE DENTURE PROSTHODONTICS, 5TH EDITION BY JOHN JOY MANAPPALLIL
• REFERENCE ARTICLES
• REMOVABLE PARTIAL DENTURES:
• MC CRACKEN’S REMOVABLE PARTIAL PROSTHODONTICS, 13TH EDITION
• STEWART’S CLINICAL REMOVABLE PARTIAL PROSTHODONTICS
• FIXED DENTAL PROSTHESIS:
• CONTEMPORARY FIXED PROSTHODONTICS, 5TH EDITION BY FUGIMOTO

6. HISTORY, EXAMINATION AND
TREATMENT PLANNING

7. FIRST CLINICAL VISIT

8. DENTURE HISTORY
• PREVIOUS DENTURE EXPERIENCE

9. PATIENT EXPECTATIONS

10. PATIENT PERSONALITY
• HOUSE CLASSIFICATION:
• PHILOSOPHICAL
• EXACTING
• INDIFFERENT
• HYSTERICAL
• SKEPTICAL

11. PHILOSOPHICAL
• WELL MOTIVATED
• REALIZE THEIR ROLE IN TREATMENT SUCCESS
• COOPERATIVE AND LEARNS TO ADJUST
• RATIONAL, SENSIBLE, CALM AND COMPOSED

12. EXACTING
• METHODICAL AND PRECISE
• REQUIRES DETAILED EXPLANATION
• MAY PROPOSE TREATMENT ALTERNATIVES
• MANAGEMENT:
• REQUIRE EXTRA CARE AND PATIENCE
• CAN BE GOOD PATIENT IF INTELLIGENT AND UNDERSTANDING
• LISTEN TO DEMANDS BUT NEVER GIVE IN

13. INDIFFERENT
• QUESTIONABLE PROGNOSIS
• LACKS MOTIVATION AND INTEREST
• TRIES TO FIND FAULTS IN TREATMENT AND BLAME THE DENTIST
• NEVER COOPERATE OR FOLLOW INSTRUCTIONS
• MANAGEMENT:
• DIFFICULT
• IDENTIFY BEFORE STARTING TREATMENT AND EDUCATE AND IMPROVE PATIENT INTEREST
• BEST TO POSTPONE TREATMENT

14. HYSTERICAL
• EASILY EXCITED
• HIGHLY APPREHENSIVE AND EMOTIONALLY UNSTABLE
• RARELY COOPERATIVE
• UNREALISTIC EXPECTATIONS
• MANAGEMENT:
• NEED A LOT OF TIME AND EFFORT
• PROFESSIONAL HELP MAYBE REQUIRED
• PROBLEMS ARE MAINLY SYSTEMIC

15. SKEPTICAL
• BAD EXPERIENCE FROM PREVIOUS TREATMENT
• OFTEN HAVE UNFAVOURABLE CONDITIONS LIKE SEVERELY RESORBED RIDGES AND POOR HEALTH
• MAY HAVE PSYCHOLOGICAL PROBLEMS
• MANAGEMENT:
• PSYCHOLOGICAL MANAGEMENT
• KINDNESS, CARE AND SYMPATHY SHOULD BE OFFERED
• REQUIRE MORE TIME AND ATTENTION

16. FACTORS FOR FAVORABLE ADAPTIVE RESPONSE
• TRUST AND CONFIDENCE IN DENTIST
• PREVIOUS FAVORABLE EXPERIENCE
• POSITIVE ATTITUDE
• REALISTIC EXPECTATIONS
• YOUTH AND GOOD GENERAL HEALTH
• WILLINGNESS TO COOPERATE
• GOOD LEARNING CAPACITY

17. FACTORS PRODUCING MALADAPTIVE RESPONSE
• LACK OF TRUST
• POOR COMMUNICATION
• PREVIOUS NEGATIVE EXPERIENCE
• UNREALISTIC EXPECTATION
• ANXIETY AND LOW TOLERANCE
• POOR HEALTH
• POOR MUSCLE COORDINATION
• POOR LEARNING ABILITY
• PSYCHOLOGICAL DISORDERS

18. EXTRA ORAL EXAMINATION

19. EXTRA ORAL EXAMINATION
LIPS
• LENGTH
• THICKNESS
• MOBILITY
• SMILE LINE
• SUPPORT
• Long
• Medium
• Short

20. EXTRA ORAL EXAMINATION
• BUCCAL CORRIDOR
• SPEECH
• MUSIC

21. INTRA ORAL EXAMINATION
• MUCOSA
• FRENAL ATTACHMENT AND VESTIBULAR DEPTH
• INFECTION
• Based on thickness
• Thin
• Thick
• Based of function
• Keratinized
• Lining
• Specialized

22. INTRA ORAL EXAMINATION
• RIDGE
• FORM
• SHAPE
• ANTERIOR RIDGE RELATIONSHIP
• POSTERIOR RIDGE RELATIONSHIP
• RIDGE PARALLELISM
• TUBEROSITY
• TORI

23. INTRA ORAL EXAMINATION
• FLOOR OF THE MOUTH
• HARD PALATE
• SOFT

24. INTRA ORAL EXAMINATION
• TONGUE
• SIZE AND SHAPE
• POSITION
• MOBILITY
• MUCOSA
• SALIVA
• QUALITY
• QUANTITY
• Class I:
Normal size, development and function with enough teeth present
to maintain form
• Class II:
Teeth absent long enough to permit change in form and function
• Class III:
excessively large tongue due absence of teeth for extended period
of time
• Class i:
Tongue lies in the floor of mouth with tip forward and slightly below the
incisal edge
• Class ii:
Flat and broadened tongue with tip in the normal position
• Class III:
Tongue is retracted and depressed into the floor of the mouth with the tip
curled upward, downward or assimilated into the body

25. EXISTING DENTURE EVALUATION
• TISSUE/INTAGLIO SURFACE
• POLISHED SURFACE
• OCCLUSAL SURFACE

26. EXISTING DENTURE EVALUATION
• EXAMINATION
• OUTSIDE THE MOUTH
• INSIDE THE MOUTH
• Denture repairs
• Flanges
• Teeth
• Favorable features/ Esthetics
• Occlusal contacts
• Denture retention
• Flange extensions
• Esthetics
• Occlusal contacts
• Denture stability
• Phonetics
• Occlusal and rest vertical dimensions

27. EXISTING TEETH
• INDICATIONS FOR RETENTION OF TEETH:
• USING TRADITIONAL DENTAL INTERVENTIONS—PERIODONTAL, RESTORATIVE, PROSTHODONTIC, AND
SURGICAL—THE HEALTH OF THE DENTITION MAY BE RESTORED
• THOSE TEETH THAT ARE REGARDED AS HAVING POOR OR DUBIOUS PROGNOSES MAY BE EXTRACTED WHILE
RETAINING OTHERS THAT OFFER A GOOD PROGNOSTIC OUTCOME
• SPECIFIC TEETH CAN BE SELECTED AS POTENTIAL ABUTMENTS FOR OVERDENTURE TREATMENT WITH OR
WITHOUT ADJUNCTIVE IMPLANT SUPPORT

28. EXISTING TEETH
• INDICATIONS FOR EXTRACTION OF TEETH:
• ADVANCED PERIODONTAL DISEASE WITH SEVERE BONE LOSS AROUND THE TEETH
• SEVERELY BROKEN-DOWN CROWNS WITH SUBGINGIVAL RESIDUAL TOOTH TISSUE THAT CANNOT BE
ADEQUATELY RESTORED
• FRACTURED ROOTS
• PERIAPICAL OR PERIODONTAL ABSCESSES THAT CANNOT BE SUCCESSFULLY TREATED
• UNFAVORABLY TIPPED OR INCLINED TEETH THAT POSE PROBLEMS FOR THEIR USE AS ABUTMENTS FOR FIXED OR
REMOVABLE PROSTHESES
• EXTRUDED OR TIPPED TEETH THAT INTERFERE WITH THE PROPER LOCATION OF THE OCCLUSAL PLANE AND ARE
NOT AMENABLE TO PROSTHODONTIC MODIFICATION.

29. INVESTIGATIONS
• RADIOGRAPHS
• DIAGNOSTIC CASTS
• PHOTOGRAPHS

31. IMPROVING DENTURE BEARING AREA

32. CATEGORIES
• PRE-PROSTHETIC NON-SURGICAL METHODS
• PRE-PROSTHETIC SURGICAL METHODS

33. PRE-PROSTHETIC NON-SURGICAL METHODS
• MANAGING TRAUMATIZED TISSUES
• OCCLUSAL CORRECTION OF OLD PROSTHESES

34. MANAGING TRAUMATIZED TISSUES
• REST FOR THE DENTURE-SUPPORTING TISSUES CAN BE ACHIEVED BY REMOVAL OF THE DENTURES FROM
THE MOUTH FOR AN EXTENDED PERIOD
• ALLOW DEFORMED TISSUE OF THE RESIDUAL RIDGES TO RETURN TO NORMAL

35. MANAGING TRAUMATIZED TISSUES
• TISSUE ABUSE CAUSED BY IMPROPER OCCLUSION CAN BE CORRECTED BY
• WITHHOLDING THE FAULTY DENTURES FROM THE PATIENT
• ADJUSTING/CORRECTING THE OCCLUSION AND REFITTING THE DENTURE BY MEANS OF A TISSUE CONDITIONER
• SUBSTITUTING PROPERLY MADE DENTURES ONCE THE DENTURE-BEARING TISSUES HAVE RECOVERED
• DENTURE-BEARING TISSUES DEMONSTRATE MICROSCOPIC EVIDENCE OF INFLAMMATION, EVEN IF THEY APPEAR
CLINICALLY NORMAL

36. PRE-PROSTHETIC SURGICAL METHODS
OBJECTIVES
• CORRECTING CONDITIONS THAT PRECLUDE OPTIMAL PROSTHETIC FUNCTION
• LOCALIZED OR GENERALIZED HYPERPLASTIC REPLACEMENT OF RESORBED RIDGES
• EPULIS FISSURATUM
• PAPILLOMATOSIS
• UNFAVORABLY LOCATED FRENULAR ATTACHMENTS
• PENDULOUS MAXILLARY TUBEROSITIES
• BONY PROMINENCES, UNDERCUTS, AND RIDGES
• DISCREPANCIES IN JAW SIZE RELATIONSHIPS
• PRESSURE ON MENTAL FORAMEN

37. PRE-PROSTHETIC SURGICAL METHODS
OBJECTIVES
• ENLARGEMENT OF DENTURE-BEARING AREA
• VESTIBULOPLASTY
• RIDGE AUGMENTATION
• PROVISION FOR PLACING TOOTH ROOT ANALOGUES BY MEANS OF OSSEO-INTEGRATED DENTAL IMPLANTS

38. SURGICAL CORRECTION OF CONDITIONS THAT
PRECLUDE OPTIMAL PROSTHETIC FUNCTION

39. HYPERPLASTIC RIDGE, EPULIS FISSURATUM, AND PAPILLOMATOSIS
• MOBILE TISSUES THAT INTERFERE WITH OPTIMAL SEATING OF THE DENTURE, LOCALIZED ENLARGEMENT OF
PERIPHERAL TISSUES OR TISSUES THAT READILY HARBOR MICROORGANISMS ARE NOT CONDUCIVE TO FIRM,
HEALTHY FOUNDATIONS FOR COMPLETE DENTURES
• THESE TISSUES SHOULD BE RESTED, MASSAGED, OR TREATED WITH AN ANTIFUNGAL AGENT BEFORE THEIR
SURGICAL EXCISION
• CONSIDERABLE REDUCTION IN THE EDEMA, MAKING THE SURGICAL PROCEDURE SIMPLER AND LESS EXTENSIVE

40. FRENULAR ATTACHMENTS
• CLOSE TO THE CREST OF THE BONY RIDGE IT MAY BE DIFFICULT TO OBTAIN THE IDEAL EXTENSION
• UPPER LABIAL FRENUM IN PARTICULAR MAY BE COMPOSED OF A STRONG BAND OF FIBROUS CONNECTIVE
TISSUE
• FRENA OFTEN BECOME PROMINENT AS A RESULT OF REDUCTION OF THE RESIDUAL RIDGES
• FRENECTOMY CAN BE CARRIED OUT EITHER BEFORE PROSTHETIC TREATMENT IS BEGUN OR AT THE TIME OF
DENTURE INSERTION WHEN THE NEW PROSTHESIS CAN ACT AS A SURGICAL TEMPLATE

41. PENDULOUS MAXILLARY TUBEROSITIES
• OCCUR UNILATERALLY OR BILATERALLY
• MAY INTERFERE WITH DENTURE CONSTRUCTION
• SURGICAL EXCISION IS THE TREATMENT OF CHOICE
• CARE MUST BE USED TO AVOID OPENING INTO THE MAXILLARY SINUS

42. BONY PROMINENCES, UNDERCUTS, SPINY RIDGES, AND TORI
• MAY HAVE TO BE REMOVED TO AVOID PAINFUL DENTURE FLANGE IMPINGEMENT AND TO ACHIEVE A
BORDER SEAL
• MAXILLARY TORI ARE RARELY REMOVED BECAUSE SATISFACTORY DENTURES CAN BE MADE OVER MOST
OF THEM BY CAREFUL RELIEF

43. BONY PROMINENCES, UNDERCUTS, SPINY RIDGES, AND TORI
• INDICATIONS FOR THE REMOVAL OF MAXILLARY TORI
• AN EXTREMELY LARGE TORUS THAT FILLS THE PALATAL VAULT AND PREVENTS THE FORMATION OF AN
ADEQUATELY EXTENDED AND STABLE MAXILLARY DENTURE
• AN UNDERCUT TORUS THAT TRAPS FOOD DEBRIS, CAUSING A CHRONIC INFLAMMATORY CONDITION; SURGICAL
EXCISION IS NECESSARY TO CREATE OPTIMAL ORAL HYGIENE
• A TORUS THAT EXTENDS PAST THE JUNCTION OF THE HARD AND SOFT PALATES AND PREVENTS THE
DEVELOPMENT OF AN ADEQUATE POSTERIOR PALATAL SEAL
• A TORUS THAT CAUSES THE PATIENT CONCERN

44. BONY PROMINENCES, UNDERCUTS, SPINY RIDGES, AND TORI
• EXOSTOSES MAY OCCUR ON BOTH JAWS BUT ARE MORE FREQUENT ON THE BUCCAL SIDES OF THE
POSTERIOR MAXILLARY SEGMENTS
• GENIAL TUBERCLES ARE EXTREMELY PROMINENT AS A RESULT OF ADVANCED RIDGE REDUCTION
• GENIOGLOSSUS MUSCLE HAS A TENDENCY TO DISPLACE THE LOWER DENTURE
• IF THE MUCOSA OVER THE TUBERCLE CANNOT TOLERATE THE PRESSURE OR CONTACT OF THE DENTURE
FLANGE IN THIS AREA, THEN IT MAY HAVE TO BE REMOVED AND THE GENIOGLOSSUS MUSCLE DETACHED

45. PRESSURE ON MENTAL FORAMEN
• EXTREME BONE RESORPTION LEADING TO OPENING OF MENTAL FORAMEN NEAR OR DIRECTLY AT THE
CREST OF RIDGE
• MARGINS OF MENTAL FORAMEN EXTEND AND HAVE VERY SHARP EDGES, 2 TO 3 MM HIGHER THAN THE
SURROUNDING MANDIBULAR BONE
• PRESSURE FROM THE DENTURE ON THE MENTAL NERVE EXITING THE FORAMEN AND OVER THIS SHARP
BONY EDGE WILL CAUSE PAIN AND PARESTHESIA
• THE MOST SUITABLE WAY OF MANAGING THIS IS TO ADJUST THE DENTURE TO RELIEVE THE PRESSURE

46. RIDGE PARALLELISM
• LACK OF PARALLELISM MAY BE CAUSED BY FAILURE TO TRIM THE TUBEROSITY, JAW DEFECTS, UNEQUAL
RIDGE REDUCTION, OR ABNORMALITIES OF GROWTH AND DEVELOPMENT
• PARALLEL RIDGES DIRECT FORCES IN A WAY THAT TENDS TO SEAT THE DENTURES

47. ENLARGEMENT OF DENTURE BEARING AREAS

48. VESTIBULOPLASTY AND RIDGE AUGMENTATION
• THE ANTERIOR PART OF THE BODY OF THE MANDIBLE IS THE SITE MOST FREQUENTLY INVOLVED WITH THE
LABIAL SULCUS VIRTUALLY OBLITERATED, AND THE MENTALIS MUSCLE ATTACHMENTS APPEARING TO
“MIGRATE” TO THE CREST OF THE RESIDUAL RIDGE
• RESULTS IN THE SETUP OF TEETH IN A MORE LINGUAL POSITION
• MYOPLASTY ACCOMPANIED BY SULCUS DEEPENING

49. CLASSIFICATIONS OF RESIDUAL RIDGE MORPHOLOGY
CLASS I: THIS CLASSIFICATION LEVEL DESCRIBES THE STAGE OF EDENTULISM THAT IS MOST APT TO BE
SUCCESSFULLY TREATED BY CONVENTIONAL PROSTHODONTIC TECHNIQUES WITH COMPLETE DENTURE
PROSTHESIS
• DEFINED BY:
• RESIDUAL BONE HEIGHT OF 21 MM OR GREATER MEASURED AT THE LEAST VERTICAL HEIGHT OF THE MANDIBLE
• CLASS I MAXILLOMANDIBULAR RELATIONSHIP

50. CLASSIFICATIONS OF RESIDUAL RIDGE MORPHOLOGY
CLASS II: THIS CLASSIFICATION LEVEL DISTINGUISHES ITSELF WITH THE NOTED CONTINUATION OF THE
PHYSICAL DEGRADATION OF THE DENTURE-SUPPORTING STRUCTURES AND IN ADDITION IS
CHARACTERIZED BY LOCALIZED SOFT TISSUE FACTORS AND PATIENT MANAGEMENT/LIFESTYLE
CONSIDERATIONS
• DEFINED BY:
• RESIDUAL BONE HEIGHT OF 16 TO 20 MM MEASURED AT THE LEAST VERTICAL HEIGHT OF THE MANDIBLE
• CLASS I MAXILLOMANDIBULAR RELATIONSHIP
• RESIDUAL RIDGE MORPHOLOGY THAT RESISTS HORIZONTAL AND VERTICAL MOVEMENT OF THE DENTURE BASE

51. CLASSIFICATIONS OF RESIDUAL RIDGE MORPHOLOGY
CLASS III: THIS CLASSIFICATION LEVEL IS CHARACTERIZED BY THE NEED FOR SURGICAL INTERVENTION
(IMPLANT THERAPY OR PRE-PROSTHETIC SURGERY) TO ALLOW FOR ADEQUATE PROSTHODONTIC FUNCTION
• DEFINED BY:
• RESIDUAL BONE HEIGHT OF 11 TO 15 MM MEASURED AT THE LEAST VERTICAL HEIGHT OF THE MANDIBLE
• CLASS I, II, AND III MAXILLOMANDIBULAR RELATIONSHIP
• RESIDUAL RIDGE MORPHOLOGY HAS MINIMUM INFLUENCE TO RESIST HORIZONTAL OR VERTICAL MOVEMENT OF
THE DENTURE BASE
• LOCATION OF MUSCLE ATTACHMENTS WITH MODERATE INFLUENCE ON DENTURE-BASE STABILITY AND
RETENTION

52. CLASSIFICATIONS OF RESIDUAL RIDGE MORPHOLOGY
CLASS IV: THIS CLASSIFICATION LEVEL DEPICTS THE MOST DEBILITATED EDENTULOUS CONDITION.
SURGICAL RECONSTRUCTION IS ALMOST ALWAYS INDICATED BUT CANNOT ALWAYS BE ACCOMPLISHED
BECAUSE OF THE PATIENT’S HEALTH, DESIRES, PAST DENTAL HISTORY, AND FINANCIAL CONSIDERATIONS
• DEFINED BY:
• RESIDUAL BONE HEIGHT OF LEAST VERTICAL HEIGHT OF THE MANDIBLE
• CLASS I, II, AND III MAXILLOMANDIBULAR RELATIONSHIPS
• RESIDUAL RIDGE OFFERS NO RESISTANCE TO HORIZONTAL OR VERTICAL MOVEMENT
• LOCATION OF MUSCLE ATTACHMENTS WITH SIGNIFICANT INFLUENCE ON DENTURE-BASE STABILITY AND
RETENTION

53. DISCREPANCIES IN JAW SIZE
• PATIENT WITH PROGNATHISM FREQUENTLY PLACES CONSIDERABLE STRESS AND UNFAVORABLE
LEVERAGES ON THE MAXILLARY BASAL SEAT UNDER A COMPLETE DENTURE
• MANDIBULAR OSTEOTOMY IN VERY CAREFULLY SELECTED CASES CAN CREATE A MORE FAVORABLE ARCH
ALIGNMENT AND ALSO IMPROVE THE APPEARANCE

54. REPLACEMENT OF TOOTH ROOTS WITH OSSEOINTEGRATED DENTAL
IMPLANTS
• DISSATISFACTION WITH TOOTH LOSS AND THE PROSTHESES USED TO
MANAGE EDENTULISM IS AS OLD AS DENTISTRY
• IMPLANT APPROACH IS FAR MORE PRACTICAL
• OUTCOME IS DETERMINED BY HOST BONE SITE AND ESTHETIC
CONSIDERATIONS AND ABOVE ALL A PROSTHODONTICALLY DRIVEN TEAM
APPROACH

55. THANK YOU