Diagnosis in Fixed Prosthodontics

Diagnosis Related to Fixed Prosthodontics

• Diagnosis is a comprehensive process of collecting data and information.
• The aim is to establish a treatment plan.
• The process involves various elements, including:
  • History (medical and dental)
  • Temporomandibular joint (TMJ), occlusal evaluation, and muscles of mastication
  • Intra-oral examination
  • Diagnostic cast analysis
  • Full mouth radiographic evaluation

Medical History

• Gather comprehensive medical information using a questionnaire.
• Identify potential risks or complications.
• Determine appropriate treatment modifications.

Frequently Occurring Conditions

• Allergic reactions
• Hypertension and coronary heart diseases
• Patients on anticoagulants
• Rheumatic fever
• Diabetes
• Epilepsy
• Infectious diseases

Dental History

• Focus on the patient's chief complaint.
• Assess previous dental treatments and patient's attitude towards treatment.
• Understand the patient's expectations.

Patient Chief Complaint

• Understand the patient's pain, discomfort, or functional issues, including:
  • Pain, sensitivity, swelling
  • Difficulty in speech or mastication
  • Bad odor or taste
  • Appearance or aesthetics

Previous Treatments and Patient Attitude

• Gauge the patient's dental awareness and cooperation.

Patient's Expectations for Treatment

• Focus on the patient's esthetic desires.

TMJ, Occlusal Evaluation, and Muscles of Mastication

• Evaluate the TMJ for any evidence of pain, clicking, crepitation, or limited movement.
• Assess muscle pain associated with parafunctional activities (bruxism) and faulty occlusion.

TMJ Evaluation

• Ensure the TMJ is healthy with no signs of clicking, crepitation, or restricted movement.
• Average maximum opening is 50mm, with less than 40mm considered limited.
• Inquire about previous treatments for joint dysfunction.

Muscles of Mastication

• Muscle pain is often linked to parafunctional jaw activity like clenching or bruxism.
• Daily clenching contributes to muscle spasm.

Occlusal Evaluation

• Evaluate wear facets, premature contacts, cuspal interference, and sliding in eccentric movements.
• Assess anterior guidance.

Intra-Oral Examination

• Perform a systematic evaluation covering:
  • Oral hygiene
  • Amount and areas of plaque and calculus
  • Caries index
  • Abnormal habits (pipe, smoker, pencil biting, bruxism)
  • Edentulous ridge, including size and relationship of spans
  • Occlusal evaluation.

Edentulous Ridge

• Record the dimensions and relationship of edentulous spans.
• Examine the form, texture, and color of the ridge mucosa.
• Analyze the dimensions of the edentulous span, critical for treatment planning.

Occlusion

• Examine wear facets (localized or widespread).
• Identify any premature contacts.
• Assess cuspal interference in eccentric movements.
• Determine the amount of slide between detruded and maximum intercuspation position.
• Evaluate the existence and amount of anterior guidance.

Prospective Abutment Examination

• Conduct in conjunction with radiographs.
• Evaluate:
  • Carious lesions
  • Pulp vitality
  • Mobility
  • Periodontal condition
  • Axial inclination
  • Coronal defects (color, attrition, crown morphology, rotation, overlapping)
  • Supra and infra eruption.

Diagnostic Cast Analysis

• Criteria for good diagnostic cast:
  • Accurate reproduction of both arches
  • No bubbles or nodules on the occlusal surface
  • Mounted in centric occlusion on a semi-adjustable articulator using a facebow and wax record.
• Diagnostic casts reveal:
  • Distribution and dimensions of edentulous spans.
  • Bite type and occlusal prematurities.
  • Occlusal discrepancies and the need for establishing a new occlusal plane.
  • Changes in teeth axial inclination for common path of insertion.
  • Abutment teeth form, size, and malposition.
  • Suitable bridge design.
  • Trial tooth preparation and waxing before treatment.

Radiographic Examination

• An integral part of diagnosis, providing information that helps correlate all collected data.
• Includes intraoral films (periodical x-rays, bitewings), digital x-rays, and extraoral imaging.

Intra-oral Radiographic Evaluation

• Used to evaluate:
  • Teeth and their investing structures
  • Edentulous areas
  • Remote areas

Radiographic Examination of the Teeth and Investing Structures

• Examine:
  • Coronal, pulp, and root portion of the teeth
  • Crown-root ratio
  • Root configuration

Periodontal Surface Area

• Ante's Law: The sum of periodontal membrane surface area of abutment teeth should be equal or larger than the teeth to be replaced.

Extra-oral Imaging

• Panoramic x-ray
• Cephalometric x-ray
• Cone beam computed tomography (CBCT)
• MRI scan

Panoramic X-ray

• Provides a wide view of the jaws and teeth.

Cephalometric X-ray

• Captures the profile of the skull and teeth for orthodontic and surgical planning.

Cone Beam Computed Tomography (CBCT)

• Provides detailed three-dimensional images of the dental structures for implant planning and diagnosis.

MRI Scan

• Provides detailed images of soft tissues and structures.