Prosthodontics Patient Interview and Treatment

Patient Interview

• A significant part of the patient's experience, allowing for a personal connection and understanding of the issue.
• Interview should include:
  • Chief complaint
  • Medical history review
  • Dental history review, with attention to previous prosthetic experiences
  • Discussion of Patient expectations

Shared Decision Making

• The patient and the clinician should collaborate to decide the most appropriate prosthodontic treatment.

Objectives of Prosthodontic Treatment

• Restore lost function within the patient's tissue tolerance.
• Maintain or improve the appearance of the mouth.
• Preserve and maintain the health of the remaining teeth and oral tissues

Oral Examination

• Visual and digital examination of teeth and surrounding structures.
• Sequence of oral examination:
  • Relief of pain, discomfort, and caries lesions with temporary fillings.
  • Thorough and complete oral prophylaxis for a clean surface and accurate diagnostic casts.
  • Complete intraoral radiographs to:
    • Locate areas of infection or other disease processes.
    • Reveal root fragments, foreign objects, bone spicules, and irregular ridge formations.
    • Reveal the presence and extent of caries.
    • Permit evaluation of existing restorations.
    • Reveal the presence of root canal fillings and evaluate their future prognosis.
    • Permit an evaluation of periodontal conditions.
    • Evaluate the alveolar support of abutment teeth.
  • Impression for accurate diagnostic casts to be mounted for occlusal examination on a semi-adjustable articulator.
  • Examination of teeth and the residual ridge using instruments and visual means.
  • Consider the overall health of the periodontium and abutment teeth:
    • Condition of the gingiva.
    • Adequate zones of attached gingiva.
    • Presence or absence of pockets.
    • Condition of the supporting bone.
    • Mobility patterns.
    • Evaluate and address mucogingival involvements, osseous defects, and mobility patterns.
    • Evaluate and educate the patient regarding their oral hygiene habits.

Interpretation of Examination Data:

• Roentgenographic interpretation:
  • Focus on prognosis of remaining teeth that may be used as abutments.
  • Evaluate the quality of alveolar support for abutment teeth.
• Value of interpreting bone density:
  • Evaluate the quality and quantity of alveolar bone: height and remaining bone structure.
  • Roentgenographic findings should be confirmed by clinical examination.
• Root morphology:
  • Evaluate the ability of abutment teeth to resist rotational forces.
  • Teeth with multiple and divergent roots are more resistant to stress loads.

Indications for RPD

• Partial edentulous spaces, particularly Class I and Class II that have an edentulous space on the opposite side of the arch for retention and stabilization.
• Replacement of teeth after recent extractions when fixed restorations are not appropriate.
• Long spans that can be totally tooth-supported with adequate abutments and framework rigidity.
• Bilateral stabilization.
• Periodontal splinting for teeth weakened by periodontal disease.
• Excessive loss of residual bone.
• Economic considerations.

Differential Diagnosis for Fixed or Removable Partial Denture:

• Removable partial denture is generally the preferred method for replacing missing teeth, either tooth or implant supported.
• The choice should consider the patient's economic limitations and personal desires.
• Unilateral RPD should be discouraged as it places excessive stress on abutment teeth and has a risk of aspiration if dislodged.

Types of RPD Base Material

• Gold alloy
• Chromium cobalt alloy
• Titanium