BDS8227 Clinical Partial Prosthodontics Patient Assessment 2023 PDF

BDS8227 Clinical partial prosthodontics: Patient assessment Date :2023 Consequences of Partial Edentulism • • • • Loss of mesial and distal contacts Overeruption Mesial drifting Unfavorable loading of remaining teeth leading to more periodontal problems • Teeth move out of arch symmetry • • •...

BDS8227 Clinical partial prosthodontics: Patient assessment Date :2023 Consequences of Partial Edentulism • • • • Loss of mesial and distal contacts Overeruption Mesial drifting Unfavorable loading of remaining teeth leading to more periodontal problems • Teeth move out of arch symmetry • • • • Disruption of the occlusal plane Wear and loss of VDO Numerous spaces between teeth Unfavorable tooth contour for retention and support Diagnosis Treatment plan • Determination of the nature of the disease • The sequence of procedures planned for the treatment of the patient after diagnosis The glossary of prosthodontic terms 8 Patient interview Determining the patient’s desires Clinical examination Determining the patient’s needs Treatment planning Developing a plan and sequenceof treatment after diagnosis Execution of Treatment Executing appropriately sequenced treatment plan and follow-up • Dental treatment should respond to the patient’s desires as perceived by the patient himself as well as their needs as diagnosed by the dentist. Treatment plan that is unique to every patient. Patient Interview 1. Chief Complaint 2. Evaluation of the patient’s psychological status 3. Medical History 4. Dental History 5. Patient Expectations Shared Decision Making Chief Complaint • Patient’s own words • The main reason of the visit Psychological Status • Patient’s psychological status is important for success of treatment House Classification Philosophical Exacting Hysterical Indifferent Medical History A comprehensive medical history including: • Systemic disorders • Chronic conditions (Diabetes, hypertension, osteoporosis, Parkinson’s) • Medications • Diet • Habits Clinical Examination 1. Extraoral Examination • Facial Examination: • Front view • Profile view • TM Examination: • • • • Range of motion clicking Opening tenderness Intraoral Examination 1. 2. 3. 4. 5. Pain relief and temporary restorations Oral prophylaxis Radiographic examination Primary impressions of both arches Clinical examination of teeth and residual ridges Pain relief and Temporary Restorations • Acute pain relief • Caries assessment or arrest • Temporization • Oral prophylaxis Clinical Examination Edentulous Ridge • Ridge contour, width and height • Ridge relation • Undercuts • Overlying mucosa • Frenal attachment • !Interarch space! Floor of Mouth Saliva Teeth • Caries, Existing restorations • Complete periodontal charting • Number, Location • Vitality • Sensitivity to percussion Teeth • Mobility • Evaluation of periodontium • Pocket depth • Furcation involvement • Occlusion • Occlusal plane • Oral hygiene Kennedy Classification of Partially Edentulous Cases I II III IV Applegate’s Rules Residual Ridge • Size and number of edentulous spaces • Quality of soft tissue covering residual ridge • Torus • Visual and digital assessment of quality and quantity of bone Floor of Mouth • Mandibular major connector • Lingual bar : need 10 mm depth Radiographic Examination • Complete intraoral radiographic survey • Infections and other pathologies • Caries extension and approximation to pulp • Existing restorations • Root canal fillings • Periodontal condition: • Periodontal ligament space • Marginal bone level • Lamina dura • Bony spicules, remaining roots Diagnostic Casts • Primary impressions to pour diagnostic casts • • • • • Patient’s records Diagnosis Patient education Reference Custom tray fabrication Diagnostic Mounting • Hand articulation in simple cases • Upper cast by Facebow record • Lower cast by jaw relation record • • • • Occlusal plane Occlusion Interarch space Residual ridge relation Diagnostic Findings • Gathered information in patient interview and clinical examination provides basis for establishing treatment option. • Interpretation of gathered findings • More than one treatment option may be considered. Patient’s financial status, age and expectations are considered. Objectives of Prosthodontic Treatment • Elimination of disease • Preservation and maintenance of remaining structures • Replacement of lost dentition • Restoration of function and esthetics Treatment Options for Partially Edentulous Patients • Implant supported prosthesis • Fixed partial denture • Removable partial denture • Combination of the above • No treatment at all Treatment Options for Partially Edentulous Patients • Removable partial dentures (RPDs) are chosen when • Financial restraints • Patient restraints • Patient desires Prevent the use of fixed partial dentures or implant restorations Fixed or RPDs??? FIXED PD • Distal extension base cases • Excessive bone resorption • Long span edentulous space • Need for cross arch stabilization • After recent extraction • Questionable abutments for fixed restorations • Economic or personal restraints Removable PD • Tooth bounded edentulous saddles • Modification spaces • Minimal bone loss • Abutments with sound periodontal support RPDs or Complete Dentures??? Choice depends on • The condition of remaining dentition and supporting structures • Expected function of each prostheses • Patient desires, psychology and expectations Summary • Diagnosis and treatment planning is a sequential process that involves many factors • The final treatment should be a shared decision depending on patient’s desires as well as needs as evaluated by the dentist through the process of diagnosis. Thank you