Diagnosis and Treatment Planning for Cr/Co RPD PDF

Diagnosis and treatment planning for Cr/Co RPD lec3 Patient interview The interview, an opportunity to develop connection with the patient, involves listening to and understanding the patient’s chief complaint or concern about his or her oral health. The chief complaint is referred to th...

Diagnosis and treatment planning for Cr/Co RPD lec3 Patient interview The interview, an opportunity to develop connection with the patient, involves listening to and understanding the patient’s chief complaint or concern about his or her oral health. The chief complaint is referred to the illness as described by the patient word. This can include clinical symptoms of pain, difficulty with function, concern about appearance, problems with an existing prosthesis, or any combination of symptoms related to the teeth, periodontium, jaws, or previous dental treatment. The patient interview (and clinical examination) should follow a sequence that includes: 1. Chief complaint and its history 2. Medical history review 3. Dental history review, especially related to previous prosthetic experience(s) 4. Patient expectations After the previous point being discussed, the time come to make a decision for the most appropriate type of prosthodontics treatment and this must be done in company with the patient by using a communication model termed (shared decision making) The objectives of prosthodontic treatment 1. The best method of restoring the lost function within the limits of tissue tolerance of the patient. 2.Maintain or improve on the appearance of the mouth. As the first objective is satisfied, so the 2nd requirement is comfort in an esthetically pleasing manner. ( esthetically pleasing restoration ) 3.The preservation and maintenance of the health of the remaining teeth and oral tissues (which will enhance the removable partial denture design). Oral examination It should include visual and digital examinations of teeth and surrounding structure with mouth mirror, periodontal probe and tweezers. Sequence of oral examination 1) Reliefs of pain discomfort and caries lesion by placements of temporary fillings 2) A thorough and complete oral prophylaxis.best doing prophylaxis to obtain:- Teeth free from accumulation of calculus and debris. Accurate diagnostic cast of dental arch can be done 3) Complete intraoral radiograph a. To locate areas of infection and other pathosis that may be present. b. To reveal the presence of root fragments, foreign objects, bone spicules, and irregular ridge formations. c.to reveal the presence and extent of caries d.to permit evaluation of existing restorations e.to reveal the presence of root canal fillings and to permit their evaluation as to future prognosis f. to permit an evaluation of periodontal conditions g. to evaluate the alveolar support of abutment teeth 4) Impression for making accurate diagnostic cast to be mounted for occlusal examination, mounting preferably on semiadjastable articulator. 5) Examination of teeth and residual ridge by instrument and visual means Visual examination will reveal many of the:- 1. signs of dental disease consideration of caries susceptibility is of primary importance, the number of restored teeth present ,signs of recurrent caries. 2. examination of periodontal disease, gingival inflammation, the degree of gingival recession, and mucogingival relationships should be observed 3. The number of teeth remaining, the location of the edentulous areas, and the quality of the residual ridge will have a definite bearing on the proportionate amount of support that the partial denture will receive from the teeth and the edentulous ridges. 4.Tissue contours may appear to present a well- formed edentulous residual ridge, however, palpation often indicates that supporting bone has been resorbed and has been replaced by displaceable, fibrous connective tissue. Such a situation is common in maxillary tuberosity regions. The removable partial denture cannot be supported adequately by tissues that are easily displaced. In preparing the mouth this tissue should be recontoured or removed surgically A small but stable residual ridge is preferable to a larger unstable ridge for providing support for the denture. 5. The presence of tori or other bony exostoses must be detected and an evaluation of their presence in relation to framework design must be made. 6.During the examination, not only each arch but also its occlusal relationship with the opposing arch must be considered separately. A situation that looks simple when the teeth are apart may be complicated when the teeth are in occlusion. For example, an extreme vertical overlap may complicate the attachment of anterior teeth to a maxillary denture. Extrusion of a tooth or teeth into an opposing edentulous area may complicate the replacement of teeth in the edentulous area or may create occlusal interference which will complicate the location and design of clasp retainers and occlusal rests. Such findings subsequently will be evaluated further by careful analysis of mounted diagnostic casts. 7.Determination of height of the floor of the mouth to locate inferior borders of lingual mandibular major connectors. Two methods used in determining the of the floor of the mouth Direct method Indirect method  Interpretation of Examination Data 1) Roentgenographic interpretation ❖ The aspects of such interpretation that are the most pertinent to partial denture construction are those relative to the prognosis of remaining teeth that may be used as abutments. The quality of the alveolar support of an abutment tooth is of primary importance because the tooth will have to withstand greater stress loads when supporting a dental prosthesis. Abutment teeth adjacent to distal extension bases are subjected not only to vertical and horizontal forces but to torque as well because of the movement of the tissue supported base. 2) Value of interpreting bone density Its importance to the dentist when evaluating the quality and quantity of the alveolar bone are the height and the quality of the remaining bone structure Roentgenographic findings should serve the dentist as an adjunct to clinical observations. Therefore roentgenographic findings should always be confirmed by clinical examination. Root morphology The morphologic characteristics of the roots determine to a great extent the ability of prospective abutment teeth to resist successfully additional rotational forces that may be placed on them. Teeth with multiple and divergent roots will resist stresses better than teeth with fused and conical roots, because the resultant forces are distributed through a greater number of periodontal fibers to a larger amount of supporting bone  Periodontal considerations An assessment of the periodontium in general and abutment teeth in particular must be made before prosthetic restoration. One must evaluate: ► the condition of the gingiva ► adequate zones of attached gingiva ► the presence or absence of pockets. ► The condition of the supporting bone ► mobility patterns recorded.. ► If mucogingival involvements, osseous defects, or mobility patterns are recorded, the causes and potential treatment must be determined. ► Qral hygiene habits of the patient must be determined, and efforts made to educate the patient relative to plaque control Indications for RPD There are several specific indications for the use of removable partial denture :- 1) The most common situations are partial edentulous space Cl I and Cl II which have an edentulous space on the opposite side of the arch is often conveniently present to aid in the required retention and stabilization of the partial denture. 2) The replacement of teeth recent extraction cannot be accomplished satisfactory with fixed restoration. 3) Along span may be totally tooth supported if the abutments and the means of transferring the support to the denture are adequate and if the denture framework is rigid. 4) Need for bilateral stabilization 5) The removable partial denture may act as a periodontal splint through its effective cross arch stabilization of teeth weakened by periodontal disease. 6) Excessive loss of residual bone 7) Economic considerations Differential diagnosis for fixd or removable partial denture replacement of missing teeth by means of partial denture either tooth or implant supported is generally the method of choice The choice of treatment must meet the economic limitations and personal desires of the patient. unilateral RPD places excessive stresses on abutment teeth the risk for aspiration is significant if such prosthesis dislodge during use.For these reasons, the use of unilateral RPD is strongly discouraged. Types of RPD base material 1) Gold alloy 2) Chromium cobalt alloy 3) Titanium