Case history, diagnosis and treatment planning.pptx

The success of complete denture depends on physical and mental factors of the patient
The use of a case history ensures that all the factors have been examined and helps in better diagnosis and treatment planning

1. Case history, diagnosis and treatment planning in complete denture patients Prepared by: Dr . Sujana U READER Department of Prosthodontics Sree Anjaneya Institute Of Dental sciences

2. Introduction The success of complete denture depends on physical and mental factors of the patient The use of a case history ensures that all the factors have been examined and helps in better diagnosis and treatment planning Sharry JJ. Complete denture prosthodontics. McGraw-Hill Companies; 1974 May 1 2

3. Diagnosis It is the examination of the physical state, evaluation of the mental or psychological makeup, and understanding the needs of each patient to ensure a predictable result. (Winkler) Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. 3

4. Patient evaluation Baseheart JR. Non-verbal communication in the dentist-patient relationship. J Prosthet Dent. 1975;34:4-10 4

5. Gait Physiotherapy Clinic   List Of Abnormal Gait: Physiotherapy Treatment :  March 2, 2019 5

6. Complexion Rahn, A. O., Ivanhoe, J. R., Plummer, K. D., & Heartwell, C. M. (2009). Textbook of complete dentures. Shelton, Conn: People's Medical Publishing House. Pallor Ruddy Bronzed skin Bluish purple colour Yellow pigmentation Pigmentation 6

7. Mental attitude Ashwin R. Mysore; Meena A. Aras (2012). Understanding the psychology of geriatric edentulous patients. , 29(2), 0–0. Gamer S, Tuch R, Garcia LT. M. M. House mental classification revisited: Intersection of particular patient types and particular dentist's needs. J Prosthet Dent. 2003 Mar;89(3):297-302 7

8. Mental attitude Jubhari EH, Rachellea K. 2020. Patient mental attitude: a systematic review. Journal of Dentomaxillofacial Science 5(2): 69-73 8

9. Clinical history taking Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 9

10. Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 10

11. Medical history Arthritis Head and neck cancer Chronic obstructive pulmonary disease Diabetes mellitus Mental health Cardiovascular diseases Hypertension Osteoporosis Parkinson disease Michael, Glick. Burket's Oral Medicine, Twelfth Edition. 12th. Ed USA: PMPH -USA, 2015. 11

12. Occupation Fenn, H. R. B., MacGregor, A. R., & Fenn, H. R. B. (1989). Fenn, Liddelow, and Gimsons' clinical dental prosthetics. London: Wright 12

13. Dental history Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 13

14. Pretreatment records Previous Denture It denotes the dentures, which were worn before the current denture. The reason for the failure of the prosthesis should be enquired with the patient. Basker RM,, Davenport JC, Tomlin HR. Prosthetic Treatment of the Edentulous Patient. 3rd ed. London: MacMillan;1992. 14

15. Clinical examination of the patient Basker RM,, Davenport JC, Tomlin HR. Prosthetic Treatment of the Edentulous Patient. 3rd ed. London: MacMillan;1992. 15

16. Extraoral examination Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 16

17. Facial form Sassouni V. A classification of skeletal facial types. Am J Orthod. 1969;55(2):109-23. House and Loop, Frush and Fisher, and Williams Square Tapering Square tapering Ovoid 17

18. Facial profile Sassouni V. A classification of skeletal facial types. Am J Orthod . 1969;55(2):109-23. According to Angle 18

19. Lower facial height Normal vertical dimension Decreased vertical dimension Increased vertical dimension Sassouni V. A classification of skeletal facial types. Am J Orthod . 1969;55(2):109-23. 19

20. Muscle tone According to House: Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 20

21. Muscle development House classified muscle development as: Class I :Heavy Class II: Medium Class III: Light. Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 21

22. Lip examination Lip support Lip mobility Lip thickness Lip length Health of the lips Zarb GA, Bolender CL, Carlsson GE. Boucher's prosthodontic treatment for edentulous patients. St. Louis: Mosby; 1997 Jan. 22

23. Lip support Adequately supported Unsupported Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 23

24. Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 24

25. Lip thickness Zarb GA, Bolender CL, Carlsson GE. Boucher's prosthodontic treatment for edentulous patients. St. Louis: Mosby; 1997 Jan. 25

26. Lip length Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. Long Normal/Medium Short 26

27. TMJ examination Examination of muscles of mastication Note the range of mandibular opening and any deviation Any joint sounds to be noted Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. 27

28. Neuromuscular examination Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 28

29. Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 29

30. Intraoral examination 30

31. 31 Intraoral examination

32. Condition of the mucosa According to House Class I: Healthy mucosa Class II: Irritated mucosa Class III: Pathologic mucosa. Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 32

33. Thickness of the mucosa Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 33

34. Mucosal displaceability Type 1 : Tissues can be displaced approx. 2 mm, cushion like yet no gross positional displacement Type 2a: Tissue thinner than 2 mm usually unyielding often atrophic, with smooth surface and poor for developing good adhesion Type 2b: Tissue thicker than 2 mm easily displaced, poor stress bearing (usually under ill-fitting dentures) Type 3: Excessively flabby to the degree that surgical excision is needed Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 34

35. Saliva Class 1: Normal quality and quantity of saliva. Cohesive and adhesive properties of saliva are ideal. Class 2: Excessive saliva; contains much mucus. Class 3: Xerostomia; remaining saliva is mucinous . Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 35

36. Residual alveolar ridge 36

37. Arch size Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 37

38. Arch form Class I- Square Class II- Tapering Class III- Ovoid Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 38

39. Ridge contour Maxillary Mandibular Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. Parallel walls from medium to tall with broad crest Short with flat crest 39

40. Ridge relation According to Angle Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 40

41. Ridge parallelism Class I : Both ridges are parallel to the occlusal plane Class II: The mandibular ridge diverts from the occlusal plane anteriorly Class III: Either the maxillary ridge diverts from the occlusal plane anteriorly or both ridges divert from the occlusal plane anteriorly Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 41

42. Inter arch space Class I :Ideal inter-arch space to accommodate the artificial teeth Class II: Excessive inter-arch space Class III : Insufficient inter-arch space to accommodate the artificial teeth Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. 42

43. Hard palate Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. 43

44. Classification of soft palates Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. 44

45. Palatal throat form Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. Class I: Large and normal in form, relatively with an immovable band of tissue 5-12 mm distal to a line drawn across the distal edge of the tuberosities Class II: Medium sized and normal in form, with a relatively immovable resilient band of tissues 3-5 mm Class III: Usually accompanies a small maxilla. The curtain of soft tissue turns down abruptly 3-5 mm anterior to a line drawn across the palate 45

46. Lateral throat form Class 1 Class 2 Class 3 Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 46

47. Kalavathy N, Kumar PR, Gupta S, Sridevi J, Shetty M, Sanketh AK. Lateral throat form re-classified using a customized gauge: A clinical study. J Indian Prosthodont Soc 2016;16:20-5. 47

48. Gag reflex and palatal sensitivity House classified palatal sensitivity as: Class I: Normal Class II: Sensitive Class III: Hypersensitive Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18 M.M. House (1958). The relationship of oral examination to dental diagnosis. , 8(2), 208–219 . 48

49. Undercuts Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. 49

50. Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 50

51. Kalaignan et al., Biomed. & Pharmacol. J, Vol. 11(2), 679-688 (2018) 51

52. Muscle and frenal attachment Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. M.M. House (1958). The relationship of oral examination to dental diagnosis. , 8(2), 208–219. Class 1 : High in the maxilla or low in the mandible with respect to the crest of the ridge. Class 2 : Medium Class 3 : Freni encroach on the crest of the ridge and may interfere with the denture seal. 52

53. Border attachment Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. Costello BJ, Betts NJ, Barber HD, Fonseca RJ. Preprosthetic surgery for the edentulous patients. Dent Clin North Am. 1996 Jan;40(1):19-38. Class 1 : Attachments are high in maxilla or low in mandible with relation to ridge crest (0.5 inches or more between level of attachment and crest of ridge). Class 2 : Attachment height in relation to the crest of the ridge is between 0.25 and 0.50 inches. Class 3 : Attachment height is less than 0.25 inches from the ridge crest 53

54. Tongue House's classification of tongue sizes Wright's classification of tongue positions Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. 54

55. Radiographic examination Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 55

56. Kenneth E. Wical ; Charles C. Swoope (1974). Studies of residual ridge resorption. Part I. Use of panoramic radiographs for evaluation and classification of mandibular resorption. , 32(1), 7–12. 56

57. Atwood Classification (1963) of Residual Ridge Resorption Atwood DA. Reduction of residual ridges: a major oral disease entity. J Prosthet Dent. 1971;26:266-79. Order I Pre-extraction Order II Immediate post-extraction Order III High well rounded Order IV Knife edge Order V Low well rounded Order VI Depressed 57

58. Radiographic Assessment of Bone Quantity and Quality Misch CE, Judy KW. Classification of partially edentulous arches for implant dentistry. Int J Oral Implantol . 1987;4(2):7-13. 58

59. Treatment planning It is the process of matching possible treatment options with patient needs and systematically arranging the treatment in order of priority with a logical or technically necessary sequence. Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 59

60. Prosthodontic diagnostic index Thomas J. McGarry ; Arthur Nimmo ; James F. Skiba ; Robert H. Ahlstrom; Christopher R. Smith; Jack H. Koumjian (1999).  Classification System for Complete Edentulism . , 8(1), 27–39. 60

61. Thomas J. McGarry ; Arthur Nimmo ; James F. Skiba ; Robert H. Ahlstrom; Christopher R. Smith; Jack H. Koumjian (1999).  Classification System for Complete Edentulism . , 8(1), 27–39. 61

62. The Glossary of Prosthodontic Terms: Ninth Edition. J Prosthet Dent. 2017 May;117(5S):e1-e105. 62

63. The Glossary of Prosthodontic Terms: Ninth Edition. J Prosthet Dent. 2017 May;117(5S):e1-e105 . 63

64. Steps in treatment planning Tissue conditioning (finger massage, soft reline) Pre-prosthetic surgery (if any) Articulator (no, manufacturer, control settings) Type of occlusion Tooth selection Denture base materials Denture base shade Anatomic palate Characterization Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. 64

65. CONCLUSION Intelligent, effective treatment will meet the specific needs of the individual patient In order to meet these needs, first they must be identified Sharry JJ. Complete denture prosthodontics. McGraw-Hill Companies; 1974 May 1 65

66. References Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for complete-denture therapy. Dent Clin North Am. 1996 Jan;40(1):1-18. Ashwin R. Mysore; Meena A. Aras (2012). Understanding the psychology of geriatric edentulous patients. , 29(2), 0–0. Gamer S, Tuch R, Garcia LT. M. M. House mental classification revisited: Intersection of particular patient types and particular dentist's needs. J Prosthet Dent. 2003 Mar;89(3):297-302 Jubhari EH, Rachellea K. 2020. Patient mental attitude: a systematic review. Journal of Dentomaxillofacial Science 5(2): 69-73 Fenn HR, McGregor AR. Fenn , Liddelow F and Gimson’s Clinical Dental Prosthetics. 66

67. References McCord, A. A. Grant, ”Identification of complete denture problems: a summary” British Dental Journal 2000; 189: 128–134 Sharry JJ. Complete denture prosthodontics. McGraw-Hill Companies; 1974 May 1 Zarb GA, Bolender CL, Carlsson GE. Boucher's prosthodontic treatment for edentulous patients. St. Louis: Mosby; 1997 Jan. Kenneth E. Wical ; Charles C. Swoope (1974). Studies of residual ridge resorption. Part I. Use of panoramic radiographs for evaluation and classification of mandibular resorption. , 32(1), 7–12. Atwood DA. Reduction of residual ridges: a major oral disease entity. J Prosthet Dent. 1971;26:266-79. The Glossary of Prosthodontic Terms: Ninth Edition. J Prosthet Dent. 2017 May;117(5S):e1-e105.

68. Cross references Goyal S, Kansal G. Complete dentures in cancer patients undergoing radiotherapy treatment. Int Dent Med J Adv Res 2015;1:1-3. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Rahn, A. O., Ivanhoe, J. R., Plummer, K. D., & Heartwell, C. M. (2009). Textbook of complete dentures. Shelton, Conn: People's Medical Publishing House. Michael, Glick. Burket's Oral Medicine, Twelfth Edition. 12th. Ed USA: PMPH -USA, 2015. 68

69. Cross references M.M. House (1958). The relationship of oral examination to dental diagnosis. , 8(2), 208–219. Kalavathy N, Kumar PR, Gupta S, Sridevi J, Shetty M, Sanketh AK. Lateral throat form re-classified using a customized gauge: A clinical study. J Indian Prosthodont Soc 2016;16:20-5. Kalaignan et al. Determination of Grading for Maxillary and Mandibular Tori- an in Vivo study Biomed. & Pharmacol . J, Vol. 11(2), 679-688 (2018) Costello BJ, Betts NJ, Barber HD, Fonseca RJ. Preprosthetic surgery for the edentulous patients. Dent Clin North Am. 1996 Jan;40(1):19-38. Thomas J. McGarry ; Arthur Nimmo ; James F. Skiba ; Robert H. Ahlstrom; Christopher R. Smith; Jack H. Koumjian (1999). Classification System for Complete Edentulism . , 8(1), 27–39.