Diagnosis and Treatment Planning In Removable Partial Dentures.pptx

The purpose of dental treatment is to respond to a patient’s needs, both the needs perceived by the patient and those demonstrated through a clinical examination and patient interview. Although similarities have been noted between partially edentulous patients (such as Classification designations), significant differences exist, making each patient, and the ultimate treatment, unique.

The delineation of each patient’s uniqueness occurs through the patient interview and diagnostic clinical examination process. This includes four distinct processes: (1) understanding the patient’s desires or chief concerns/complaints regarding his or her condition (including its history) through a systematic interview process, (2) ascertaining the patient’s dental needs through a diagnostic clinical examination, (3) developing a treatment plan that reflects the best management of desires and needs (with influences unique to the medical condition or oral environment), and (4) executing appropriately sequenced treatment with planned follow-up. The ultimate treatment is individualized to address disease management and the coordinated restorative and prosthetic needs that are unique to the patient. Provision of the best care for a patient may involve no treatment, limited treatment, or extensive treatment, and the dentist must be prepared to help patients decide the best treatment option given his or her individual circumstances.

1. Diagnosis and Treatment Planning In Removable Partial Dentures Dr. Abhidha Tripathi

2. Contents Introduction Diagnosis Patient interview and history taking Initial examination Diagnostic impressions and casts Jaw relations and mounting of the casts Radiographic interpretation Definitive oral examination Treatment planning Conclusion

3. Removable Partial Denture Prosthesis Any prosthesis that replaces some teeth in a partially dentate arch. It can be removed from the mouth and replaced at will also called partial removable dental prosthesis. A tooth supported RPD A tooth and tissue supported RPD

4. Introduction The purpose of dental treatment is to respond to a patient’s needs, both the needs perceived by the patient and those demonstrated through a clinical examination and patient interview. The delineation of each patient’s uniqueness occurs through the patient interview and diagnostic clinical examination process which includes Understanding the patient’s desires or chief concerns/complaints regarding his or her condition (including its history) through a systematic interview process

5. 2. Ascertaining the patient’s dental needs through a diagnostic clinical examination 3. Developing a treatment plan that reflects the best management of desires and needs 4. Executing appropriately sequenced treatment with planned follow-up.

6. THE ULTIMATE GOAL PROVISION OF BEST CARE NO TREATMENT LIMITED TREATMENT EXTENSIVE TREATMENT

7. DIAGNOSIS The determination of the nature of a disease. - GPT 9 TREATMENT PLANNING The sequence of procedures planned for the treatment of a patient after diagnosis. -GPT 9

8. The dentist should follow a sequence that includes: Chief complaint and its history a. Correction of an abnormality b. Maintenance of optimum oral health 2. Medical history review 3. Dental history review 4. Patient expectation Patient Interview and History Taking

9. Evaluation of patient’s psychological status Personal and psychological factors are significant for the success of prosthodontic treatment House Classification (1950) Philosophical Exacting Hysterical Indifferent House Classification Revised Ideal Submitter Reluctant Indifferent Resistant

10. Clinical Examination Objectives Of Prosthodontic Treatment Elimination of disease Preservation restoration and maintenance of remaining teeth and oral tissues Selective replacement of lost teeth for the purpose of restoration of function Treatment plan should be formulated first Should precede all but emergency treatment

11. Initial Assessment And Emergency Treatment Diagnostic Casts Overall Evaluation And Assessment of Force Factors Design the Prosthesis Detailed Charting of Oral Conditions and Proposed Treatment Plan Execution Ina Planned Sequence Follow Up

12. Clinical Examination Process of clinical examination involves two stages Medical Examination Oral Examination A comprehensive medical history includes: Systemic disorders Medication history Diet Habits

13. Diabetes Mellitus Multiple small oral abscesses and poor tissue tone Decreased resistance to infection Reduced salivary output Discomfort while wearing prosthesis Increased occurrence of caries Cardiovascular Disease Physician should be consulted Antihypertensive drugs are associated with xerostomia, gingival hyperplasia and lichenoid reactions All these can complicate restorative care and require careful mangement

14. Arthritis Arthritic changes in TMJ may produce change in occlusion Difficulty in determining and recording jaw relations Paget’s Diseases, Acromegaly Paget’s disease- enlargement of maxillary tubersities Acromegaly- enlargement of mandible Change in fit and occlusion of the prosthesis Requires frequent replacement of prosthesis Candida associated lesion Site- usually under CD and RPD Appearance- patchy distribution often associated with speckled curd like white lesion

15. Oral Examination An oral examination should be accomplished in the following sequence Visual examination, pain relief and temporary restorations radiographs, oral prophylaxis, evaluation of teeth and periodontium, vitality tests of individual teeth, determination of the floor of the mouth position, and impressions of each arch.

16. Diagnostic Casts A diagnostic cast should be an accurate reproduction of all the potential features that aid diagnosis. These include the teeth locations, contours, and occlusal plane relation ship; the residual ridge contour, size, and mucosal consistency; and the oral anatomy delineating the prosthesis extensions . A diagnostic cast is usually made of dental stone because of its strength and the fact that it is less easily abraded than is dental plaster. The impression for the diagnostic cast is usually made with an irreversible hydrocolloid (alginate) in a stock (perforated or rim lock) impression tray

17. Purpose of Diagnostic Casts Diagnostic casts are used to supplement the oral examination by permitting a view of the occlusion from the lingual, as well as from the buccal aspect.

18. Purpose of Diagnostic Casts Diagnostic casts are used to permit a topographic survey of the dental arch that is to be restored by means of a removable partial denture. The principal considerations is to deter mine the need for mouth preparation: (a) proximal tooth surfaces, which can be made parallel to serve as guiding planes; (b) retentive and nonretentive areas of the abutment teeth; (c) areas of interference with placement and removal; and (d) esthetic effects of the selected path of insertion.

19. Purpose of Diagnostic Casts To permit a logical and comprehensive presentation to the patient of present and future restorative needs, as well as of the hazards of future neglect. To fabricate individual impression trays may be fabricated on the di agnostic casts

20. Diagnostic Findings The information gathered in the patient interview and clinical examination provides the basis for establishing whether treat ment is indicated, and if so, what specific treatment should be considered A patient complaint regarding the prosthesis needs to be confirmed through evaluation which includes concern about a symptom that can be related to support, stability, retention, and/or appearance.

21. Interpretation of Examination Data Disease management takes into account findings from the radiographic examination, periodontal disease and caries assessments, and pathology requiring endodontic considerations.

22. Radiographic Interpretation Complete intraoral radiographic survey of remaining teeth and adjacent edentulous areas reveals much more information vital to effective diagnosis and treatment planning. It allows diagnosis of bone lesions associated with both the jaws and the teeth. The implications for tooth stability and ridge support are important to factor into prosthesis prognosis.

23. Tooth Support Bilateral stabilization against horizontal forces is one of the attributes of a properly designed tooth-supported rpd Abutment teeth adjacent to distal extension bases are subjected not only to vertical and horizontal forces but to torque as well because of movement of the tissue supported base.

24. Index areas are those areas of alveolar support that disclose the reaction of bone to additional stress. Teeth that have been subjected to abnormal loading because of the loss of adjacent teeth or that have withstood tipping forces in addition to occlusal loading Index Areas The canine has provided support for the distal extension There has obviously been positive bone response (arrow) to increased stress generated by the removable partial denture. The mandibular first premolar has provided support for the distal extension denture for 3 years. Bone response (arrow) to past additional stress has been unfavorable

25. Alveolar Lamina Dura During the active tipping process, the lamina dura is uneven, with evidence of both pressure and tension on the same side of the root. . The reaction of bone adjacent to teeth that have been subjected to abnormal stress serves as an indication of probable reactions of that bone when such teeth are used as abutments for fixed or removable restorations. Such areas are called index areas.

26. Root Morphology Multiple and divergent roots are favorable as they resist stresses better and the forces are distributed through a greater number of PDL fibres The prognosis for abutment service is more favorable for a molar with divergent roots (shaded) than for the same tooth if its roots were fused and conical

27. Prosthodontic Diagnostic Index (PDI) Based on diagnostic findings, The American College of Prosthodontists (ACP) has developed a classification system for partial edentulism Criteria 1: Location and extent of the edentulous area Criteria 2: Abutment conditions Criteria 3: Occlusion Criteria 4: Residual ridge

28. Treatment Planning Short Modification Spaces < OR = 3 Missing teeth natural tooth and implant supported fixed prostheses as well as removable partial dentures can generally be considered. Implant placement requires the decision that ample bone volume exists Advantage of not requiring the use of teeth for support, stability, and retention requirements, and consequently do not increase the functional burden on the natural dentition

29. 2. Longer Modification Spaces >4 Missing teeth treatment options include the rpd and the implant-supported prosthesis. An implant prosthesis has the same bone volume requirements and will likely require additional implants for an increased span this can significantly increase the cost difference between treatment options.

30. 3. Distal Extension Spaces without tooth support at the end of the missing teeth treatment options include the rpd and the implant-supported prosthesis. 4. Endodontic Treatment Because tooth support helps control prosthesis movement, the need for endodontic treatment should include assessment of overdenture abutments for removable partial dentures, especially to control movement of distal extensions.

31. Indication for Removable Partial Denture Distal Extension Spaces After recent Extractions Long span Edentulism Need for cross arch stabilisation Excessive ridge resorbtion Abutments with Guarded Prognoses Economic Considerations

32. CLINICAL FACTORS RELATED TO METAL ALLOYS USED FOR REMOVABLE PARTIAL DENTURE FRAMEWORKS All cast frameworks for removable partial dentures are made from a chromium-cobalt (Cr-Co) alloy due to their low density (weight), high modulus of elasticity (stiffness), low material cost, and resistance to tarnish

33. Gold frameworks for removable partial dentures are more prone to produce uncomfortable galvanic shock to abutment teeth restored with silver amalgam than are frameworks made of chromium-cobalt alloy

34. PEEK Framework Commercially pure Titanium and Titanium alloys

35. Conclusion The diagnosis and treatment planning for removable partial denture is a sequential methodological process. The responsibility of decision still rests with the dentist, who must evaluate all factors in relation to the desired results The dentist must weigh the problems involved, compare and evaluate the characterstics of different potential materials, and then make a decision that leafd to the greates possible service to the patient.

36. References Stewart,Rudd,Kuebker;Clinical removable partial prosthodontics.2nd edition.AIPDP.2000. Glen P. McGivney,Alan B. Carr: McCracken”’s Removable partial prosthodontics.10th edition.Mosby co.2002. O.C.Applegate:Essentials of removable partial denture prothesis.2nd edition.W.B.Saunders co.