diagosis in complete denture bpc colkege.pptx

diagnosis complete denture

1. بسم الله الرحمن الرحيم

2. Diagnosis & Treatment Planning for edentulous patients

3. De VAN (1961) : we should meet the mind of patients before we meet their mouths Boucher ( 1970 ) : the 1 st 5 minutes spent with a patient are the most important

4. Diagnosis - personal history - mental History - medical history - dental history Treatment Planning

5. History Personal history : - Name - address - age - sex - occupation… etc.

6. History Personal history : Name - For the purpose of communication and identification. -Most patients liked to be called by their name, this has a psychological effect as well

7. History Personal history : age The age of patient influences denture success. . Younger patients are expected to develop denture skills and adapt faster than old patients. . Younger patients are more concerned with esthetics.

8. Old patients( geriatric patients ) show diminished hearing Weak vision Reduce or Loss of muscular tone (cause difficulty during jaw relation) decreased salivary flow(cause difficulty during denture construction) Tissue takes longer time to heal Tissues are less resilient and the oral mucosa and submucosa are thinner

9. History Personal history : - sex . Men are usually more busy . Females are more concerned with esthetics . Burning sensation to denture is reported with menopause .

10. History Personal history : - occupation . Public speakers requires a denture that help in phonation “position of anterior teeth, thickness of palate. . Wind instrument players require special modification of the shape and position of the anterior teeth and denture with good retention. . With most professional men, denture retention is much more important than any other property

11. History Mental attitude (Dr. House’s classification) Dr. House’s classified patients into four Psychological type : - Philosophical - Exacting - Indifferent - Hysterical

12. History Philosophical . calm, rational and cooperative . Optimistic, cheerful and self-confident . show best mental attitude and accepts advise . gives the best prognosis . Have ideal attitude for best treatment.

13. History Exacting . like to explain every step “loves details” . Difficult to be pleased “previous dentures history” . Not easy to treat . needs extra care, effort and patience . This pt can be a good pt if he is intelligent and understanding

14. History Indifferent . they are not concerned about their general health or being without teeth . they are very passive and give up easily . Pushed to treatment by their families . show poor prognosis “explain limitations before giving promises”

15. History Hysterical .emotionally unstable . very nervous, excitable, hypersensitive and apprehensive . they need psychiatric skills as their actual problem is systemic “mental” and not local “ edentulism ”

16. History Medical History : - DM, Cardiac Disease, Hypertension, Hormonal disturbance, Infectious diseases, Malignancies, Epilepsy ...

17. History Medical History : - Diabetes . Manifestation * high liability to infection and inflammation * increase bone resorption (may need relining of denture) * ulcerated thin mucosa * xerostomia (decrease salivation)

18. History Medical History : . Management of DM * use atraumatic impression techniques * try to avoid ZOE * the denture teeth should have reduced occlusal table to reduce pressure on denture supporting structures

19. History Medical History : - Cardiac Disease * make short early appointment * use simple techniques - Hypertension . They usually are on diuretics which usually causes dry mouth

20. History Medical History : - Arthritis (infection in TMJ) . Cause sever pain during opening and closing of mouth . Present difficulty during impression making and jaw relation - Infectious diseases . E.g. TB, syphilis, AIDS, HCV… etc . measures of infection control will be enough

21. History Medical History : - Malignancies . Radiotherapy and chemotherapy causes xerostomia . Atraumatic techniques are mandatory

22. History Medical History : - medication It is important to know the side effect of drugs the patient is taking. * Xerostomia ( dry mouth) antihistamines , antihypertensive, antidepressant * change in oral flora broad spectrum antibiotics * nausea and vomiting aspirin

23. History Dental history : - History about teeth loss . History of difficult extractions will need radiographic examination of the jaw. . The reasons of loss of teeth : patients with periodontal disease expect to have rapid bone resorption and frequent relining.

24. History Dental history : - Denture history . Satisfaction with old dentures . No. of previous dentures . Age of last denture . Causes of failure of previous dentures . Why is he requesting the new one ?!!!

25. History Dental history : - Denture history . Problem of old denture can be due to excessive ridge resorption - over extended borders. - reduction of the vertical dimension - repeated midline fracture.

26. Diagnosis history taking - personal history - mental History - medical history - dental history clinical examination - extra-oral examination - intra-oral examination Treatment Planning

27. Extra-Oral Examination Facial examination 1- Examination of Head -Examine head for signs of swelling (symmetrical or asymmetrical) 2- muscle tone Are strong in healthy persons In old age wrinkle and folds appear in face.

28. Extra-Oral Examination Facial form Classification of Frontal Face Forms (House and loop) Examining the facial form helps in teeth selection . General outline of the tooth should confirm to the general outline of the face when viewed from the frontal aspect

29. Extra-Oral Examination 4-Examination of T.M.J . Dislocation history must be considered during different steps of denture construction . Clicking of TMJ may be an indication of irregular occlusal plane or para -functional habit

30. Extra-Oral Examination 5- Examination of the lips: Lip fullness restoration of lip support must be considered during placement of anterior teeth. An existing denture with an excessively thick labial flange could make the lip appear to be too full.

31. Intra- oral examination I-Denture supporting structures: 1- soft tissue 2- bony foundation

32. Denture supporting structures 1- soft tissue A- denture bearing mucosa: Ideal mucosa should be: Firmly bound to the bone Slightly compressible B- border tissue Should be in slightly displaceable tissue Intra- oral examination

33. C- frenum Relieving in the denture should be done by providing v- notch

34. Intra- oral examination D- abnormal soft tissues Any variation on colour is due to inflammation of mucosa Inflammation may be due to( old denture, asprin ,fungal infection)

35. 2- bony foundation a-Arch Form and size After extraction of tooth the bone exposed to resorption so the shape of ridge will change to 40 Class I Square Class II Tapering Class III Ovoid Intra- oral examination Denture supporting structures

36. b-Form & shape of ridge: Favrable ridge form: - Square shape ridge . Parallel sides . Best support and resistance to lateral forces

37. Unfavorable ridge form knife edge . Give less support . Selective impression technique is required . Alveolo-plasty

38. - flat ridge . Less support and lateral stability . Selective pressure impression . Augmentation - Ridge with undercut area Present diffeculty during different steps of denture construction Should be relieved or surgically removed

39. Intra- oral examination(visual examination) c- Ridge relationship

40. d- inter- ridge space: Insufficient space is usually present in maxillary tuberosity and retromolar pad area It affect retention and stability of denture Problem with setting of teeth

41. Intra- oral examination(visual examination) E-Shape of hard palate and vault The shape of palate affect stability of denture U-shaped palatal vault; best retention & lateral stability. V-shaped vault : less retention . Flat palatal vault: also unfavourable cause displacement of denture by horizontal force ( poor retention).

42. Intra- oral examination 2- Soft Palate: Classified according to it is curvatures into: Class I: soft palate with gentle curveture . Most favourable condition as it allows for more tissue coverage for posterior palatal seal(post dam ).

43. Intra- oral examination(visual examination) Soft Palate: Class II: Turns downward forming a 45o angle to hard palate(medium curvature). Medium width for post dam. Class III: Turns downward sharply at 70o angle just posterior to hard palate. Least favourable soft tissue form(allow narrow post dam)

44. 3-Tongue size and position If patient has been without teeth for a long time: tongue becomes enlarged & powerful. This will create a problem in impression making & may contribute to denture instability. Tongue position is very important to the prognosis of the mandibular denture.

45. 4- depth of the sulcus Shallow sulci need special impression technique.

46. Intra- oral examination 5- Salivary flow Thin saliva : provides an insufficient film for denture retention. Thick mucous saliva interferes with accuracy of impression and increase gage reflex. It will push out denture by accumulating beneath the denture. -Mixture of both Thin serous & Thick mucous saliva is the best to work with. Xerostomia reduces denture retention

47. Intra- oral examination 6- Interfering factors Exostosis & tori - surgical correction is the best solution BUT - relief may be the treatment option if the tori is small Prominent anatomical landmarks - e.g. median palatine raphe - they may require relief

48. Intra- oral examination(digital examination) Any area which is painful to the pressure of soft finger must be found firmness of ridge The normal firm ridge is composed of bone covered with thin layer mucosa flappy ridge such ridges are soft and mobile. they should be treated “ surgicaly ” before the denture construction

49. Intra- oral examination(digital examination) irregularities of the alveolar ridges Alveolar ridge is never uniform It may show sharp edge, nodules Surgical correction is needed or relief of denture

50. Intra- oral examination Maxillary tuberosity Provide retention to denture the denture should completely covered with them but can present problems if it is enlarged and undercut. no enough space to set all molars An undercut maxillary tuberosity can make denture removal and insertion difficult and painful.

51. Panomaric radiograph should be done to detect the following : Amount of ridge resorption Screening of Jaws to check for retained root fragment, unerupted teeth. Panoramic Radiograph

52. TREATMENT PLANNING Treatment plan include pre-prosthetics care Prosthodontics care

53. TREATMENT PLANNING Treatment plan include pre-prosthetics care Elimination of infection Elimination of pathology Pre-prosthetic surgery Tissue conditioning

54. PROSTHODONTIC CARE Complete denture implant (fixed). Implant ( overdenture ) 59