Preparation of patient for Complete denture

in detail explanation on preparation of patient

1. PREPARATION OF PATIENT FOR COMPLETE DENTURE PROSTHESES

2. INTRODUCTION All patients seeking dental services do so with some degree of understanding and experience. The extent of the experience and the validity of the understanding will vary greatly. This diversity must be recognized by the dentist and addressed in the treatment plan and its presentation. Respecting the patient’s uniqueness, the dentist must use the treatment plan as an educational tool to raise the patient’s level of understanding of dentistry and their understanding of how the proposed treatment will meet their individual needs identified through diagnosis. Patient education is an essential element in patient care that should start with the initial contact with the patient.

3. PROCEDURES TO BE CARRIED OUT BEFORE DENTURE TREATMENT: GENERAL INFORMATION CHIEF COMPLAINT AND PATIENT EXPECTATIONS MENTAL ATTITUDE OF THE PATIENT MEDICAL HISTORY DENTAL HISTORY VISUAL AND MANUAL EXAMINATION OF THE MOUTH RADIOGRAPHIC Pre-prosthetic surgery

4. GENERAL INFORMATION : 1 st step for all patients is establishment of their identity. The dentist should address the patient by name and confirm more personal information such as date of birth. Knowledge of patients’ social settings can help the dentist understand patients’ expectations and the evolution of their dental status. An exploration of a patient’s habits will help identify those who might have contributed to their present condition and those who will help ensure success or failure for the treatment to be supplied.

5. PATIENT’S EXPECTATION : Patients’ expectations will be strongly influenced by their denture experiences. Those experiences may be the source of both good and bad habits. Aside from biological compatibility and mechanical precision, success in prosthodontic treatment is largely dependent on matching patient expectations to the treatment provided. Although it is important to strive to raise the quality of care to match the highest of patient expectations, it also is appropriate to lower the patient’s expectations through education about denture wearing.

6. MENTAL ATTITUDE OF THE PATIENT House classified patients as : PHILOSOPHICAL - Best mental attitude. Sensible, calm and composed in difficult situations. EXACTING - May require extreme care, effort and patience on dentist side. Methodical, precise, accurate and at times make severe demands. They like explanation in detail. INDIFFERENT - Questionable or unfavourable prognosis.Apathetic and uninterested and lack motivation.No attention to instructions.Will not cooperate. HYSTERICAL - Emotionally unstable, excitable, excessively apprehensive, and hypertensive.The prognosis is often unfavourable.Demand efficiency and appearance equal to that of natural tooth.

7. DEBILITATING DISEASES(Diabetes , tuberculosis, blood dyscrasias) should be under medical control Require extra instructions in oral hygiene, eating habits, and tissue rest. Advisable to consult a physician and determine the health status before denture construction . MEDICAL HISTORY

8. DISEASES OF THE JOINT(osteoarthritis ) Osteoarthritis of tmj presents a problem in fabrication of complete denture where mandibular movements are difficult. Due to limited mouth opening jaw relation records are difficult to record and repeat. They require subsequent occlusal corrections due to frequent changes in joint.

9. Consultation with patient cardiologist is required. Denture procedures of any nature may be contraindicated. Short appointments with premedication may be required. Pt’s on aspirin(antiplatelet drug), clopidogrel, EACA(epsilon amino caproic acid), tropdigine SHOULD BE PROPERLY EVALUATED.Blood loss will be more in these patient’s so proper care has to be taken before any surgical procedure. CARDIOVASCULAR DISEASES :

10. DISEASES OF THE SKIN : Dermatologic diseases such as pemphigus and lichen planus often have oral manifestations. The oral mucosa- becomes extremely painful. The constant use of dentures is contraindicated and their use is primarily for mental comfort .

11. ORAL MALIGNANCIES The radiation therapist should be consulted and no denture should be fabricated without his approval.

12. DENTAL HEALTH An understanding of the etiology of tooth loss by a patient will help a dentist estimate the patient’s appreciation of dentistry and contribute to the prognosis for prosthodontic success.

13. NUTRITION AND DIET A good nutritional program must be emphasized for each edentulous patient because metabolism and masticatory effieciency has already been compromised.

14. RADIOGRAPHIC EXAMINATION: Radiographs are important aids in the evaluation of submucosal conditions in patients seeking prosthodontic care. Extraoral radiographs can provide a general survey of a patient’s denture foundation and surrounding structures. They can show the amount of bone lost around the remaining teeth and in the edentulous regions . They show the relative thickness of the submucosa covering the bone in edentulous regions, the location of the mandibular canal, and the mental foramina in relation to the basal seat for dentures.

15. LOCAL FACTORS Broad square ridges Definite cuspid eminences and alveolar tubercles Broad buccal shelf and firm retromolar pads A definitive vestibular fornix Frenum attachments A clearly defined and well developed lingual sulcus A lateral throat form A firm mucosal covering Mucous membrane in vestibular fornix and floor of mouth Gradually sloping palate Tongue A normally related maxillae to mandible Good muscle tonus Adequate inter-ridge space Saliva

16. PREPROSTHETIC SURGERY PREPROSTHETIC SURGERY : Surgical procedures designed to facilitate fabrication of a prosthesis or to improve the prognosis of prosthodontic care. (gpt-9) SURGICAL PREPARATION ARE CARRIED OUT UNDER FOLLOWING STEPS; 1. Preoperative examination 2. Initial hard tissue procedures 3. Initial soft tissue procedures 4. Secondary hard tissue procedures 5. Secondary soft tissue procedures

17. PREOPERATIVE EXAMINATIONS Patients past medical history and current medical status must be reviewed with particular attention to allergies, drug idiosyncrasies, medications, hemorrhagic tendencies or systemic disorders Additional radiographic studies should be done. Lateral view and occlusal radiographs should be taken if pathology is suspected .

18. INITIAL HARD TISSUE EXAMINATIONS Bony alveolar margins should be firmly palpated through their soft tissue covering to discover Sharp bony alveolar projections. Root tips and unerupted teeth must be evaluated and any pathologic change related to these must be removed. If any impacted tooth is left and is covered with denture, it should be recorded and the patient made aware of its presence. Radiographs should be taken at reasonable intervals to be sure that no adverse changes occur.

19. NON PATHOLOGICAL BONY CONDITIONS ALVELOPLASTY Surgical reshaping of the alveolar ridge. It is usually possible for the dentist to anticipate the need for alveoloplasties at the time of the extractions by firm palpation of the residual ridge directly or through its soft tissue covering.

20. ELIMINATION OF UNFAVOURABLE UNDERCUTS Unfavourable undercuts are developed due to severe atrophy of the mandible which hinders in proper denture construction. These undercuts are mostly present on lingual aspect of mandible like genial tubercle prominences , sharp mylohyoid ridge prominences . Most of the times, patient wearing old dentures comes with the complaint of ulceration or inflammation on these lingual prominences.

21. MAXILLARY AND MANDIBULAR TORI Palatal tori - present on the midline of the hard palate.  Less than 2 cm in diameter, but their size can change throughout life. Interfere with denture retention. Small tori can be relieved during denture construction but large tori should be surgically removed. Mandibular tori are usually present in premolar region on lingual aspect. They too interfere with denture retention because of the loss of marginal seal in premolar region.

22. LINGUAL FRENECTOMY Lingual frenum should be evaluated carefully. In some individuals with excessive alveolar resorption, the genioglossus muscle could be mistaken for high frenal attachment. If the attachment results in a partial ankyloglossia, a simple release is sufficient. If wide band attachment is present that is strong and resistant to displacement when the tongue is elevated will necessitate alveolar detachment as an additional dissection.

23. INITIAL SOFT TISSUE PROCEDURES LABIAL FRENECTOMY Enlarged or prominent frenae represent probably the most common abnormality the Dentist will encounter while considering pre-prosthetic surgical preparation. Various surgical procedures have been recommended to correct abnormal frenal Attachments. These range from simple incisions to more complicated Z OR V-Y plasties

24. RIDGE AUGMENTATION PROCEDURE (secondary hard tissue procedures ) Mandibular augmentation procedures: d. Visor osteotomy e. Onlay grafting Superior border augmentation Bone graft Cartilage graft Alloplastic graft b.Inferior border augmentation Bone graft Cartilage graft c. Inter positional or sandwich bone grafting Bone graft Cartilage graft Hydroxyapatite blocks

25. Maxillary augmentation procedure: 1.Onlay bone grafting 2.Onlay grafting of alloplastic material 3. Interpositional or sandwich graft 4. Sinus lift procedures Augmentation with orthognathic surgery : Mandibular osteotomy procedures Maxillary osteotomy procedures Combination procedures