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Department Of Prosthodontics and Maxillofacial Prosthetics

Peoples Dental College and Hospital,
Nayabazar, Kathmandu
REMOVABLE PARTAL DENTURE CASE HISTORY
SHEET
PERSONAL INFORMATION:
Reg. No: 4808 Case No: 2
Patients Name: Dhawa Buti

Sex:/ Age:57/f
Address: RASHUWA Telephone:
Mobile No:9741025654
Email address:

History
I) Chief complaint: replacement of missing upper front teeth


II) History of present illness:


III) Evaluation of systemic status/ general health



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IV) Medical history:

V) Past dental history:
Surgical Restorative/ Endodontic history

Periodontal history:

Prosthodontic history:

Orthodontic history:

Others:

VI) Denture history
a. No. and types of previous denture:
i. Duration of wear:
b. Previous denture experience:

i. Removable partial:

Maxillary: Mandibular: .

ii. Single Complete denture:

Maxillary: Mandibular: .

c. Reasons for requesting a new denture:

VII) Diet and personal history:
a. Diet:
b. Oral hygiene habits:
c. Other habits:
VIII) Socio-psychological status:
a. Marital status:
b. Occupation:

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c. Family status:
d. Education status:

Clinical examination:
Extra-oral Examination:
1. Examination of face:
a) Form: Ovoid/ Tapering/ Square/
b) Profile: Normognathic / Prognathic /Retrognathic
c) Symmetry: Symmetrical/ asymmetrical
d) Facial height: Decreased/Normal/Increased
e) Complexion:
I. Face: Dark/ Fair/ Medium
II. Eye: Black/Brown/Gray/Blue
III. Hair:
f) Lip:
I. Type: Thick/Average/Thin
II. Contour: Adequately supported/ Unsupported
III. Length: Short/ Average/ Long
IV. Mobility: Normal/ Reduced/Paralyzed/Hyperactive
1. Unilaterally/Bilaterally
2. Upper/Lower
g) Nasolabial fold:
h) Mentolabial sulcus:
2. Neuromuscular evaluation:
a) Muscle of mastication/facial expression:

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b) Speech: Normal/Affected:
c) Facial muscle tone:
d) Co-ordination: Good/ Fair/ Poor

3. T.M.J. Examination:
a) Normal:
b) Pain:
c) Clicking:
d) Movement: Normal/Deviated/ Restricted

4. Lymph node examination
a) Area
b) Palpable/ Nonpalpable
c) Tender/ Nontender
d) Movable/Fixed

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Intra Oral Examination:
A. Number & distribution:


B. Evaluation of remaining teeth:
a. Caries status:
b. Existing restorations and its status:
c. Occlusal evaluation

d. Periodontal evaluation:
i. Mobility
ii. Bleeding on probing
iii. Furcations
iv. Oral hygiene
e. Oral hygiene status:
C. Evaluation of the pulp:

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D. Evaluation of sensitivity to percussion:
E. Occlusal analysis:
Jaw relation:
Anterior posterior relation: R: Class I/ Class II/ Class III
L: Class I/ Class II/ Class III

Vertical: Overjet: _____mm/ Overbite: _______mm

Transverse: Crossbite: in respect to: ________

Occlusal plane: Straight/ Curved/ Reversed

Type of occlusion:

Centric tooth contact:

Eccentric tooth contact:
Latrotrusive Contacts:
Protrusive Contacts:


F. Hard tissue evaluation:
Torus palatinus
Torus mandibularis
Exostoses
Bony undercut
G. Others
The evaluation of the edentulous area/load bearing structures:
A. The form of the edentulous ridge:
a. Mucosa:
I. Thickness:
II. Resiliency:


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B. Maxillary tuberosities:

C. Mylohyoid ridge:


D. Siverts classification:
a. Class I:
b. Class II:
c. Class III:



E. Edentulous space evaluation :

b. Cervico occlusal:
c. Mesio- distal :

F. Tissue reaction to wearing a previous prosthesis:
a. Palatal papillary hyperplasia:
b. Epulis fissuratum:
c. Denture stomatitis :


Soft tissue evaluation:
A. Buccal mucosa:

B. Lip and cheek mucosa:


C. Floor of mouth:

D. Tongue:


E. Soft palate:

F. Frenal attachment:

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a. Maxillary: Normal/ Close to crest/ Broad
b. Mandibular: Normal/ Close to crest/ Broad
Evaluation of the quantity & quality of saliva:
Quantity: Serous/ Mucous/ Mixed
Quality: Normal/ Scanty/ Abundant



Evaluation of existing denture:
Occlusion


Vertical dimention
Extention
Teeth
Denture base:
Major connector:


Minor connector:
Rest seat:


Direct retainer:


Indirect retainer


Denture Hygiene




Evaluation of prospective abutment teeth:

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Endodontic evaluation:
Restorative evaluation:
Periodontal evaluation:
Occlusal evaluation:




General radiographic evaluation (if appreciable):


Provisional diagnosis:


Provisional treatment plan:
A. Surgical procedures:

B. Occlusal adjustment:


C. Periodontal therapy:

D. Restorative procedures:


E. Endodontic Therapy:


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F. Cast crowns:

Radiographic evaluation of prospective abutment:
A. Abnormalities/Pathology
B. Pulpal considerations
C. Root length, size & form:
D. Crown/ root ratio:
E. Tooth alignment
F. Root proximity
G. Lamina dura:
H. PDL space
Evaluation of study casts:
On the articulator
a. Inter ridge space: adequate/ inadequate

b. Occlusion plane retrievable? Yes/ Doubtful


c. Is there adequate interocclusal space for contempleted rest seats and rests

where they will be needed??

On the surveyor
a. Most suitable abutment:

b. Tooth alteration is required:


c. Adequate retentive undercuts in a favourable location on abutment tooth:

d. present/ not present

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Definite Diagnosis:

Treatment planning:
Preprosthetic:
Prosthetic: