Beruflich Dokumente
Kultur Dokumente
PERSONAL DATA
-Name
-SSN:
A Social Security number or Patient number is required.
-Age: Age is an indicator of the patient's ability to wear and to use dentures.
Through the fourth decade of life tissues heal rapidly and are relatively resilient,
Individuals adapt to new conditions more readily and esthetics are of paramount
importance. Beyond the fifth decade, however, tissues do not heal as rapidly. The
body does not adapt readily to new situations. Women facing the physiologic and
psychological problems of menopause often present as exacting or hysterical
patients who are very concerned with esthetics. Men at this age often are
preoccupied with their careers. It is not unusual for them to present as indifferent
patients who are concerned only with comfort or function.
Normal
Class 2
Retrognathic
Class 3
Prognathic
may have unrealistic expectations regarding functional and esthetic results. Classify lip
mobility as normal (class 1), reduced mobility (class 2), or paralysis, (class 3).
Comment on any unilateral reduction of mobility. Lip length also plays an important
role in esthetics. A long lip reveals little of the anterior teeth, whereas a very short lip
allows the display of the denture base. Mold selection and denture characterization can
be critical factors in these cases. Classify lip lengths as long, normal or medium, and
short.
f. Temporomandibular joint (TMJ): Note any crepitus or clicking. Report any
history of TMJ discomfort or locking. Comment on the smoothness of mandibular
movements. Note any deviation of the mandible. Severe joint pain can indicate a severe
discrepancy in the VDO.
g. Neuromuscular Evaluation:
- Speech: Patients who are capable of articulate speech with existing dentures; (or
natural teeth) usually have no problem producing articulate speech with new
dentures. Patients with speech impediments or those who cannot articulate optimally
with their existing dentures require special attention when the dentist places the
anterior teeth and forms the palatal portions of the denture base. If normal muscle
activity is altered by -significant changes in tooth placement and denture-base
contour, a longer and more difficult period of adjustment may be anticipated.
Classify speech as "normal" or "affected" (comment on any impediments).
- Coordination: Patients with good neuromuscular coordination can be expected to learn
to manipulate dentures relatively quickly and likewise adapt readily to new dentures.
Patients with poor coordination or a neurologic deficit (such as from a stroke) may
never adapt to a denture completely. Classify neuromuscular coordination as follows:
Class 1: Excellent
Class 2: Fair
Class 3: Poor
h. Oral Cavity:
- Arch Size: Classify arch size as follows:
Class 1: Large (best for retention and stability)
Class 2: Medium (good retention and stability but not ideal)
Class 3: Small (difficult to achieve good retention and stability)
- Arch Form: Classify according to House:
Class 1: Square
Class 2: Tapering
Class 3: Ovoid
Square
Tapering Square- Tapering
Ovoid
Ridge Form: Maxillary ridge and vault form should be classified as follows:
Class 1: Square to gently rounded
Class'3: Flat
Class 3: Unfavorable:
Inverted "W"
Defects: Note ridge defects, such as exostoses or divots, that may pose problems for
complete-denture patients or may warrant preprosthetic surgery.
Tori: Classify maxillary and mandibular exostoses as follows:
Class 1: Tori are absent or minimal in size. Existing tori do not interfere with denture
construction.
Class 2: Clinical examination reveals tori of moderate size. Such tori offer mild
difficulties in denture construction and use. Surgery is not required.
Class 3: Large tori are present. These tori compromise the fabrication and function of
dentures. Such tori usually require surgical recontouring or removal.
Ridge Parallelism: Classify ridge parallelism as follows: Class 1: Both ridges are parallel
to the occlusal plane.
Class 2: The mandibular ridge is divergent from the occlusal plane anteriorly.
Class 3: The maxillary ridge is divergent from the occlusal pladne anteriorly or both
ridges are divergent anteriorly,
Class 2: Retrognathic
Class 3: Prognathic
Class B:
Maxillae
Class C:
Maxillae
Mandibles
Mandibles
Class D:
Maxillae
Mandibles
Class E:
Maxillae
Mandibles
Class 2:
Class 3:
Class 4:
Class 2:
Class 3:
Class 2: Medium size and normal in form, with a relatively immovable resilient band of
tissue 3 to 5 mm distal to a line drawn across the distal edge of the tuberosities.
Class II
Class 3: Usually accompanies a small maxilla. The curtain of soft tissue turns down
abruptly 3 to 5 mm anterior to a line drawn across the palate at the distal edge of the
tuberosities.
Class III
borders rest above the mandibular occlusal plane. The floor of the mouth is raised
and tense.
V. EXISTING DENTURES
- Anterior Tooth Shade, Mold, and Material
- Posterior Tooth Shade, Mold, and Material: Existing dentures should be evaluated to
determine physical, esthetic, and anatomic characteristics. Shade, mold, and
material should be recorded for both anterior and posterior teeth. If the mold
cannot be determined, the general shape of the teeth should be recorded (e.g.,
square, square-tapering, tapering, ovoid, etc.).
- Esthetics, phonetics, retention, stability, extensions, and contours: Existing esthetics,
phonetics, retention,, stability, extensions, and contours should be evaluated.
These attributes should be rated (1) good, (2) fair, and (3) poor.
- Centric Relation and Vertical Dimension of Occlusion: Centric relation and vertical
dimension of occlusion should be assessed and rated "acceptable" or
"unacceptable," If unacceptable, it should be noted whether the existing VDO is
"inadequate" or "excessive."
- Occlusal Plane Orientation: The orientation of the occlusal plane should be noted.
Improper orientation as a result of tooth setting or changes in bony architecture
often creates a "reverse smile line." This condition is characterized by teeth that
slope downward as one progresses posteriorly. Consequently, the anterior teeth
assume a curvature that does not follow the arc of the lower lip.
- Palate: The palate of the existing maxillary denture should be examined. The denture
base material and thickness should be noted. Anatomic features should be
assessed. The practitioner should note the presence or absence of rugae on the
cameo surface of the denture base. Denture wearers may have become
accustomed to a particular palatal form, and may resist change. The practitioner
should listen to speech patterns, and determine whether appropriate "valving" is
taking place. Placement of rugae or a change in thickness may affect
pronunciation.
- Post dam: The posterior border of the maxillary denture should be examined. Likewise,
soft tissues in the vicinity of the "vibrating line" should be observed. The seal of
the existing maxillary denture should be evaluated clinically. Often, deficiencies
in retention of the maxillary denture may be traced to improper post-damming.
The post dam should be rated "acceptable" or "unacceptable."
- Base Adaptation: The fit of maxillary and mandibular bases should be assessed using
an appropriate disclosing medium, Adaptation should be rated "acceptable" or
"unacceptable."
- Midline: Maxillary and mandibular midlines should be observed. Although
discrepancies between maxillary and mandibular midlines, may be present, it is
critical that the maxillary midline coincide with the facial midline. Discrepancies
in midline placement create noticeable facial disharmonies. The existing
maxillary midline should be evaluated using intraoral (e.g., incisive papilla) and
extraoral landmarks (e.g., nasion, filtrum, middle of the chin). The midline should
be rated "acceptable" or "unacceptable.' Deviations of the maxillary midline
should be recorded by direction and amount (e.g., maxillary midline 2 mm to the
right of the facial midline).
- Buccal Vestibule: The buccal vestibule is an important esthetic and functional
component in complete denture service. Consequently, this space should be
assessed carefully. The buccal vestibule should be judged "acceptable" or
"unacceptable." Corrective actions should be proposed.
- Crossbite: The presence of a unilateral or bilateral crossbite often presents a
challenging situation. Crossbites should be noted and their effects on tooth
placement anticipated. This information may be entered into the diagnostic record
using the categories "none , unilateral," or "bilateral."
- Characterization: Characterization or staining of existing denture bases should be
evaluated and recorded. Existing denture bases may be classified as
"characterized" or ' 'uncharacterized."
- Comfort: The patient should be questioned regarding the comfort of maxillary and
mandibular dentures. Comfort for the respective arches should be classified as
"acceptable" or "unacceptable." Patients who experience discomfort should be
questioned to determine the nature and source of the discomfort.
- Hygiene: The patient's ability and motivation to clean the dentures should be assessed
during the clinical evaluation. The patient also should be questioned about his or
her denture cleansing regimen. These factors may affect denture-base contouring
(e.g, closed interdental contours versus open interdental contours) and tooth
arrangement (e.g., presence or absence of diastemata). Hygiene should be
classified as (1) good, (2) fair, or (3) poor.
- Wear: Wear often is an indicator of parafunctional habits or an abrasive diet. The wear
process must be assessed with respect to time. With these factors in mind, wear
should be classified as (1) minimal, (2) moderate, or (3) severe.
- Attachments and Hardware: Attachments and hardware usually are limited to
overdenture situations. When working under these constraints, it is important to
know the specific system in use and the availability of components.
VI. TREATMENT PLANNING
- Tissue conditioning: List proposed therapy as finger massage, prescribed medications,
type of tissue treatment material to be used and frequency of soft reline changes,
etc.
- Preprosthetic surgery: List any proposed preprosthetic procedures along with the staging
of these procedures.
Articulator:
- Instrument Number and Manufacturer
- Control Settings:
Horizontal condylar guidance (right and left);
lateral condylar guidance (right and left);
incisal guide anterior angle (right and left);
and incisal guide lateral angle (right and left).
-Tooth Selection: The shade, mold, and material of the maxillary anterior,
mandibular anterior, maxillary posterior, and mandibular Posterior should
be selected.
- Denture Base Material: Available materials include microwave resin, gold,
heat-cured resin, soft base, etc.
- Denture Base Shade: Base shade depends on the brand of acrylic.
- Anatomic Palate: Yes or no.
- Characterization: Establish the stains to be used; draw a "map" of the proposed stain
placement.
- List items to improve on in the new dentures, such as inadequacies of the existing
dentures (e.g., items from Section V).
- List items not to be changed in the new dentures, such as good features of the existing
dentures (e.g., items from Section V).
VII. PROGNOSIS:
Give the prognosis and list the reasons for the prognosis.
SUMMARY
A checklist is presented for use in evaluating and planning the treatment of patients for
complete-denture therapy. A thorough explanation of each item and classification
included in the checklist list also is presented. Classifications from the classic
prosthodontic literature are used wherever possible and their sources are referenced
appropriately.