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EXAMINATION, DIAGNOSIS
(3) The selected replacement of lost teeth for the purpose of restoration of
function in a manner that ensures optimum stability and comfort in an
esthetically pleasing manner.
G. Anterior esthetics.
J. Ease of plaque removal from the natural teeth and partial de ture.
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Diagnosis of partially edentulous patients
G. Periodontal health.
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Diagnosis of partially edentulous patients
(2) Ascertaining the patient's dental needs through a diagnostic clinical exam.
(3) Developing a treatment plan that reflects the best management of the
desires and needs (unique to their medical condition or oral environment).
a prophylaxis,
full-mouth radiographs,
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Diagnosis of partially edentulous patients
A. Patient interview:
C. Oral prophylaxis
B-Radiographic survey
D. Consultation requests:
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Diagnosis of partially edentulous patients
A ] PATIENT INTERVIEW
1- Structure of interview:
HISTORY TAKING
2- Objectives:
a. Establishing of a rapport:
We should meet the mind of the patient before we meet his mouth.
De Van stated, "Meet the mind of the patient before meeting the mouth
of the patient". Hence, we understand that the patient's attitudes and
opinions can influence the outcome of the treatment.
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Diagnosis of partially edentulous patients
Arthritis Epilepsy
Acromegaly Cancer
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Diagnosis of partially edentulous patients
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Diagnosis of partially edentulous patients
*Anticoagulants
*Saliva-inhibiting drugs
e. Dental history:
The cause of teeth loss: If the teeth were lost because of caries,
special emphasis will have to be placed on oral hygiene
procedures. If the teeth were lost because of periodontal disease,
every effort must be made to discover and eliminate its cause.
Chewing habits: The patient is asked about the preferred and non
preferred side for chewing. This will determine the amount of
support, retention and bracing of the denture on each side.
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Diagnosis of partially edentulous patients
3- Obstacles:
INFECTION CONTROL
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Diagnosis of partially edentulous patients
B] Clinical examination
PATIENT EVALUATION
• Age : patients belonging to the fourth decade of life will have good
healing abilities and patients above the sixth decade will have
compro¬mised healing.
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Diagnosis of partially edentulous patients
Extraoral examination
a-Facial Features :If the face appears collapsed, it indicates the loss of
vertical dimension (VD). Decreased VD produces wrinkles around the
mouth. Excessive VD will cause the facial tissues to appear stretched.
b. Complexion :The colour of the eye, hair and the skin guide the selection
of artificial teeth.
Oral Examination
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Diagnosis of partially edentulous patients
visual examination,
oral prophylaxis,
radiographs,
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Diagnosis of partially edentulous patients
arches can be obtained only if the teeth are clean; otherwise the teeth reproduced
on the diagnostic casts are not a true representation of tooth and gingival contours.
Objective:
1. Opposing occlusion.
3. Parafunctional habits.
a. Clenching. b. Bruxism
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Diagnosis of partially edentulous patients
1. Caries and existing restorations: All carious teeth must be restored prior to
starting definitive prosthodontic treatment,
3. Sensitivity to percussion
4. Mobility and C/R ratio: The degree of mobility of all teeth should be
recorded using a scale commonly used for classifying mobility:
Causes:
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Diagnosis of partially edentulous patients
Treatment:
Scaling
Splinting when:
• The first premolar and all molars have been lost and the
second premolar is to serve as the abutment
5. Periodontium:
2. Furcation involvement
4. Marginal exudate
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Diagnosis of partially edentulous patients
B] . Oral mucosa:
Pathologic changes
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Diagnosis of partially edentulous patients
o Relieving the denture base or reducing the length of the denture border
o Surgical correction of undercuts.
o Flexible denture base or flexible border
o Reduce length of denture border
The mylohyoid ridge: Some of these ridges are felt to be
pronounced and the soft tissue covering is thin and is easily
traumatized by insertion and removal of prosthesis.
D]. Soft tissue abnormalities:
E] Occlusal relationships:
It is the relation between the opposing teeth and between the teeth and
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Diagnosis of partially edentulous patients
Thick ropy saliva alters the seat of the denture because of its tendency
to accumulate between the tissue and the denture. Thin serous saliva
does not produce such effects.
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Diagnosis of partially edentulous patients
Anterior abutments that are considered poor risks may not be so freely
used because of the problems involved in adding a new abutment retainer when
the original one is lost. It is rational that such questionable teeth be condemned
in favor of more suitable abutments, even though the original treatment plan
must be modified accordingly.
Kennedy Class II, mod I in which molar abutment has a guarded prognosis. Premolar clasp assembly is a
mesial rest, distal guide plane, and wrought wire retainer design that will accommodate future distal extension
movement.
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Diagnosis of partially edentulous patients
a- the design and quality of construction should be noted and any associated
problems in relation to gingival and mucosal inflammation or to decalcification
of contacting tooth surfaces.
C -Radiographic survey:
All radiolucent and radiopaque areas that vary from normal ranges
to determine whether a pathologic condition is present.
Root fragments and other foreign bodies to determine whether
their removal is indicated.
Un erupted third molars to determine whether they should be
retained or removed.
Evaluate quantity of bone.
oAlveolar.
oResidual ridge.
oBasal.
a. Bone Index (bone factor):
The bone factor provides an assessment of the relative response
of bone to stimulation or irritation. This assessment is made by
analyzing bone index areas.
Bone index areas are those areas of bony support which disclose
the reaction of bone to increased force, e.g. areas of bone around
abutment teeth or any other teeth subjected to increased loading.
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Diagnosis of partially edentulous patients
b. Bone Density
In the mandibular arch the external oblique ridge, the mylohyoid ridge
and the genial tubercles, which are areas of muscle attachments, continue
to resist resorption even when the residual ridge is greatly resorbed.
The presence of dense cortical bone is often the result of applied forces
arising from ligamentous or muscle attachments which provide tension to
the underlying bone.
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Diagnosis of partially edentulous patients
Genetic. Pathologic.
Hormonal. Biochemical.
Nutritional. Other.
The presence and extent of caries and the relation of the carious lesion
to the dental pulp
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Diagnosis of partially edentulous patients
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Diagnosis of partially edentulous patients
D] DIAGNOSTIC CASTS
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Diagnosis of partially edentulous patients
(b) Retentive and non retentive areas of the abutment teeth; (c)
areas of interference to placement and removal; and
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Diagnosis of partially edentulous patients
Occlusion,
The mounted diagnostic casts provide visual access from all directions and
enable the dentist to make a detailed analysis of the patient’s occlusion.
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Diagnosis of partially edentulous patients
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Diagnosis of partially edentulous patients
3. Inspection of:
Interarch distance
Caused by
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Diagnosis of partially edentulous patients
A segment of teeth that has been unopposed for a prolonged period will
frequently overerupt, carrying the alveolar process with it. Subsequent
removal of the teeth will produce a situation in which it is impossible to
establish a functionally and aesthetically acceptable plane of occlusion.
Management
The surgical reduction of the vertical height of the tuberosity and at times
the adjacent residual ridge is necessary if satisfactory replacement of the
missing teeth is to be accomplished. The area and amount of tissue that should
be removed can be indicated on the diagnostic east. This provides an excellent
guide for the oral surgeon or dentist who performs the surgical correction. The
radiographs are a valuable aid in planning the surgical of fibrous tissue.
Healing is usually complete in 7 to 10 days. The healing period is extended to 2
to 5 weeks when bone removal is necessary.
Management
The undercut must be evaluated with the aid of the dental surveyor.
With the cast on the surveying table at the predetermined path of insertion, a
determination is made as to the amount of relief that will be required in the
denture if the undercut is not reduced. Moderate to severe tuberosity undercuts
usually require surgical correction with bone removal.
bulbous tuberosities
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Diagnosis of partially edentulous patients
Management
Occlusal plane
Management
Available treatments depend on the degree of extrusion and the condition of the
tooth:
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Diagnosis of partially edentulous patients
• Severely extruded teeth such as those contacting the opposing ridge present
greater problems. If the alveolar bone has followed the eruption of the
offending tooth, it may be necessary to extract the tooth and remove the
surrounding bone.
• At times endodontic treatment and & drastic reduction of the tooth will enable
it to be used as an overdenture abutment. This treatment can provide valuable
support for a distal extension base. Extruded teeth must always be evaluated
with the occlusal plane in mind.
Management
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Diagnosis of partially edentulous patients
Malrelation of jaws:
Severe malrelation of the jaws can prevent the restoration of adequate function
and esthetics.
Management:
Management:
Classification:
Akerly (1977) has classified traumatic vertical overlap into the following
four basic types:
Type I -The mandibular incisors extrude and impinge into the palate.
Type II-The mandibular incisors impinge into the gingival sulci of the
maxillary incisors.
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Diagnosis of partially edentulous patients
Clinical symptoms:
Abrasion,
Mobility,
Management:
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Diagnosis of partially edentulous patients
If all the maxillary teeth are present and have healthy support, it may
be possible to build up the cingula of the anterior teeth with cast
restorations >>>>> not feasible if the horizontal overlap is too great.
Occlusion
The mounted diagnostic casts are also used for an evaluation of the patient’s
occlusion. The information obtained from the analysis of the occlusion should
be correlated with other clinical findings.
Occlusal interferences:
Bruxism:
Severe bruxism can injure the teeth, the periodontium, and the
Temporomandibular joint and may initiate muscle spasm, pain, or discomfort.
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Diagnosis of partially edentulous patients
• Root resorption.
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Diagnosis of partially edentulous patients
E. Consultation requests:
3. The physical aspects of the prosthesis with regard to bulk and tissue
coverage.
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Diagnosis of partially edentulous patients
Elimination of Infection
Elimination of Pathology
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Diagnosis of partially edentulous patients
Preprosthetic Surgery
Alveolectomy Implants
Tissue Conditioning
The patient should be requested to stop wearing the previous denture for
at least 72 hours before commencing treatment. He/she should be taught to
massage the oral mucosa regularly.
Nutritional Counseling
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Diagnosis of partially edentulous patients
PROSTHODONTIC CARE
For a patient with few teeth, which are likely to be extracted an immediate
or conventional, definitive or interim, implant or soft tissue supported
dentures can be given.
1-fixed bridge
Indication:
A-GENERAL INDICATIONS:
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Diagnosis of partially edentulous patients
B-LOCAL INDICATIONS:.
3- short span.
Contraindication:
A-GENERAL CONTRAINDICATIONS:
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Diagnosis of partially edentulous patients
• poor cooperation
3- contraindication to L.A
1- long span
2- when the bridge will occlude with opposing teeth on its end or 1/2 or less of
its length
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Diagnosis of partially edentulous patients
2-Complete denture
Indication:
1-poor abutment
6- poor alignment
7- radiation therapy
Indicaton
4- weak abutment
8- immediate replacement
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Diagnosis of partially edentulous patients
10- need for complete denture in future( due to increase possibility of further
tooth loss)
12- patient desire (economic and time and preserve of sound teeth )
20- diabetic pt
Containdications:
A-Intraoral contraindication
B-Patient contraindication
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Diagnosis of partially edentulous patients
1- un cooperative pt.
1-AGE:
• Avoid extraction
Physiologic
psychologic
b- old patient :
2-GENERAL HEALTH:
3- SEX:
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Diagnosis of partially edentulous patients
Female:
4- ECONOMIC CONSIDERATION
R P D may need root canal treatment and crown inlays thus more cost.
5- SOCIOECONOMIC BACKGROUND
7- OCCUPATIONAL FACTORS
8- TIME FACTORS
Removable partial denture . may be used for long term prognosis, the best
R.P.D, service for many years.
Or for short term prognosis and in future the patient need complete denture,
must be simple in design and permit the addition of future teeth (additive
partial denture)
This temporizing treatment gives the patient experience in denture wearing and
in adaptation to artificial dentition.
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Diagnosis of partially edentulous patients
Clinical factors related to metal alloys used for removable partial denture
frameworks: see denture base
Various alloys can be considered for use, Practically all cast frameworks
for removable partial dentures are made from a chromium-cobalt alloy.
Questions
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