CONTENTS

INTRODUCTION
PURPOSE AND UNIQUENESS
PATIENT INTERVIEW
INFECTION CONTROL
CLINICAL EXAMINATION
DIAGNOSTIC CASTS
INDICATIONS
PHASES OF TREATMENT PLANNING
REFERENCES

DIAGNOSIS
Diagnosis is the determination of nature of disease.
Clinical diagnosis include:-Personality evaluation
-Clinical examination
-Radiographic examination.
Post-clinical or derived diagnosis deals with the
evaluation of the patients condition using the
diagnostic data collected during clinical diagnosis.

PURPOSE AND UNIQUENESS

It includes 4 processes
1) Chief concern/complaints including its history
2) Ascertaining the dental needs through a
diagnostic clinical examination
3)Developing a treatment plan
4)Sequenced execution of the treatment with
planned follow-up.

Patient Interview
The dentist should follow a sequence that includes
1) Chief complaints and its history
2)Medical history review
3)Dental history review;especially related to
previous prosthetic experiences
4)Patient`s expectation

Keys to a successful Interview

Dentists attitude
Caring
Understanding
Respectful
Phrasing of questions
Open-ended questions
Houses Classification
A. Philosophical: easy going, congenial, mentally well
adjusted, cooperative and confident of the dentist.
Excellent prognosis.
B. Exacting: precise, usually dissatisfied by their
previous
treatment, do not have confidence in the dentist, very
difficult to satisfy them. But once satisfied they become
the dentist`s greatest
supporter.
C. Hysterical: highly negative attitude to the dentist and
the treatment, have unrealistic expectations and want
the dentures to be better than their natural teeth. Most
difficult to manage and show poor prognosis.
D. Indifferent:unconcerned about their appearance and
feel very little or no necessity of teeth for mastication.
Uncooperative,will not maintain the denture properly
and do not appreciate the efforts and skills of the
dentist.

Health Questionnaire:

Diabetes
Decrease resistance to infection
Patients often display reduced salivary output.

Arthritis
If it is in TMJs, may produce changes in occlusion
Very rare in TMJ, and if it is in TMJ it is usually a
secondary site

Parkinsons Disease
Oral hygiene and handling of dentures will be
impaired
Difficult impressions due to excessive quantities of
saliva

Pagets Disease
Patients may present enlargement of tuberosities.
Frequent recall program.
Quite rare

Acromegaly
Enlargement of the mandible
Frequent exams to evaluate fit and function of
removable prosthesis

Epilepsy
Removable dentures may be contraindicated if they
are
small and seizures are frequent and severe:
choking
Ifpatient takes phenytoin (common drug to take),
make sure that RPD does not irritate gingival
tissues.

Pemphigus Vulgaris
Common symptoms: oral discomfort and dryness.
Establish smooth and polished borders to reduce soft
tissue harm.
Greater follow up is anticipated.

Transmissible Diseases
Hepatitis
TB

 Influenza
HIV
Make sure impressions are disinfected

Infection Control
Recommended infection control practices for dental
treatment.
1)Gloves should be worn in treating all patient
2)Masks should be worn for oral and nasal
mucosa from splatter of blood and saliva
3)Eyes should be protected
4)Sterilization should be maintained
6)Cleanup of instruments and surfaces in the
operatory
5)Contaminated disposable material should be
handled carefully and discarded in plastic bags,
sharp items should be kept in puncture resistant
bags
Examination
Extra-Oral examination
1. Size of face
2. Form and contour of face(ovoid, rectangular or
tapered)
3. Face color and symmetry
4. Profile (Class I,II,III)
5. Facial muscle tone tense or flaccid
6. Lip length and support
7.TMJexamination

Clinical Evaluation of the Existing Teeth

Periodontal Health
Signs of inflammation of the gingiva, bleeding on
probing, periodontal breakdown, and mobility of the
teeth etc. should be evaluated.
Radiographic evaluation for bone loss.
Oral hygiene status is evaluated
If needed periodontal therapy or extraction is carried
out.
Occlusion of the Existing Teeth
Should have good cusp to fossa relationship.
Improper occlusal contacts should be corrected.
Tilted or malaligned teeth which are unfit to support
prosthesis can either be extracted or orthodontically
realigned.
Conservative and Endodontic Status of the
Existing
Teeth
Examine to rule out presence of carious lesions
Vitality of the pulp is checked
Appropriate treatment is carried out
Retained root stumps should be extracted unless a post
and core preparation is decided.
Derived Diagnosis or PostRClinical Diagnosis
Making the Diagnostic Impression
The impressions made using the stock trays
Impression materials used are
- Irreversible hydrocolloids(alginate)
- Reversible hydrocolloids(agar)
- Elastomeric impression materials
(for cases with deep undercuts)

Diagnostic Casts
Purpose of diagnostic casts
1) Supplement the oral examination by permitting a view
of
the occlusion from the lingual and buccal aspect.
2)Permit topographic survey of the dental arch
that is to be restored by means of a removable partial
denture.
3)Permit a logical and comprehensive
presentation to the patient of present and
future restorative needs and the hazards of
future neglect.
4) Individual impression trays may be fabricated on the
diagnostic casts, or the diagnostic cast may be used in
selecting and fitting a stock impression tray for the final
impression.
5) Diagnostic casts may be used as a constant reference
as
the work progresses.
6) Unaltered diagnostic casts should become a
permanent
part of the patient record

Objectives of ProsthodonticTreatment
1. Elimination of disease
2. Preservation, restoration, maintenance
3. Selected replacement of lost teeth and restore
esthetics
and functions

\INDICATION FOR REMOVABLE PARTIAL DENTURE

1) Distal extension situation
2) After recent extraction
3) Long span
4) Need for effect of bilateral stabilization
5) Excessive loss of residual bone
6) Unusually sound abutment tooth
7) Abutment with guarded prognosis
8) Economic consideration

Treatment Planning
Prosthodontic treatment for partially edentulous
patient can be divided into
5 separate phases
PhaseI:
evaluation,
immediate treatment,
diagnostic mounting, wax-up, partial design,
referral to other specialties (endo, ortho,
etc.),
patient education (OHI, etc).
Phase II
Removal of caries,
extractions,
perio tx,
occlusal equilibration,

 placement of temporary restorations

(temporary crowns, etc).
Phase(IIIcontinuation of Phase II):
Pre-prosthetic surgeries,
root canal therapies,
definitive restoration of teeth,
RPD mouth preparation, final impressions,
metal try-in, records(if needed).
Phase IV:
Delivery of RPD,
Instruction for patient.
Phase V:
Periodic recall, reinforcement of education.

Conclusion:
Although there are similarities between
partially edentulous patients ( such as
classification designations); significant
differences exist making each patient, and
the ultimate treatment, unique.
And a successful treatment plan go hand in
hand with a complete patient interview and,
diagnostic clinical and radiological
examination

References:
McCracken`s Removable Partial
Prosthodontics 11th Edition
Textbook of Prosthodontics -Deepak
Nallaswamy