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E. F. G. 1.
Need for cross-arch stabilization. Restoration of an extension base. Anterior esthetics. Attitude and desires of patient.
Diagnosis:
It is the determination of the nature, location, and causes of diseases.
To assemble all appropriate information about the patients medical and dental history and conduct clinical examination including evidence from radiographs and mounted diagnostic casts to
Treatment plan.
1. Patient history
Personal and Social history. Chief complaints Medical history. Dental history. Mental attitudes
Chief complaints
Reason for attendance (Patient's requests and desires).
Medical history.
Diabetes Arthritis Pagets disease Acromegaly Parkinsons disease Pemphigus vulgaris Epilepsy Cardiovascular diseases Cancer Transmissible diseases
1. Smoking
has been known to be associated with a variety of oral conditions including: Periodontal disease. Bone & tooth loss. Peri-implantitis. Dental implant failure. The effect of tobacoo is due to: 1. resistance to inflammation. 2. resistance to infection. 3. Impaired wound healing. 4. Calcium absorption.
. Patients who are unable to sustain a high level of plaque control e.g Parkinsonism
Dental history.
The cause of teeth loss Patient' experience during and following previous partial denture construction. Expectation of treatment: Chewing habits: preferred side for chewing. This will determine the amount of support, retention and bracing of the denture on each side. Para functional habits: clinching and bruxism.
Mental attitudes
House's Classification Based on patients mental attitude,
philosophical patients. (Well adjusted and easygoing) Exacting patients. (Precise in everything they do) Hysterical patients. (Are emotionally unstable and convinced that they will never be able to wear a prosthesis) Indifferent patients. (are uncooperative)
Clinical examination
PATIENT EVALUATION
EXTRAORAL EXAMINATION INTRAORAL EXAMINATION
PATIENT EVALUATION
II-Clinical Examination
Extra oral
Facial Examination TMJ Examination
Intra-oral
Visual Examination Digital Examination
Radiographic Examination
Front View
Angle of the mentolabial Sulcus
Profile View
Size - Form Shape of the face Juvenile Appearance of the patient
Radiographic Interpre.
Panoramic Corrected Cephalometric Clicking or Pop sounds Tomography on jaw Opening Transcranial Radiography Computerized Tomography MRI
EXTRAORAL EXAMINATION
Facial examination:
Facial Form Facial Features
A- Visual Examination
Edentulous Area
Colour- Contour-Ridge Relationship -Tongue ToriUndercutThroat formSaliva- Frena Att.
Mobility- pocket
Evaluation
Oral Hygiene
The patient must have a high standard of plaque control .
4-Tooth mobility
Causes: Trauma from occlusion (usually reversible). Inflammation in PL (usually reversible). Loss of osseous support (irreversible)
Whether to splint a mobile tooth with a strong one is questionable!!!! So many clinicians prefer to use a mobile tooth as an overdenture abutment
5-Sensitivity to percussions
All remaining teeth should be tested for sensitivity to percussion Possible causes: 1. Tooth in traumatic occlusion. 2. Periapical or pulpal abscess. 3. Periodontitis. 4. Cracked tooth.
The cause must be identified and treated before partial denture construction
7-Attrition
Types of wear
1. Attritional wear (due to rubbing of opposing teeth). 2. Wear from erosion. Carbonated beverages (Coke-Swishing). Amalgam restoration will be raised above the eroded surface. GERD. Most pronounced on the lingual surface of molars (depends on the patients sleeping position) Regurgitation (Self induced projectile vomiting ) mostly wear appears in the upper anterior segment Bulemia. 3. Abrasive wear (tobacco chewers and toothpaste abuse)
A popular misconception about severely worn dentition is that patients have lost their VDO and that it must be restored
The VDO is maintained even when rapid abrasive wear occurs. As the occlusal surface of teeth wear, the dento alveolar process elongates by progressive remodeling of the alveolar bone
!!!!!!!
2.
8- Occlusion
A situation that looks simple when the teeth are apart may be complicated when the teeth are in occlusion.
9. Ridge Morphology
Ridge morphology will give an indication about the bone available and the need for augmentation
11-Interarch space
For fixed restorations 7 mm in the posterior region and 8-10 in the anterior region. For removable restoration at least 12 mm. An increased space is not a problem in removable restoration but is a problem in fixed due to increased crown height lateral forces on the implant increased failure rate.
In case of angle class II cases: Managed by anterior cantilever on implants in the mandibular arch but this requires: Increase number of implants. Increase in the anteroposterior distance between implants
14-Para-functional habits
Bruxusm. Clenching. Tongue thrust.
15-Mouth opening
Tongue Position
Normal tongue positions Retracted or awkward tongue positions
4. Radiographic examination
1. Caires
Clinical findings must be correlated with radiographic examination to reveal: Severity and extent of caires. Number of lesions.
5-Lamina dura
Resorption of LD occurs where there is pressure and apposition occurs when there is tension. Loss of lamina dura may be due to: 1. Systemic disorders as hyperparathyrodism or Pagets disease. 2. Excessive pressure on the tooth. Thickening of lamina dura may be due to: The tooth is under heavy function and the patient has high resistance.
The cause of change in the lamina dura must be corrected or the abutment will have poor prognosis
If the bone responds to extra loading by increasing bone density the patient is said to have +ve bone factor and vice versa
If the tooth is not mobile this signs may indicate a favourable response to heavy occlusal forces. So we predict that this tooth will have a good prognosis as a PD abutment
10-Proximity of roots
If the roots of adjacent teeth are in close proximity and display little interproximal bone, moderate irritation or forces may be destructive. So additional abutment must be used to support the PD
11-Third molar
If its size, shape and position appears favorable, it should be retained to avoid a free end saddle condition.
1-Interarch distance
Loss of interarch space is frequently caused by a large maxillary tuberosity. A segment of teeth that has been unopposed for a prolonged period will overerrupt carrying the alveolar process with it. Subsequent removal of these teeth will produce a situation in which it is impossible to establish an acceptable occlusal plane.
Surgical correction
2- Diagnostic surveying
To determine: 1. Parallelism or lack of parallelism of tooth surface involved . 2. Areas of interferences to path of placement and removal. 3. Esthetic effects of the selected path of insertion.
3-0cclusal plane
Most partially edentulous pts. have occlusal interferences due to drifting and migration of natural teeth which require occlusal equilibration.
1. 2. 3. 4. 5.
extraction of the tooth. If a single tooth is overerupted it may be treated by: Simple enameloplasty if overerruption is within 2 mm. Reduction and crowning if dentine will be exposed. RCT, reduction and crowning. RCT and reduction of the tooth to be used as an overdenture abutment. in severe overeruption it may be necessary to remove the tooth and recontour the surrounding bone.
to
5.Occlusal equilibriation
Occlusal equilibration is
the selective grinding or occlusal reshaping of teeth to eliminate premature or deflective occlusal contacts that interfere with the physiologic function of the TMJ.
Clinically: 1. Wear facets. 2. Tooth mobility. 3. Muscle spasm, pain and TMD Radiographically: 1. Widening in the periodontal membrane space. 2. Periapical radiolucency. 3. Bone condensation. 4. Bone resorption. 5. Root resorption.
The T-Scan III uses a sensor that record occlusal contacts on a thin film and relays the information to a computer to obtains the actual occlusal contact time and force data for each tooth and graphically illustrate it.
T-scan III
Diagnostic equilibriation
Occlusal equilibration should be first made on accurately mounted diagnostic cast, and all steps should be recorded then duplicated in the patient mouth.
when do we decide to treat a partially edentulous patient at centric relation or maximum intercuspal position?
The following situations suggest that prosthesis should be constructed at centric relation: 1. Coincidence of CR and CO. 2. Absence of posterior teeth contact. 3. When all posterior teeth contact are to be made by fixed restoration. 4. Few remaining posterior contacts. 5. Clinical symptoms of occlusal trauma (TMJ disorder)
Number of missing teeth. Inter-arch space analysis. -Perform wax up and surgical template. -Perform the provisional prosthesis. -Ridge mapping. -Future comparison.