Case Sheet FPD

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UNIVERSITY OF 7THAPRIL

Department of Fixed Prosthodontics


CASE RECORD SHEET

NAME : CASE RECORD


NO_____

Age /Sex O.P NO________________

Address

Occupation.

DIAGNOSTIC EVALUATION

CHIEF COMPLAINT:

History of presenting illness:

Medical History:

Past Dental History:

Removable prosthodontic history:

CLINICAL FINDINGS

EXTRA ORAL EXAMINATION:


TMJ:

Muscles Of Mastication:

Lips:

Smile :

INTRA ORAL EXAMINATION

Hard Tissue

Teeth missing:

Dental caries:

Restored teeth:

Teeth alignment and occlusal plane:

Occlusion:

Type of occlusion-

Initial tooth contact-

Lateral and protrusive contacts-

Edentulous space:

Class-I defect / Class-II defect / Class-III defect

Abutment evaluation:
Soft tissue

Gingiva:

Periodontium:

PROVISIONAL DIAGNOSIS

RADIOGRAPHIC ASSESSMENT:

OPG

IOPA X-RAY

Crown root ratio of abutment teeth:

Bone status:

Endodontically treated teeth:

TREATMENT PLAN:

Type of Fixed Partial Denture/ Crown:

Number of abutment:

Tooth preparation:

Material used for provisional restoration:


Materials used for permanent restoration:

Type of pontic :

Planned occlusion:

Shade:

FOLLOW UP

FINAL ASSESSMENT AND EVALUATION: Evaluated on a score of 0-10

1. Dentist evaluation 2. Patient evaluation

Marginal fit Esthetic

Contacts /contours Function

Occlusion Comfort

Esthetics

APPOINTMENT SCHEDULE CHART

Sl . Procedure Date Time Next Staff


no Appointme signature
nt

1. Case discussion

2. Diagnostic cast, wax


up and bite
registration

3. Tooth preparation
and temporization

4. Metal try- in

5. Cementation

6. Post insertion check


up

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