Diagnosis & Treatment Planning

Diagnosis
Covert Examination
History
Personal History
Mental Attitude

Medical History

Dental History
Definitive Examination
Clinical Examination
Oral Extra Oral
Radiographic Evaluation
Study Casts
Patient interview
Personal data
Name, age, sex, occupation, address,
and telephone number
Positive identification and
communication
philosophic Exacting
Hysterical Indifferent
) seeking - Truth Patients( Philosophical
) Demanding Exacting Patients (
Calm -- Best mental attitude

Good prognosis
needs great care, effort - Good as philosophical
- &explanations
Good prognosis

) stricken - Panic Hysterical Patients (
) Uncaring ,cool Indifferent Patients (
Excitable - Unstable

Poor prognosis
- depressed - Uninterested
- no cooperation
unfavorable prognosis
Medical history
Some
dangerous
transmissible
diseases
Some systemic
diseases might
affect the
outline of
treatment
Some other
transmissible
diseases but
not dangerous
Some drugs might
affect the outline
of treatment
1) Jaundice
2) AIDS
3) TB
1) Cardiac
patients
2) Diabetes
3) Osteoporosis
4) Osteo-arthritis
5) Hormonal
disorder
6) Neurologic
disorder
7) Skin disease
1) Influenza
2) Rhinitis
3) Bronchitis
1) Anticoagulants
2) Dilantin Na
3) Meduretics
4) Antihypertensive
drugs
5) Endocrine therapy
6) Saliva inhibiting
drugs
Dental history
History about loss of teeth:
1-Reasons for extraction

2-Length of time since extraction.

3-Sequence of teeth extraction.

4-Diet & methods of home care.

5- Presence of any Para functional
habits.

Denture history

1-Age of present denture & dentist
evaluation to determine its
suitability.

2-Number of previous dentures &
degree of patient satisfaction.

3- evaluation of present denture.

4-Reasons for requesting a new
denture.
1
Extra-oral
examination
2
Intra-oral
examination

1. Size of face.

2. Form & contour of face.
(ovoid, rectangular, tapered)

3. Face color & symmetry.

4. Profile ( class I,II, III)
5. Facial muscle tone, tense or
flaccid.

6. Lip length, mobility & support.

7. TMJ examination to detect any
abnormalities in jaw relation
records
1- Remaining natural teeth:

A- number & distribution

B- condition of teeth.

1.Caries involvement:
dent - DIAGNO

2. Existing restorations:
3. Periodontal involvement:

1. Gingival inflammation

2. Depth of periodontal pocket

3. Degree of gingival recession


4.Mobility of teeth: may be due to:
i) Trauma from occlusion

ii) Inflammatory changes

iii) Loss alveolar bone support

5.Evaluation of the pulp:

Electric & thermal pulp testing should
be used to assess the vitality the
remaining teeth either normal, necrosed
or pulpitis.

Evaluation of sensitivity to percussion:
All remaining teeth are tested for
sensitivity to percussion. :
-tooth movement by prosthesis or
occlusion
-traumatic occlusion
-periapical or pulpal abscess
-acute pulpitis
-gingivitis or periodontitis
-cracked tooth syndrome
2-The condition of the
edentulous area:
1. The form of the edentulous ridge:

2. Oral mucosa:

3. Shape of the vault:

3-Soft & hard tissue
abnormalities:

Soft tissue

3-Soft & hard tissue
abnormalities:

Hard tissue:
1. Torus palatinus

2. Torus mandibularis

3. Bony Exostoses

4. Bony undercut

4-Tissue reaction to wearing
a previous prosthesis
1. Palatal papillary hyperplasia

2. Epulis fissuratum

3. denture stomatitis

5-Evaluation of the quantity
& quality of saliva
6- The tongue:
Size & mobility are evaluated.
Large tongue with excessive
mobility causes great
displacing force to RPD.

7- Occlusion of the natural
teeth (static teeth relation):
a) Minor occlusal discrepancy:
-Deflective occlusal contact:
centric occlusion is not in the same position
as the centric relation.
-Premature occlusal contact:
b) Gross occlusal discrepancy:

The occlusal plane is not uniform due
to over eruption of teeth opposite to
the edentulous space.
c) Loss of occlusal stops:

the mandible closes as if the jaws are
edentulous.
8- Articulation of the natural
teeth (Dynamic teeth relation):

If there is good balance of teeth
during centric & excursion
movement, the artificial teeth should
be set following this pattern by using
adjustable articulator & face bow
transfer to be in balance with the
natural teeth.
9- Space for mandibular major
connector:
If 8 mm space is available from the
free gingival margin to the position of
elevated floor of mouth, lingual bar
can be used, or you will have to use a
lingual plate.
Evaluation of radiographic
survey
Periapical radiographs:

Bite-wing radiographs:

panoramic radiographs:
The radiographic finding
The presence of hidden caries

The relation of the carious lesions to
the dental pulp.

Existing restorations are evaluated
to determine their accuracy.

Root fragment, foreign bodies &
unerupted third molars are
evaluated.
Root canal fillings are evaluated.
Radiographic evaluation of
prospective abutment teeth
1. Root length, size & form:

2. Crown/ root ratio:

3. Lamina Dura:

4. Periodontal ligament space

Radiographic evaluation of
prospective abutment teeth
5. Bone index areas:
Positive bone factor
.Normal bone height
Regular trabecular pattern
Heavy cortical layer
Negative bone factor
Loss of lamina dura
loss of bone height
Thin cortical layer
irregular trabecular pattern.
Evaluation of study casts
Purpose for which the study cast are used:
1. Aid in planning the design.
2. To supplement the oral examination by
permitting the view from all
directions.
3. To permit primary survey of the study
casts.
4. Used to fabricate special tray.
5. Used as a constant reference as the
work progress.
6. Patient education.
Purpose for which the study cast
are used:
7.As a permanent part of patient record
8. Mounted diagnostic casts can provide
important information that may be
difficult to obtain by intraoral
examination alone as:
i) Insufficient interarch distance
ii) Irregular occlusal plane
iii) loss of occlusal stops
Prescribing the prosthetic
service
There are different
prosthodontics restorations
Removable partial
denture
Indications:

free end saddle cases.
In extensive bone loss in the anterior region.
Patients desire not to grind his natural teeth.
When a successful long-term prognosis is
expected.
When fixed partial denture is not indicated.
When cross-arch stabilization is needed.
Fixed partial denture
Advantages:
Preferred by some patients.
Fixed.
Superior function.
Superior esthetic.
Minimal bulk.
Has splinting effect.
Disadvantages:
High standard of oral hygiene is needed.
Tooth grinding is imperative.
More chair-time, more lab-time, more
expensive.
Difficult to repair & difficult in accepting
additions.
The number of teeth that can be
replaced is limited.

Contraindications:
Very young patients.
Very old patients.
Long spans.
Free-end saddle.
Extensive bone loss in the anterior
part of edentulous ridge.
Weak abutments.

Complete upper &/or lower
dentures
Indications:
Advanced periodontal disease.
-Gross extensive caries.
Over denture
Indications:
When remaining teeth are few & distant,
e.g. two canines or two molars.
Patients should have good systemic &
oral health.
Abutment teeth with healthy
periodotium.
Implant denture
Indications:
Patients should have good general,
oral & mental health.

Healthy periodontium is essential
for the remaining natural teeth.
Leaving the condition as it is
As in:
Missing last molar.

Narrow edentulous space.

Severe periodontal disease.

Hysterical patients.

Too bad oral hygiene.

Diagnosis & Treatment Planning

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