FIXED PROSTHODONTIC III

Department of Fixed Prostodontics

DIAGNOSIS RELATED TO FIXED
PROSTHODONTICS
:Diagnosis

Diagnosis is simply defined as the procedure of

collecting data and informations through different
channels so that a proper line of treatment could
.be proposed
:Elements of proper diagnosis

(I. History (Medical-Dental

II. T.M.J and occlusal evaluation

III. Intra-oral examination

IV. Diagnostic cast analysis

V. Radiographic Examination
(:I. History (Medical history

To determine any special precautions to be taken before the. 1

.start of the treatment

Any selective treatment which might be postponed or. 2

eliminated because of the patient’s psychological or physical
health

Any necessary pre-medication. 3

(:I. History (Medical history

(Allergic reactions (drugs, local anesthetics. 1

Hypertension and coronary heart diseases. 2

Rheumatic fever and valvular dysfunction, a history of previous. 3

bacterial endocarditis, congential heart malformations or mitral
valve prolapse should be pre-medicated with amoxicillin or
.clindamycin in cases of allergy to amoxicillin

Patients receiving anti-coagulants should be asked for their. 4

physicians consultation before starting any treatment that will
cause even minor bleeding
Diabetic patients should be well controlled before receiving. 5
. routine dental treatment

Epileptic patients should not be treated unless precautionary . 6

measures are taken to minimize seizure (ex.: anxiety should be
(avoided, no long fatiguing appointments

Infectious diseases should be known for protective measures . 7

((ex.: HIV, hepatitis

N.B. The patient’s physician should be consulted before beginning

.the treatment
(:I. History (Dental history

Patient’s chief complaint-

Previous treatment and patient’s attitude-

Patient’s expectations from treatment-

:Patient’s chief complaint

(Comfort (pain, sensitivity, swelling-

(Function (difficulty in speech, or mastication-

(Social (bad odor or taste-

Appearance or esthetics (fractured or unattractive -

(teeth, or discoloration
:Previous treatment and patient’s attitude
This gives an insight into the patient’s level of dental awareness
and the expected patient’s cooperation

:Patient’s expectation from treatment

Special attention should be given to the esthetic effect anticipated
by the patient. Conflicts in this area with sound restorative
procedures should be noted, and the option of not providing
.treatment should be considered
:II. T.M.J and occlusal evaluation

:A. Temporomandibular joints

TMJ should be healthy with no evidence of clicking, crepitations-
.or limiting of movement on opening or closing or lateral shifting
Maximum opening of the jaw less than 40mm is an indication of -
(jaw restriction (average opening more than 50mm

:B. Muscles of mastication

Muscle pain is usually associated with parafunctional jaw activity-
.related to stress or faulty occlusion
Evidence of pain in either muscles or TMJ should be properly-
evaluated before starting treatment

:C. Occlusal evaluation

:III. Intra-oral examination

This should be carried in a systematic manner to include

:the following

Oral hygiene and caries index-

Abnormal habits-
Edentulous ridge-
Occlusion-
Prospective abutment-
:III. Intra-oral examination

:Oral hygiene and caries index

The first thing to be observed intra-orally is the patient’s oral

hygiene, amount and areas of plaque, as well as the general
. periodontal condition

It should be noted that because of the long-term periodontal

health is necessary to successful fixed prosthodontics, existing
periodontal disease must be treated before any definitive
.prosthodontic treatment is undertaken
:III. Intra-oral examination

:Abnormal habits

Examination for any abnormal oral habits should be identified (ex.:

pipe smokers, pencil biting, bruxism…..(. This would affect the
.prosthesis type, retainer and bridge design

:Edentulous ridge

The relationship of edentulous spans if more than one should be

recorded. Examine the form and texture and color of ridge
mucosa. Dimensions of edentulous span is a critical deciding
. factor in the treatment planning
:III. Intra-oral examination

:Occlusion
:Occlusal evaluation should be carried out for

(Wear facets (localized, or wide spread-

Presence of any premature contacts-

.Existence of cuspal interference in eecenrtic movements-

:III. Intra-oral examination

:Clinical evaluation of the proposed abutments

:Carious lesions

(:Condition of the pulp (vitality

:Mobility

:Periodontal condition

:Coronal defects
:III. Intra-oral examination

:Clinical evaluation of the proposed abutments

:Coronal defects: Examined for

(Color variations (extrinsic or intrinsic-

(Areas of (attrition, erosion, abrasion-

(Crown morphology (long, short, malformed-

Axial inclination-

Supra and infra eruptions-

:IV. Diagnostic Cast Analysis
:It is an important adjunct of the diagnostic procedures

:Criteria of good diagnostic cast

Accurate reproduction of both arches-

No bubbles or nodules on the occlusal surface-

Mounted in centric occlusion on a semi-adjustable articulator by-

means of a face bow and occlusal wax records
:Diagnostic casts reveal
Distribution and dimensions of edentulous . 1
:span
Diagnostic casts allow an easy unobstructed view of
;edentulous spans from these aspects
(Mesio-distal length ( to assess liability to flexibility-

(Occluso-gingival dimension ( for pontic design-

(Arch curvature ( to assess liabiliy to flexibility-

Arch curvature ( to assess whether the pontic (s( will act as a -

(.lever arm on the abutments

Distribution and extent of edentulous areas could be properly, -

evaluated as to whether construct RPD, or FP
:Diagnostic casts reveal

:Type of bite and occlusal prematurities . 2

The type of bite whether being anterior or posterior
cross bite, deep over bite or over-jet could be properly
assessed. Occlusal prematurities as well as wear
facets, their number size and location, could be
.properly evaluated
:Diagnostic casts reveal

Occlusal discrepancies and the need to . 3

:establish a new occlusal plane
With the aid of radiographs, over-erupted teeth can be
easily spotted and evaluated and the amount of
.reduction needed could be determined
:Diagnostic casts reveal

Changes in teeth axial inclination for a . 4

:common path of insertion
Problems anticipated to attain a certain path of
insertion could be evaluated with the aid of dental
surveyor. Together with radiographic evaluation, the
amount of reduction needed without endangering the
pulp could be properly gauged. Accordingly the type of
.bridge and retainer could be decided
:Diagnostic casts reveal

:Abutment teeth form, size and mal-position . 5

Considering the necessary retentive means the length
of abutment can be properly assessed to determine the
.type of retainer and the retentive features needed

:Planning the suitable bridge design . 6

.This could be easily proposed on the cast

:Diagnostic casts reveal

Trial tooth preparation and waxing prior to . 7

:initiating the treatment
This is a very useful diagnostic technique for those
cases to be restored with fixed partial dentures.
Apractitioner could rehearse a proposed treatment plan
on a stone cast, this enables him to visualize the
possible problems to be encountered in the clinical
treatment, also through daignostic wax-up the final
shape and form of the prosthesis could be properly
. assessed
:V. Radiographic Examination
Radiographic Examination of the Teeth and Investing
:Structures

:Coronal portion. 1

Pulp portion. 2

Root portion. 3

Periapical area. 4

Thickness of periodontal membrane. 5

:V. Radiographic Examination
Radiographic Examination of the Teeth and Investing
:Structures

Coronal portion: Together with clinical. 1

:examination
Any carious lesions both on the unrestored proximal -
.surfaces and recurring around previous restorations

Any local formative defects ( ex. Hypoplastic pits, -

(amelogenesis imperfecta
:V. Radiographic Examination
Radiographic Examination of the Teeth and Investing
:Structures

:Pulp portion. 2
Size of pulp chamber (necessary in cases of over -
(eruption, mesial tilting

In non-vital teeth, whether endodontically treated or -

.not, and to evaluate the perfection of endo-treated teeth

The size, direction and number of RC to determine its -

suitability for endodontic treatment
N.B.: If a non-vital tooth not suitable for endodontic
therapy, so extraction is the treatment choice
:V. Radiographic Examination
Radiographic Examination of the Teeth and Investing
:Structures

Root portion: Radiographic evaluation of the root. 3

:and supporting tissue for

:Crown: root ratio

:Root configuration

:Periodontal surface area

:Crown: root ratio
It is a ratio between the linear length of that part of “
tooth above the level of alveolar crest of bone to that
”.part of root embedded in the bone, optimally 2:3
N.B.: More details are discussed in treatment planning
.section
:Root configuration
Abutment roots are evaluated for their configuration “
:and direction
Broader roots labio-lingual are preferable than those -
.rounded cross section
Multi rooted widely separated roots provide better -
. support than converging fusing roots
:Periodontal surface area