D IAGNOSIS AND

TREATMENT PLANNING FOR

COMPLETE DENTURES

By
Dr. Muhammad Afzal
Registrar
“The dentist should meet
the mind of the patient
before he meets the
mouth of the patient”
De Van - 1942
 DIAGNOSIS

 Familiarity with the patient

 Principles of perception
 Detection
 Discrimination
 Recognition
 Identification
 Judgement
 S OCIAL INFORMATION

 Name.
 Age.
 Sex.
 Religion and race.
 Occupation.
 Address.
 Telephone number.
 Marital Status.
 Previous dental or denture experience.
 M EDICAL STATUS

 Medical history.
 Family history.
 Dental history.
C ONDITIONS OF DEBILITATING
NATURE

 Senility  Endocrine disorders

 Diabetes  Menopause
 Tuberculosis  High basal
metabolic rate
 Joint diseases
 Grand climacteric.
 Blood dyscrasias
 In which there is
generalized loss of
bone through out
the body.
 D ENTAL HISTORY

 How many dentures?

 How long worn?
 Age of present set?
 Satisfaction with dentures?
 Things patient likes - what they want
changed
 M ENTAL HEALTH

A denture always fits better in

the mouth of a satisfied patient
 M ENTAL HEALTH

Alan Mack classified individuals according

to their mental attitude.
 Ectomorph(Worrying type).
 Endomorph(Care free).
 Mesomorph(Passive).
 M ENTAL HEALTH

House divided the mental attitude into 4 major

groups
 Philosophic or Reasonable
 Indifferent or passive
 Critical or Exacting
 Skeptical or Antagonistic
 P HILOSOPHIC OR
REASONABLE

 These are normal ideal.

 They understand the limitations of an artificial

prosthesis.

 They are ready to play their role in the perseverance

and learning phase.

 They do not unnecessarily criticize the operator.

 They correctly interpret their problems neither

overstating nor under expressing.
 I NDIFFERENT OR PASSIVE

 Patient shows no concern. They are not interested and

lack motivation.

 Pays no attention to the instructions.

 They are non cooperative.

 They seek prosthesis at the request of family members

or at the advice of the physician.
 C RITICAL OR EXACTING

 The patient is methodical, precise and accurate.

 At time he is more demanding.

 Can be managed if handled properly.

 S KEPTICAL OR ANTAGONISTIC
/ HYSTERICAL

 Emotionally unstable.

 Excitable, hypertensive.

 Grumbling even with little things.

 Patients having family problems or psychological

disturbances usually fall into this category.
 G ENERAL EXAMINATION

 General health and constitution

 Cardiovascular System Disturbances
Blood pressure, Angina, Infarction, Rheumatic fever

 Respiratory System Diseases

Tuberculosis, Asthma, Dyspnoea, Edema

 Gastrointestinal Tract Disturbances

Ulcers, Jaundice, Nausea, Vomiting, Diarrhea, Constipation,
Cirrhosis
 G ENERAL EXAMINATION

 Endocrine Disturbances
Diabetes , Steroids

 Hematopoetic Disorders
Anemia, Bleeding disorders

 Neurological Disturbances
Epilepsy, Convulsions, Paralysis, Psychiatric
treatments,, Tranqulizers.
 L OCAL EXAMINATION

 Visual examination
 Physical examination
 Digital examination
 Conditions of occlusion
 V ISUAL EXAMINATION

 Oral Cavity
Inflammation, Growth, Cysts, White lesions
 Character of Enamel
Rampant caries, Abrasion, Attrition, Erosion,
Abfraction
 Periodontal Conditions
Gingiva, Pockets, Tooth mobility
 Oral Hygiene habits
 C AUSES OF TOOTH LOSS

 Periodontal disease
 Caries
 Trauma
 Orthodontic indications
 C ONSEQUENCES OF TOOTH
LOSS
 Extra load on digestive
organs
 Impaired digestion
 Systemic disturbances
 General poor health
 Impaired phonetics
 TMJ Changes
 Supra occlusion of
opposing teeth
 Tilting of adjoining teeth
 Discomfort
 Loss of confidence
 D IGITAL E XAMINATION

 Sharp bony spicules

 Torus palatinus
 Mid-palatal suture
 Torus mandibularis
 Ridge form
 R ADIOGRAPHIC E XAMINATION

 Bone
Nature, Degree of calcification,
Stress bearing quality.

 Pathology
Cysts, Embedded roots, Unerupted
teeth
 R ADIOGRAPHIC E XAMINATION

 Foci of infection
Remaining teeth, Number and length of
roots, Interproximal caries

 Foraminae - exact position

A NATOMY OF M AXILLARY DENTURE
BEARING AREA
M AXILLA
E DENTULOUS M AXILLA
 E DENTULOUS M AXILLA

 Foundation of denture
bearing area:
 Stress Bearing or
supporting area

 Peripheral or limiting
area
 E DENTULOUS M AXILLA

 Supporting structures
• Bone
• Residual ridge
• Mucous membrane
 E DENTULOUS M AXILLA

 Supporting structures
• Bone
• Residual ridge
• Mucous membrane
 S UPPORTING STRUCTURES

 Bone:
 Hard Palate:
 PRIMARY SUPPORT AND STRESS BEARING
AREA
 Two maxillary and two palatine bones –
Foundation for hard palate
 Palatine process of two maxillae joined
together at mid palatal suture.
 H ARD PALATE

Incisive
foramen
Palatine
process of
Maxilla
Alveolar
ridge

Palatine Greater
bone Palatine
foramen
H ARD PALATE

Buccal
Frenum

Mid
Palatal
suture

Hard
Palate

Maxillary
tuberosity
 R ESIDUAL RIDGE

 Alveolar ridges after removal of natural teeth are called

residual ridges

 Size and shape changes. Rapid at first then reduced rate

throughout life

 SECONDARY SUPPORTING OR STRESS BEARING AREA

 During 1st year of extraction, reduction of residual ridge

in Maxilla in midsagittal plane is 2-3 mm.

 After that, it is reduced to 0.1 to 0.2 mm per year.

 M UCOUS MEMBRANE

MUCOUS MEMBRANE

Mucosa Submucosa
Dense
Stratified sqamous epithelium Connective tissue
Loose areolar tissue
Often Keratinized
Fat Glandular
Masticatory mucosa Transmit nerve and
Muscle
blood supply to mucosa
Hard Palate
Crest of residual ridge
Residual attached gingiva
 S HAPE OF SUPPORTING
STRUCTURE

 Various factors depend on the form and size of the

supporting bone:
1. Original size and consistency
2. General health of person
3. Forces developed by the surrounding musculature
4. Extent of periodontal disease
5. Effect of wearing dental prosthesis
6. Surgery at the time of extraction
7. Span of being edentulous
 I NFLUENCES ON SHAPE OF
HARD PALATE AND RIDGE

Incisive Foramen

Maxillary
tuberosity
Sharp Spiny
processes
Torus Palatinus
 E DENTULOUS M AXILLA

 Limiting structures
 E DENTULOUS M AXILLA

 Limiting structures
• Labial Vestibule
• Labial frenum
• Buccal vestibule
• Buccal frenum
• Vibrating line
 L ABIAL VESTIBULE

 Divided into right and left by

labial frenum

 Labial frenum contains no

muscles

 Mucous membrane lining the

Labial vestibule – thin mucosa.

 Submucosa thick – loose

areolar tissue and elastic
fibers.

 Lining mucosa

 Orbicualris oris
 B UCCAL VESTIBULE

 Lies opposite to tuberosity and

extends from buccal frenum to
hamular notch.

 Buccal frenum – Levator anguli

oris, Orbicularis oris (pulls
frenum forward), Buccinator
(pulls backward)

 Distal to frenum lies root of

zygoma.

 Increasing resorption makes it

prominent
 V IBRATING LINE

 Imaginary line drawn on soft

palate that marks beginning of
motion of soft palate. Extends
from one hamular notch to
other.

 Ahhh

 Midline – 2 mm anterior or
posterior to Fovea palatinae

 Vibrating line always on soft

palate

 Anterior and posterior

vibrating lines