CASE HISTORY IN

COMPLETE DENTURE
PATIENTS
 Introduction

The successful complete denture therapy begins with

thorough assessment of patients physical and
psychological condition and determining the
treatment that will deliver a functional complete
denture.
 Definition

Case history:- A collected data about an

individual ,family ,environmental
factors (including
medical/dental history) and
other information that may be
useful in analyzing and
diagnosing conditions and for
instructional purposes ;best
termed as patient history.(GPT 8)
 Importance of Case History

• Obtaining a patient’s history and conduct a physical

examination are requisities to establish diagnosis and
treatment planning.

• To evaluate patient’s psycological behaviour.

• To understand expectations of patient regarding

denture.
 Sequence of recording case history

Personal data

 Name

 Age – It is an indicator of the patients ability to wear

and use dentures.

 Sex- Womens are more concerned about esthetics.

 Race- Critical factor in characterization of dentures

 Occupation- It is related to the design of the denture

 Personality- According to M.M.HOUSE

 Philosophic- Easy going,mentally well adjusted,cooperative

and has confidence in dentist

 Exacting- Precise,above average in intelligence,concerned

in their dress and appearance,often dissatisfied
with past treatment

 Hyterical- Patients are often in poor health,are poorly

adjusted,appear exacting but with unfounded
complaints,have failed at past attempts to wear
dentures and have unrealistic expectations

 Indifferent- Unconcerned with appearance often go without

denture for years
 Medical history

As a health professionals,dentist are responsible for the well being of patients

under care.
Systemic factors that may affect the complete denture therapy includes-
 Infectious diseases
Hepatitis B
Tuberculosis
 Metabolic diseases
Diabetes mellitus-bone response prosthetic stress is poor and requires
a pressure free impression tecniques.

Diseases of bone
Osteoporosis
osteoarthritis
pagets diseases
 Diseases of bone
Osteoporosis
Osteoarthritis
Paget’s disease

 Neuromuscular diseases

Parkinsonian disease- affects the stomatognathic

system by
altering the functions of
the jaws and tongue.Regular
exercises,maintainence of
prosthesis,adaptation and
oral hygeine are to be
encouraged.

Bells palsy- partial support for the affected oral

commisure is often possible with a
prosthesis a hook like device attached to
denture.
 Blood dyscrasias
Anemia
Leucopenia
Leukemia
 Cardiovascular diseases

Angina pectoris
Myocardial infarction

 Diseases of skin
Pemphigus
 Oral malignancies

• Tissues chronically abused by poorly maintained

natural and artificial dentition ,alcohol and tobacco
predispose the oral tissues to malignancy.

• Sharp borders of denture are avoided.

• In case of radiation therapy sufficient time has to be

given for the tissues to recover before treatment is
initiated.
 Nutritional status
• A complete denture prosthesis depends ultimately
upon the health and integrity of the denture bearing
tissues for successful function and comfort to the
patient.

• The following nutritional factors should be

considered-

 Xerostomia- Causes and effect of negative water

balance.

 Negative calciuum balance-Causes and effects on

alveolar bone.

 Nitrogen protein balance- Musle weakness tissue

fragility.
 Dental history
 Chief complaint

“The dentist should meet the mind of the patient before

he meet the mouth of the patient”-De Van

Importance-
 The chief complaint may be overlooked during therapy
 To access the patients expectations
 To determine patients psycological classification
 Expectations
 Years of edentulousness,max/man
 Reasons and sequence of teeth loss
 Previous dentures,max/man
 Existing or current dentures
 Denture success.
 Pre extraction records.
 Clinical evaluation
• Extraoral
 Facial form(frontal)
Facial form(profile)
 Muscle tone

• According to M.M.House

 Class 1- Normal muscle tone

 Class 2- Slight impaired muscle tone

 Class 3- Greately impaired muscle tone

 Complexion

Hair, eye , skin colour provides useful guides in the shade selection.

 Lip

 Examined for cracking ,fissuring at th corner and ulceration.

 Lip support- adequetely supported

unsupported

 Thickness- Thin
thick

 Lip length- long

normal
short

 Lip mobility- normal

reduced
paralysis
 Temporomandibular joint

• Palpation

• Auscultation

• Mandibular movements- normal

impaired
 Neuromuscular evaluation

 Speech- normal
affected

 Coordination- patient with good neuromuscular

coordination can be expected to
learn to manipulate dentures
relatively quickly and likewise adapt
readily to new dentures.

It can be classified as-

 Class 1-Excellent

 Class 2-Fair

 Class 3-Poor
 Intra oral examination

 Arch size
 Class 1-Large
 Class 2-Medium
 Class 3-Small

 Arch form-
 Class 1-Square
 Class 2-Tapering
 Class 3-Ovoid
 Ridge form

• Maxillary • Mandibular

Parallel walls
 Defects
• Ridge defects such as exostoses,sharp bony spicules
should be noted that may pose problem for complete
denture patients or may warrant preprosthetic
surgery.

• Tori may be classified as-

 Class 1-Tori are absent or minimal in size

 Class 2-Moderate in size
 Class 3-Large in size
 Inter arch space

• Class 1-Ideal

• Class 2-excessive

• Class 3-Insufficient
 Ridge parallelism

• Class 1

• Class 2

• Class 3
 Ridge relationship

• Class 1-Normal

• Class 2-Retrognathic

• Class 3-Prognathic
 Radiographic evaluation

Radiographic examination is an essential part of

diagnosis and treatment planning for all dental
patients.

The screening of jaws includes

 Retained tooth roots
 Unerupted teeth
 Foreign body
 Various pathosis of devlopmental,inflammatory or
neoplastic origin
 Bone quatity and quality
 According to Branemark et al

Bone qantity Bone quality

 Lateral throat form

• According to Neil
 Class 1

 Class 2

 Class 3
 Palatal throat form

According to M.M.House
 Class 1

 Class 2

 Class 3
 Palatal sensitivity

• According to M.M.House
 Class 1-Normal
 Class 2-Subnormal
 Class 3-Supernormal
Mucosa thickness
 Class 1-Normal uniform density of mucosal
tissue,investing membrane is firm.
 Class 2-Mucous membrane is thick,thin investing
membrane.
 Class 3-Excessive thick investing membrane filled
with redundant tissues.
 Mucosa condition

• 1According to M.M.House
 Class 1-Healthy
 Class 2-Irritated
 Class 3-Pathologic
Frenum attachments
 Class 1-High in maxilla or low in mandible
 Class 2-Medium
 Class 3-Freni encroach the crest of the ridge
 Saliva
 Class 1-Normal quality and quantity
 Class 2-Excessive saliva
 Class 3-Xerostomia
Tongue size
 Class 1-Normal in size,devlopnment and function
 Class 2-Teeth have been lost long enogh to permit a
change in form and function of tongue
 Class 3-Exceesively large tongue
 Position of tongue

• According to Wright
 Normal

 Class 1-Retracted

 Class 2-Retracted
 Existing dentures
 Existing esthetics,phonetics,retention,
stability,extensions and contours
should be evaluated.
 Should be rated as-
 Good
 Fair
 Poor
 Centric relation and vertical dimensions of occlusion
should be assesed and evaluated
 Occlusion plane orientation
 Midline
 Hygiene-good
-fair
-poor
 Wear
 Conclusion

A complete case history is presented for use in

evaluating and planning the treatment of patient for
complete denture therapy. The treatment plan
devloped for a patient should reflect the dentist’s
best efforts at interpreting the diagnostic findings
and addressing the patient’s need in keeping with
their appreciation for dentistry and their ability to
accept the proposed treatment.
 References
• Robert L.Engelmeier,Rodney D.Phoenix:Patient
evaluation and treatment planning for complete
denture therapy,Dental Clinics of North
America:40,1-18,1996.
• Heartwell MC:Diagnosis. In Syallabus of Complete
Dentures,ed 4,Charles M.Heartwell,Jr Arthur
O.Rahn,Varghese publishing house;Bombay;1992;106-
142.
• Douglas V.Chaytor:Diagnosis and Treatment Planning
for Edentulous or Potentially Edentulous Patients. In
Prosthodontic Treatment for Edentulous
Patients(Complete dentures and implant-supported
prosthesis),Zarb,Bolender,Mosby;St.Louis
MO;2005;73-99.
• Robert L.DeFranco,Lance F.Ortman: Diagnosis and
Treatment Planning.In Essentials of complete denture
prosthodontics,ed 2,Sheldon
Winkler;A.I.T.B.S;India;2000;39-55.