Diagnosis and Treatment Planning -

Removable Partial Denture

Part-1
Dr. Mustafa zeinalabidin
 Definitions:

• Diagnosis : the determination of the nature

of a disease

• Treatment plan : the sequence of

procedures planned for the treatment of a
patient after diagnosis
“Most clinicians also choose an RPD for a partially
edentulous patient if they need to restore lost residual
ridge, achieve appropriate esthetics, increase
masticatory efficiency, and improve phonetics but are
unable to do so with dental implants or fixed partial
dentures due to financial constraints or patient desires”

“Problems related to RPDs may be associated with

errors in diagnosis and treatment planning, including
inadequate mouth preparation “
Purpose of Treatment
The purpose of dental treatment is to respond to a
patient's needs, both the needs perceived by the
patient and those demonstrated through a clinical
examination and patient interview.
 Treatment planning
The treatment of partially edentulous patient
can be divided into six phases.
• Phase I:
• Emergency treatment to control pain or infection.
• Collection and evaluation of the diagnostic data –
diagnostic casts and radiographs.
• Biopsy or referral of the patient
• Developing a design and formulating a treatment
plan.
• Reinforcement of education and motivation of patient
• Phase 2: Preparation of mouth.

– Removal of deep caries and placement of temporary

restorations
– Extirpation of inflamed or necrotic pulp tissues
– Removal of non retainable teeth
– Periodontal treatment
– Construction of interim prosthesis for function or
esthetics
– Occlusal equilibration
– Reinforcement of education and motivation of patient

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• Phase 3 : continue in preperation of mouth
– Preprosthetic surgical procedures

– Definitive endodontic procedures

– Definitive restoration of teeth, including placement of

cast metallic restorations

– Fixed partial denture construction

– Reinforcement of education and motivation of patient

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• Phase IV
Final impressions and fabrication of master cast.

Fabrication of removable partial denture.

• Phase V
• Denture insertion.
• Postinsertion instructions.
• Phase VI
• Maintenance and recall.
Organizing the diagnostic examination
The examination can be completed most effectively
and expeditiously if two appointments are used.

In the first appointment the patient

1. fills out a health questionnaire and is interviewed.
3. A cursory examination of the oral cavity is made to
identify any condition that requires immediate attention.
4.Oral prophylaxis is accomplished; a radiographic survey
is completed.
5. Accurate diagnostic impressions and casts are made.

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 The second appointment includes

 Mounting of The diagnostic casts ,

 A definitive examination of the oral cavity,

 Interpretation of radiographs & correlated with the clinical findings,

 Arrangements are made for any needed consultation with a medical or

dental specialist,

 The diagnostic data are analyzed and a definitive treatment plan is

formulated.

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 Health questionnaire

• It should be inclusive enough to provide

information concerning any systemic
condition and other that may affect the
prognosis of the treatment.

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• Valuable information may be gained from
many patients by simply allowing them to talk.

• The patients opinion of the dentists, past dental

treatment, their fears, their health, expectations of
treatment may be learned by asking few general
questions.

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 PATIENT INTERVIEW

patient interview

personal information chief complain medical history dental history

name,age systemic
pain,swelling,esthetic, last visit,denture
,occupation,mobile disease,family
function....etc. history.
number. histiry,drugs
 Aids for successful
interview
Dentist's attitude and behavior:
 The patient who perceives the dentist as
caring, understanding, and respectful is more
likely to be honest and co-operative.

 The dentist should make eye contact with

the patient, looking directly at the patient
and displaying complete attention rather
than studying radiographs or writing.
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 The dentist should maintain a relaxed and
attentive physical posture.

 The dentist should employ head nodding,

verbal following, and verbal reflection.

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Questions from the patient:

– Asking whether the patient has any questions is a

good way to terminate the interview, and it allows
the patient to open any new subject or to add to
any previous areas that have been

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 chief complain

the patient comes for professional examination because

of some perception of :
(1)an abnormality that requires correction or (2) to
maintain optimum oral health.
The interview involves understanding the patient's chief
complaint or concern about their oral health.
• symptom of pain
• difficulty with function,
• concern about their appearance
• problems with an existing prosthesis
• symptoms related to their teeth, periodontium, jaws,
or previous dental treatment.
Medical History

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 Medical history

A comprehensive medical history includes :

- systemic disorders (Chronic degenerative
or dysfunctional diseases)
- Medication history
- Diet
- Habits
Systemic disorders include:
❑Hypertension
❑Diabetes
❑Pernicious anemia
❑Vitamin or nutritional deficiencies
❑Osteoporosis
❑Chronic pulmonary disease (i.e., emphysema
and chronic bronchitis)
 Medication history
 Some of the frequently prescribed drugs that can affect Prosthodontic
treatment are

 Antihypertensive drugs:
Most common side effect is orthostatic, or postural
hypotension which may result in syncope when the patient
suddenly assumes upright position.

Therefore care must be taken when the patient gets up from

the dental chair.

Diuretic agents prescribed for hypertension patients leads to

decrease in saliva, and dry mouth

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– Anti coagulants:
• Post surgical bleeding could be a problem

• These patients should be referred to an oral surgeon

for management of the surgical phase of the
treatment.

– Endocrine therapy:
• May develop an extremely sore mouth

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– Saliva inhibiting drugs
• Banthine, atropine which are used to control excessive
salivary secretion are contraindicated in patients with
cardiac disease because of their vagolitic effect.

• Other contraindications are prostatic hypertrophy, and

glaucoma.

• Saliva should be controlled by mechanical means in these

patients.

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 Diet

 Frequent usage of mints, soft drinks, sugar-

containing products, a change must be affected.

 The problems caused by sugar are compounded

by the wear of removable partial denture
because the denture shields the micro organisms
from the cleansing and buffering action of
patient’s saliva.
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 Habits
 Evaluated to determine their effect on prognosis

 Bruxism and clenching:

Bruxism is often initiated by interceptive occlusal contacts

The occlusion should be analyzed to determine any correction

is indicated, if the efforts are unsuccessful the patient should
wear occlusal splint to protect the remaining teeth.

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 Tongue thrusting:
Could cause extensive stress on the teeth retaining
and supporting the partial denture.

Eliminate the habit before fabrication of the

prosthesis, if it persists the partial denture should
be designed to distribute the forces to as many
teeth and supporting structures as possible.

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 • Dental History
Structure of the interview
• How did he/she lose his/her teeth? Caries? Periodontal?
Gather information about existing dentures. (reason for
dissatisfaction)

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 Patient interview
• Objectives:
1. To Establish Rapport with the patient
We should meet the mind of the patient before we
meet the mouth of the patient.”

2. To Gain Insight Into The Psychologic Makeup of

the patient (Philosophical, Exacting, Hysterical,
Indifferent)

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3. Ascertaining the patients expectations of treatment
The fourth objective of the interview - determine whether
they are realistic in the light of oral and physical conditions.

Any partial denture will complicate oral hygiene procedures,

occupy space in the oral cavity, necessitate a learning and
adaptation period.

If these inconveniences are not acceptable, chances for

successful treatment are limited.

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.

4. Explore Any Physical Problems that may affect the

treatment .

 Any positive responses in the health questionnaire

must be explored in detail and evaluated.

 When any doubt exists, the most prudent action is

to seek a medical consultation before initiation of
the dental treatment.

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 INITIAL EXAMINATİON
Problems requiring immediate attention:
 Large carious lesions: excavation, temporary
restorations
 Ill-fitting dentures: adjustment or temporary relining
to eliminate discomfort & allow recovery of the
damaged tissues.

Evaluation of oral hygiene:

 Inadequate oral hygiene must be recognized
 Preventive dentistry programs are initiated
 The ultimate success of the treatment depends on
home care of the patient, technical procedures
provided by the dentist.

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• Oral prophylaxis

– Supra gingival calculus should be removed and oral

prophylaxis should be performed if these procedures have
not been performed recently.

– The diagnostic casts and the definitive intra oral examination

will be more accurate if the teeth are clean.

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Radiographs

 A complete series of periapical and bitewing

radiographs is essential for complete examination.

 Panoramic radiographs are ideal for screening for

pathologic conditions.

 Excellent periapical radiographs are essential for

determining the crown/ root ratio of the remaining
teeth, the status of periodontal ligament space, and
lamina dura, quality of ridge in the edentulous
areas.

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 Diagnostic impressions and casts
• A diagnostic procedure is incomplete unless it
includes the evaluation of accurate diagnostic casts.
– Permits analysis of contour of both hard and soft tissues of
the mouth

– Determines the type of restorations to be placed on the

abutment teeth

– Determines the need for the correction of exostoses, frena,

tuberosities, and undercuts

– The casts are surveyed, the proposed design is drawn on

the casts.

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• The designed casts serve as a blue print for the
placement of restorations, the re contouring of teeth,
and preparation of rest seats.

• Aid in the presentation of proposed treatment plan to

the patient.

• The mounted diagnostic casts permit analysis of the

patients occlusion, adequacy of inter arch space, and
of the presence of over erupted or malposed teeth and
tuberosity interferences.

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• It is the dentists responsibility to explain to the
patient

– The signs and symptoms of dental disease,

– The equipment and techniques for proper home care,

– The patients responsibilities in preventing further

dental disease, and their importance for the long-term
success of the treatment.

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