DIVISIONS OF RESTORATIVE DENTISTRY

Monday, 6 February 2023 1:36 pm

Prognosis
• Refers to an estimation of the likelihood of a favorable outcome for a disease and is
usually expressed in such general terms as
○ Excellent
DIVISIONS OF RESTORATIVE DENTISTRY ○ Good
EXAMINATION AND DIAGNOSIS ○ Favorable
• Process of observing both normal and abnormal condition of the teeth, the oral ○ Unfavorable
cavity as a whole in order to arrive at an accurate diagnosis ○ Poor
○ Any deviation/abnormality can be a pathologic condition or there is disease • Be familiar on the expected outcome.
process already.
• By several procedures
○ Visual inspection - common
○ Problem
▪ Check clinically the condition of the tooth structure
○ Radiograph ▪ General or specific issues that are considered as significant findings
▪ May affect the treatment plan but doesn't fit the definition of diagnosis
○ Percussion
▪ Pieces of information in the patients data base gathered through scientific
○ Palpation - aids procedures
▪ e.g.
CHIEF COMPLAINT □ Financial constraints (patient factors)
○ Also known as chief concern □ Pain (disease condition)
▪ Patient's own words ○ Prognosis
▪ Use quote and quote ▪ Refers to an estimation of the likelihood of a favorable outcome for a disease and
○ The primary reason/s that the patient has first present for treatment is usually expressed in such general terms as
▪ Those defect on the teeth that does not require full coverage restoration □ Excellent
HPI □ Good
○ The history of chief complaint which the patient usually supplies with a little □ Favorable
prompting □ Unfavorable
○ Third person □ Poor
○ The clinician tells the story ○ Treatment planning
▪ Elaboration of chief complaint/ or history.
• Check the teeth and surrounding tissues Prophylactic procedures
○ Seen in oral cavity ○ Preliminary procedures
○ Clinical examination refers to what is seen in the oral cavity.
Treatment planning/procedures
• Includes:
○ Sequenced series of services designed to eliminate or control etiological factors,
○ PHYSICAL EXAMINATION repair existing damaged, and create a functional maintainable environment
○ RADIOGRAPHIC EXAMINATION ▪ If we have preventive modalities, still, we need to properly follow the sequence
□ Even we have a plan, although a patient is compalining a problem or
concern, we still have additional procedure that needs to done, like
prophylactic procedures. So that after diagnosis, for example, the patient is
▪ wanting to have a restoration, but when you do the assesment, the patient
mouth is not clean. So do we need to proceed to do a restoration, or have
cleaning? It should be cleaning first to maintain the oral environment of the
patient that is condusive for oral health.
▪ Radiolucent (dark gray to black) - soft tissues  If the patient wants to have restoration but the environment of their oral
□ Gums/ gingival tissues cavity is not conducive, you need to do cleaning first
□ Pulp/ pulp chamber and root canal ▪ If the patient wants to have extraction but there are a lot of plaque, OP comes
□ Periodontal ligament space first
▪ Radiopaque (white) - hard tissues
□ Enamel Steps in the development of treatment plan
□ Dentin ○ Examination and problem identification
□ Bone/ alveolar bone ▪ that is related to the case
 Radiopaque line - lamina dura ▪ Problem listing
□ Any radiolucent area in radiopaque tissues/structures you may ○ Decision to recommend intervention
suspect a pathological issue ▪ Our Clinical judgement as to what will be our recommended treatment
 If there's a radiolucency in the enamel part, a carious lesion is ○ Identification of treatment alternatives
suspected. ▪ If the prognosis of the treatment recommendation may deal with unfavorable
 Also used to trace extent of carious lesion outcome, you may opt to choose alternative treatment
 Periodontal issues ▪ Do not only provide one or single treatment recommendations but provide
□ Bone, if there's a radiolucency: periodontal problem, the surrounding treatment alternatives
tissues are affected already. □ For example, patient is complaining about a severe pain on a tooth, and the
□ During trauma, the periodontal ligament space widens which leads to tooth is already badly broken.
periodontitis. □ Part of your recommended treatment would be extraction or root canal
therapy replacement. But the patient is having a financial constraint.
 Periapical radiolucency □ So what would be our treatment, extraction or root canal. And that depends
on our clinical judgement.
○ Selection of the treatment with the patients involvement
 ▪ Its not only the dentist dictating but together with the patient
○ Case discussion
○ Explain everything
◊ Abscess/pus formation/periodontitis: inflammation of the
▪ Findings in assessment
periodontium
▪ Created treatment plan
◊ Through case history taking or ask the patient or clinical Guidelines for sequencing dental treatment
examination (check for swelling) ○ Systemic treatment
◊ If there's swelling: abscess formation/apical abscess ( acute ▪ Involved a thorough evaluation of the patients health history and any procedures
or chronic ) necessary to manage the patients general and psychological health before or
◊ No swelling, pain when biting: Periodontitis during dental treatment
□ Whatever findings in medical and psychosocial, we need to consider it here
▪ Bitewing □ Because any condition may alter the treatment

a. Consultation with patients physician

▪ □ Clearance
□ Or write a letter template to the patient’s physician
 Dear dr. Rain, I have examine mr. John and I found out that tooth 11 is
indicated for root canal therapy. I will be using using lidocaine for
□ Identify interproximal caries
anesthetics. Since I will be doing the procedure with that said pain
□ You can see cleary here your enamelo junction, dentin, etc control. In this regard, may I seek from your office a clearance to this
□ To access alveolar bone loss patient. Sincerely yours
How to compute for bone level  This to inform the patient’s physician so that if the patient is taking any
 Get the CEJ and alveolar bone crest then minus 2mm medication, the physian will advice the patient not to take it because it
□ Level of bone might interfere with anesthetic solution the dentist will use.
 Bone resorption/loss is seen ◊ Physician will also advice the patient to take antibiotics 30 mins prior
▪ Panoramic to treatment.
b. Premedication
□ Instructed by the medical doctor
 Hand in hand with patient’s medical doctor, we are preventing possible
complications
□ □ e.g. stopping maintenance drugs minutes before the treatment

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 b. Premedication
□ Instructed by the medical doctor
 Hand in hand with patient’s medical doctor, we are preventing possible
complications
□ □ e.g. stopping maintenance drugs minutes before the treatment
□ Related to the medical condition of the patient
c. Stress/ fear management
□ Complications before the procedure
□ Trauma from previous practitioner
□ Structures seen: □ Debriefing
□ TMJ  Preparing the patient for fear/stress management
□ Defects on maxillary and mandibular jaws d. any necessary treatment considerations for systemic disease
□ Radiopaque structures can be restorations/crown ○ Acute treatment
□ To assess the presence of third molars ▪ The purpose is to resolve any symptomatic problems that a patient may present
with
▪ Complaints or problem that require attention such as pain, swelling, infection,
Intraoral and Extraoral Soft Tissue Examination broken teeth and missing restoration

a. Emergency treatment for pain and infection

□ Premedication (pain reliever)
 If the relief of pain is pertaining to pain reliever
b. Treatment of the urgent chief complaint when possible
□ Some complaints cannot be addressed right away
• ○ Disease control
▪ The goal is to control active oral disease and infection, stop occlusal and esthetic
deterioration and mange any risk factors that cause oral problems, includes also
oral hygiene instructions, scaling and root planing (oral prophylaxis), caries risk
assessment (identify level of patient)
□ If it is not a patient's complain it is under disease control but if it is the main
• Check if there could be presence of swollen area complain of the patient, place it under Acute treatment
• Asymmetry a. Caries removal to determine restorability of questionable teeth
o Mouth (opening) □ teeth that need to be restored
• Bony Overgrowth □ Not Chief complaint
□ Note that if you put the complaint under disease control, no need to place it
on definitive phase
b. Extraction of hopeless or problematic teeth
□ If this is the complain of the patient it is under chief complaint that needs
Acute treatment. But if it is not the complaint and the tooth really needs to be
extracted because it is badly broken not painful anymore it is under disease
control.
c. Periodontal disease control
□ Patients with calcular deposits and plaque that needs oral
prophylaxis/scaling or polishing
d. Caries control
□ Composite or amalgam restoration and replacing tooth defective tooth
Bony Exostosis / Torus Mandibularis Torus Palatinus restoration
• bony overgrowth in the floor of the mouth • Palate e. Replace defective restoration
□ Recurrent
□ Overhanging/overfilling
Clinical Significance: f. Endodontic therapy for pulpal or periapical pathology
Fabrication of Dentures: □ If patient complains that it is painful because of pulpal disease, it is under
• Consider removing the overgrowth through preprosthetic surgery. Acute treatment
Steps: g. Stabilization of teeth with temporary or foundation restoration
1. Flap the gums □ Deep cavitations that need observation placing temporary filling
2. Expose the bones h. Posttreatment assessment
3. Bur it out
4. Suture the gums back ○ Definitive treatment
▪ Aims to rehabilitate the patients oral condition and includes procedures that
Periodontal Examination improve appearance and function of the patient.

a. Advance periodontal therapy

□ Deep scaling and polishing wherein the calcular deposits are in the root
portion
b. Stabilize occlusion
c. Orthodontic, orthognathic surgical treatment
d. Occlusal adjustment
□ Orthodontic braces, splints, TMJD
e. Definitive restoration on individual teeth
□ This could either be definitive treatment or disease control
f. Esthetic dentistry
□ Venners, diastema closure, Laminates, peg-shaped lateral
g. Elective extraction of asymptomatic teeth
• Normal color: coral pink □ Wisdom teeth removal
o Reddish/purplish: Gingival to periodontal disease h. Prosthodontic replacement of missing teeth
• Attachment of Gingival Sulcus □ Jacket crown
o Margination line is seen between tooth structure and gingiva, appears to be □ Bridge
bulbous and hyperplastic.
□ Complete denture
▪ Consider Gingival Hyperplasia
i. Posttreatment assessment
▪ Gingival Disease: gingival only
▪ Periodontal Disease: Gingiva and bone
○ Maintenance therapy
• Assessed through radiograph.
▪ Periodic reevaluate the patient and provide supportive care to prevent relapse
Examination of the Teeth
and recurrent of disease. Includes periodic examinations, periodontal
Fistulous Tract maintenance treatment, fluoride application (reapplication) and oral hygiene
• Opening of pus/Bavarian instructions.. Check up every 6 months.
• Where it drains □ Fluoride application should be placed under disease control but for
• Abscess Formation REAPPLICATION it is under maintenance.

a. Periodic visits

Flat gums, Discoloration AAE CONSENSUS CONFERENCE RECOMMENDED DIAGNOSTIC TERMINOLOGY

• No striplings, no alveolar bone and mucosa NORMAL PULP a clinical diagnostic category in which the pulp is symptom free and
normally responsive to pulp testing
• Feel the stimulus w/o pain
• TESTS FOR PULP VITALITY
• Heat Test
• Cold Test
• Electric Pulp Testing (EPP)
Fluorosis
•

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 • Electric Pulp Testing (EPP)
Fluorosis
• Test cavity
• Excessive fluoride intake
• Opacification REVERSIBLE a clinical diagnostic based on subjective and objective finding that the
PULPITIS inflammation should resolve and the pulp return to normal
• Subjective finding: complaint from the patient
• Objective: from your test
• Px should feel the pain less than 5 seconds
Occlusal Analysis • Can be restored
• Check if there is good occlusal harmony / balanced occlusion. • Carious lesion
• There can be functional/parafunctional contacts IRREVERSIBLE a clinical diagnostic based on subjective and objective finding indicating
PULPITIS that the vital inflamed pulp is incapable of healing
• Px will feel the pain more than 5 seconds
• For root canal treatment
A. SYMPTOMATIC Lingering thermal pain. Spontaneous pain, referred pain
Diagnosis Irreversible • With or without stimulus, the px still feel the pain
• Determination or identification of the diseases condition based from thorough pulpitis
examination B. ASYMTOMATIC No clinical symptoms but inflammation produced by caries, caries
o Dental terminologies/scientific names are needed, as we give names now to Irreversible excavation, trauma
disease conditions. pulpitis • Px can't feel any pain but the pulp is infected but it is not dead yet
• Precise, scientific terms used to describe variations from normal because when you do drilling, may konti pang nararamdaman
Tentative Diagnosis • May be made when the PULP NECROSIS a clinical diagnostic category indicating death of the dental pulp, the pulp
diagnosis is uncertain but it is is usually nonresponsive to pulp testing
prudent to begin some type of
treatment Reversible pulpitis: the diagnostic terminology for your carious lesions other than GV black
• Hypothetical guess classification, because you can still bring back the status of the tooth through restoration
• A temporary dx can be used as
a basis for an intermediate tx. CASE ANALYSIS
Working Diagnosis A 30-year old male student complains of black discoloration of tooth 12 and 22. The said teeth
have class III caries on their mesial aspects. She also complains of bleeding on his gums
Differential Diagnosis • Findings suggest several during tooth brushing, Due to severe caries, his 14, 34 and 35 were extracted, his molars were
possible conditions. not carious but have deep pits and fissures. He is fond of eating sweets as well
• Possible conditions
Definitive Diagnosis • Specific disease entity as PROBLEM LIST POSSIBLE TREATMENT SEQUENCE
pointed out clearly by several
Black discoloration of 12 andComposite restoration (anterior) Acute treatment
findings.
22 & OP
• Final dx
Gingival bleeding Oral prophylaxis and oral Disease control
CLINICAL CASE: hygiene instructions
A Px complains mild pain on Tooth 11.
• Tentative Diagnosis: Pulpitis (either Missing 14, 34 and 35 Fixed partial denture, RPD, Definitive treatment
reversible) (edentulous between 13 & 15; implants
o This will be your working diagnosis or initial 33 & 36
diagnosis. Deep pits and fissures Pits and fissure sealants Disease control
Upon assessment, during stimulus placed Fond of eating sweets Diet counselling Disease control
on tooth, there is mild to moderate pain that
last longer even after the stimulus is
removed. TREATMENT PLAN
• Differential Diagnosis: Irreversible Pulpitis. SYSTEMIC PHASE Vitamin C supplement 500mg/day
o We can come up with different diagnosis. ACUTE PHASE Composite restoration of 12 & 22
Confirm. Test it. Apply heat stimulus to DISEASE CONTROL PHASE Diet counselling
determine the pain is continuous or Oral hygiene instruction
lingering. Test it through objective tests. Oral prophylaxis
Then ask the patient if he/she can feel pain Pit and fissure sealants on molars
or any symptom. After application, the pain
lasted for 3 seconds. DEFINITIVE PHASE Fixed bridge in b/w 13&15, 33&36
• Definitive Diagnosis: Reversible Pulpitis MAINTENANCE PHASE Reinforce OHI
• Within 5mins Reversible Pulpitis and OP/ check up every 6 month
more than 5mins Irreversible pulpitis.
• Pag wala nararamdaman at 5 years
nakayo doon, pulp necrosis hahahah

Aside from subjective finding form patient,

do your confirmatory test/diagnostic
procedures to come up with definitive
diagnosis. You should have your initial
diagnosis to be able to provide immediate
treatment to the Px complaint.

Problem
• General or specific issues that are considered as significant findings.
o Which is why we make problem list.
• May affect the treatment plan but doesn't fit the definition of diagnosis
o Dental Caries: Problem
o Classification of Caries/Reversible or Irreversible Pulpitis: Diagnosis
• Pieces of information in the patient’s data base gathered through scientific procedures
o e.g.
▪ Financial constraints (patient factors)
▪ Pain (disease condition)
• What you should point out as a beginner.

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