Professional Documents
Culture Documents
planning in removable
partial denture
BY
Dr.chakradhar
I st year post graduate student
Dept. of prosthodontics 1
contents
• Introduction
• Definitions
• Patient interview and history taking
• Initial examination
• Diagnostic impressions and casts
• Development of treatment plan
• PDI
• Review of literature
• Conclusion
• References
2
For any disease or condition to be treated, it is very
important to know the background and forms of the
disease itself, so that it can be identified in the
various patterns that it presents and the necessary
treatment be instituted. So, an accurate diagnosis
is important.
3
Many failure in removable partial denture
treatment can be traced to inadequate diagnosis
and incomplete treatment planning.
4
DEFINITIONS
Diagnosis: The determination of the nature of a disease.
(GPT-9)
6
Objectives:
1. To Establish Rapport with the patient
In 1961, Dr M. M. Devan stated, “ We should
meet the mind of the patient before we meet
the mouth of the patient.”
7
Phoenix DR Cagna DR , DeFreest CF; Stewart’s Clinical removable partial
prosthodontics - 4th edition 119-204.
8
3.To Ascertain The Patients Expectations of
treatment.
10
The dentist should maintain a relaxed
and attentive physical posture.
11
Medical History
12
DIABETES :
HYPERTHYROIDISM
PAGET'S DISEASE:
PEMPHIGUS VULGARIS
17
EPILEPSY
19
CARDIOVASCULAR DISEASES
20
Prophylactic antibiotic coverage is always
recommended if surgical procedures are to be
accomplished for patients with a history of
21
CANCER
23
Some of the frequently prescribed drugs that can
affect Prosthodontic treatment are
Antihypertensive drugs:
Mostcommon side effect is orthostatic, or postural
hypotension which may result in syncope when the
patient suddenly assumes upright position.
Diuretic
24
agents prescribed for hypertension
patients
leads to decrease in saliva, and dry mouth
Anti coagulants:
Post surgical bleeding could be a problem
Endocrine therapy:
May develop an extremely sore mouth
25
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.
26
Dental History
27
• How did he/she lose his/her teeth? Caries? Periodontal?
Gather information about existing dentures. (reason
for dissatisfaction)
28
Presence of large number of restored teeth,
signs of recurrent caries, the evidence of
decalcification – susceptible to caries
31
Radiographs
32
Frequent usage of mints, soft drinks, sugar-containing
products, a change must be affected.
33
Evaluated to determine their effect on prognosis
Bruxismand clenching:
Bruxism is often initiated by interceptive occlusal
contacts(occlusal prematurities).
35
Askingwhether 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
discussed.
36
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.
42
CLASS III CLASS IV
Class V : An edentulous situation in which
teeth bound, anterior and posterior but the
anterior boundary tooth not suitable for
abutment.
43
Rule I : Classification should follow rather than
precede, any extraction of the teeth that might alter
the original classification.
Long span:
A long edentulous span would have
abutment teeth which cannot bear the
trauma of horizontal and diagonal occlusal
forces.
47
Also because of ridge resorption, the
pontics may have to be placed in extreme
labial inclination for lip support.
In such cases a removable partial denture which
provides favorable esthetics and cross arch
stabilization is indicated.
48
• Excessive loss of bone in posterior area.
• Where a future change in denture
design is anticipated
• Economic
considerations
49
Position of the patient
The occlusal plane of the arch should be parallel
to the floor when the patient opens his mouth.
The patients mouth should be at the same level
as the dentists elbow.
Selection of the trays for alginate impression
Rim lock trays
Perforated metal trays
Plastic disposable trays
Ask the patient to rinse the mouth with a
50
mouth wash
Making impressions
Removal of impression from the mouth
2-3 min. after initial set
Cleaning the impression
Disinfecting the impression
Pouring of the cast
Dental stone
Trimming of the cast
51
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
53
Objective:
Toposition the casts of dental arches on an
articulator so that the casts have the same
relationship as do the mandible to maxilla in
the patient skull.
55
Centric jaw relation record
56
Why to mount the diagnostic casts
in centric relation
57
Media for recording centric jaw relation
58
Centric jaw relation records using
base - plates with occlusion rims
59
It should include
A thorough examination made of a dry field in
good light
60
Theteeth are tested for sensitivity to percussion
and mobility
Periodontal examination that includes
Determination of pocket depth, examination for
evidence of infection or inflammation, the amount of
attached gingiva of the prospective abutment teeth is
made
63
Evaluation of caries and existing
restorations
68
Evaluation of periodontium
71
If the irritation is removed – resolves on its own
o Denture stomatitis
72
Contributing factors: TFO, poor fit of the prosthesis,
poor oral hygiene, continuous wearing of prosthesis
73
Evaluation of hard tissue abnormalities
o Torus palatinus:
76
Evaluation of soft tissue abnormalities
Labial
and lingual frena as well as un supported
and hyper mobile gingiva should be evaluated to
determine whether surgical correction will
improve the prognosis of the treatment
77
Evaluation of quantity and quality of saliva
79
Evaluation of radiographic survey
All
prospective abutment teeth must be critically
evaluated
80
o Root size, length and form
81
o Lamina dura:
loss of lamina dura- hyperparathyroidism, Paget's
disease
Thickening of lamina dura- mobile teeth,
occlusal trauma,
Evidence of changes in lamina dura should be
correlated with findings of the clinical
examination and evaluation of the occlusion.
o Periodontal ligament space:
Widening with thickening of lamina dura
indicates – mobility, occlusal trauma, and heavy
function.
82
o Bone index areas:
These are the areas of alveolar bone that support
the teeth known to have been subjected to a
larger than normal work load.
83
• Signs of positive bone factor
A supportive trabecular pattern
Heavy cortical layer
Dense lamina dura
Normal bone height
Normal periodontal ligament space.
84
Evaluation of mounted diagnostic casts
85
o Interarch space
86
o Occlusal plane
87
• Irregular occlusal plane
Treatment
Moderately tooth – aprox 2mm -
extrude
enameloplasty.
If the extrusion is greater than 2 mm or if the tooth
does not lend itself to enameloplasty, the placement
of a crown is indicated.
If size of pulp prevent the required tooth reduction
endodontic therapy
If clinical crown length is inadequate crown
lengthning
Type 3:
Both maxillary and mandibular incisors incline lingually
with impingement of the gingival tissues of each arch
Type 4: 89
The mandibular incisors move or extrude into
the
abraded lingual surfaces the maxillary anterior teeth
o Clinical symptoms of traumatic vertical overlap
Abrasion
Mobility
Migration of the teeth
Inflammation , ulceration of the gingiva and
palatal mucosa
90
Malrelation of jaws
91
o Tipped or malposed teeth
92
o Occlusion
The information obtained from the analysis of
occlusion should be correlated with other clinical
findings.
• Radiographic findings
Widening of periodontal space with either thickening
or loss of lamina dura
Periapical or Furcation radiolucency
Resorption of alveolar bone
Root resorption
94
The decision must be made in the
diagnostic phase of the treatment.
97
Development of treatment plan
98
Phase 2:
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
• Reinforcement of education and
motivation of patient
99
Phase 3 :
• 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
100
Phase 4 :
• Construction of removable
partial denture
• Reinforcement of education
and motivation of patient
101
Phase 5 :
• Post insertion care
• Periodic recall
• Reinforcement of education
and motivation of patient
102
Prosthodontic diagnostic index (PDI)
Following a complete and thorough
diagnosis of dental and oral conditions, it
may be helpful to classify the patient.
• A classification system provide a
framework for orgainizing clinical
diagnostic findings,
• categorizing potential treatment
approaches, and
• indicating when specialty referal is most
appropriate.
103
DIAGNOSTIC CRITERIA FOR PDI
Criteria 1 : Location and extent of the edentulous area(s)
Class I
Ideal or minimally compromised edentulous area – single
arch and one of the following:
• Any anterior maxillary edentulous area – not exceed 2
incisors
• Any anterior mandibular edentulous area – not exceed 4
incisors
• Any posterior maxillary or mandibular edentulous area –
not exceed 2 PM or 1 PM and 1 molar
104
111
Kelly studied that almost inevitable degenerative changes
develop in the edentulous regions of wearers of complete
upper and partial lower dentures.
112
Ellsworth kelly: Changes caused by a mandibular removable partial denture opposing a maxillary
complete denture. J Prosthet Dent 1972;27:140-150.
Ill fitting denture have been blamed for all of the lesions
of the edentulous tissues, yet the most perfect denture
will be ill-fitting after bone is lost from the anterior part
of the ridge.
113
Ellsworth kelly: Changes caused by a mandibular removable partial denture opposing a maxillary
complete denture. J Prosthet Dent 1972;27:140-150.
conclusion
116