 Diagnosis : determination of the nature of a

disease

 Treatment plan : the sequence of procedures

planned for the treatment of a patient after
diagnosis
 The ultimate treatment is individualized to address
disease management and the coordinated restorative
and prosthetic needs that are unique to the patient.

 understanding the patient’s desires or chief

concerns/complaints regarding his or her condition

 ascertaining the patient’s dental needs through a

clinical examination,

 developing a treatment plan that reflects the best

management of desires and need

 Executing appropriately sequenced treatment with

planned follow-up
 The process of clinical examination
involves two stages :
- Medical examination

- Oral examination

A comprehensive medical history includes :

systemic disorders (Chronic degenerative or
dysfunctional diseases)
Medication history
Diet
Habits
Systemic disordes include:
Hypertension

Diabetes

Pernicious anemia
Vitamin or nutritional deficiencies
Osteoporosis

Chronic pulmonary disease (i.e.,emphysema and

chronic bronchitis)
 Climacteric (i.e., menopausal changes)
 Parkinsonism
 Salivary gland disorders
 TM disturbances
 Post radiation therapy
 Bell ’ s palsy
 Lichen planus
 Fungal infections
An oral examination should be accomplished in
the following sequence :

1.visual examination,
2.pain relief and temporary restorations,

3.radiographs,

4.evaluation of abutment and periodontium,

5.vitality tests of individual teeth,

6.determination of the floor of the mouth position,

7.Oral prophylaxis and impressions of each arch.

This includes : extra oral and intra oral examination.

TMJ - tenderness, mouth opening deviation & clicking

 No of teeth present with their clinical evaluation
 Malposed teeth
 Carious teeth
 Existing restoration- sensitivity to percussion
 Periodontium
 Residual ridges
 Saliva
 Investing structures
 Occlusion and occlusal plane
 Oral hygiene index
 to determine the need and management of
acute needs and whether a prophylaxis is
required to conduct a thorough oral
examination.

 to relieve discomfort arising from tooth defects

 the extent of caries and arrest further caries

activity
1) areas of infection and other pathologies

2) the presence of root fragments, foreign

objects, bone spicules and irregular ridge
formations

3) the presence and extent of caries and the

relation of carious lesions to the pulp and
periodontal attachment

4) evaluation of existing restorations : evidence

of recurrent caries, marginal leakage, and
overhanging gingival margins
5) the presence of root canal fillings

6) evaluation of periodontal conditions present

7) to evaluate the alveolar support of abutment

teeth, their number, the supporting length and
morphology of their roots

8) the relative amount of alveolar bone loss

suffered through pathogenic processes, and the
amount of alveolar support remaining
  To locate inferior borders of lingual mandibular
major connectors.

 oral hygiene status before prosthodontic treatment is

important.

 The impression for the diagnostic cast is usually

made with an irreversible hydrocolloid in a stock
(perforated or rim lock) impression tray.
• Anatomic consideration
 - Root length, size and
form
• vitality tests
• caries evaluation
• Periodontal health
• Malpositions
• Analysis of Occlusal
Factors
Vitality tests should be given particularly to teeth to be used as
abutments and those having deep restorations or deep carious
lesions.Radio graphic interpretation : Bone density, Periodontal
ligaments and the lamina dura, Root configuration, Radiolucent or
radiopaque lesions
Vitality tests : should be given particularly to
teeth to be used as abutments and those
having deep restorations or deep carious
lesions.

Radio graphic interpretation : Bone density,

Periodontal ligaments and the lamina dura,
Root configuration, Radiolucent or
radiopaque lesions.
• Supplements oral examination
• Permit a topographic survey of the dental arch
• Patient education and motivation
• Custom tray fabrication
• Constant reference
• Patient's record
 verification of appropriate
mouth modifications for a
removable partial denture.

 To determine the most

desirable path of placement
that will eliminate or minimize
interference to placement and
removal.

 To locate and measure areas

of the teeth that may be used
for retention.
 To determine whether tooth and
bony areas of interference will need
to be eliminated surgically or by
selecting a different path of
placement

 To determine the most suitable path

of placement that will permit
locating retainers and artificial teeth
to the best esthetic advantage.

 To permit an accurate charting of

the mouth preparation to be made
including the preparation of
proximal tooth surfaces to provide
guiding.
• Occlusal plane & relationships
• Abutment tooth contours
• Rest seat areas
• Interarch space
• Residual ridge relation
• Tissue contours
 Akerly (1977) has classified traumatic vertical overlap
into four basic types:

Type 1 – the mandibular incisors extrude and impinge into

the palate.

Type 2 – the mandibular incisors impinge into the gingival

sulci of the maxillary incisors.

Type 3 – both maxillary and mandibular incisors incline

lingually with impingement of the gingival tissues of
each arch.

Type 4 - the mandibular incisors move or extrude into the

abraded lingual surfaces of the maxillary anterior teeth.
The objectives of any prosthodontic treatment may
be stated as follows:

 the elimination of disease

 the preservation, restoration, and maintenance of

the health of the remaining teeth and oral tissues

 the selected replacement of lost teeth; for the

purpose of restoration of function

 comfort and in esthetically pleasing manner

 Implant supported fixed dental prosthesis
 Fixed dental prosthesis
 Removable partial denture
 Complete denture
 Combination of the above
 No treatment at all
1. Distal extension situations
2. After recent extractions
3. Long span
4. Need for cross-arch stabilization
5. Excessive loss of residual bone
6. Sound abutment teeth
7. Abutment with guarded prognosis
8. Economic considerations
1. An RPD can replace lost supporting tissues
in addition to missing teeth. Normal
contour, appearance, and facial support
may be restored with the acrylic resin
denture base material where bone and alveolar
tissue have been lost.
2. An RPD can use soft tissue areas of the
mouth for support in addition to using the
teeth, so an RPD may function successfully
when the teeth alone cannot support an
FPD.
3. An RPD may help the patient maintain a
more acceptable level of oral hygiene. Use
of an RPD enables the patient to clean both
the prosthesis and the remaining natural
teeth, since the prosthesis can be removed.
4. An RPD may be designed to splint and
stabilize weakened abutment teeth
and prevent the loosening, drifting, or
extrusion of retained teeth. The cost
of cast restorations and the problem
of unhygienic soldered splints may
sometimes be avoided when an RPD
is used.
5. An RPD may be designed to distribute
the forces of mastication on to many
support areas and to multiple abutment
teeth to prevent overloading only two or
three teeth.
 It is a communication model

 a process where the provider and the patient identify

together the best course of care.

 it addresses the need to fully inform patients about

risks and benefits of care options

 ensures that patient values and preferences play a

prominent role in the process.
 Computer-designed
polycarbonate RPD
framework.

Digital partial design and manufacturing: using 3D printing

technology to fabricate RPD frameworks
 Valplast RPDs with
anterior flexible nylon
clasps.

A cast metal framework

with metal clasps and
flexible nylon polyamide
retentive clasps
 Mandibular overlay RPD
metal framework

Mandibular overlay
unilateral distal extension
RPD with tooth-colored
acrylic resin processed to
the metal framework
Minimize rotation about an axis in a Kennedy
Class I or II arch, or any long modification span

direct retainers
rests
Phase I Phase II
Collection and  Removal of deep caries
evaluation of data  Extirpation of necrotic
Pain, infection control pulp
Biopsy  Extraction of non-
Patient motivation retainable teeth
 Periodontal treatment
 Interim prosthesis
 Occlusal equilibrium
 Patient education
Phase III
 Preprosthetic surgical procedures
 Definitive endodontic procedures
 Definitive restoration of teeth
 Fixed partial denture construction
 Reinforcement of education and motivation of the
patient
 Phase IV
 Construction of removable partial denture
 Reinforcement of education and motivation of patient

Phase V
 Post insertion care
 Periodic recall
 Reinforcement of education and motivation of patient.
 Plan the amount of time and appointment schedule
 Provides information to the patient.
 Estimate the professional fees for the treatment.
 Coordinate the schedule for dental laboratory procedures
 Meet the legal requirements of informed consent
 Cummer’s system – 1921
 The Kennedy System – 1923
 The Applegate – Kennedy system
 Fiset-Applegate-Kennedy classification
 Bailyn’s system – 1928
 Neurohr’s System – 1939
 Mauk’s system – 1941
 Godfrey’s system – 1951
 Beckett’s system – 1953
 Friedman’s system – 1953
 Craddock’s system- 1954
 Watt’s system - 1958
 The Austin Ledge – 1956
 The Skinner’s system – 1957
 Wild’s system
 Swenson’s System – 1960
 Avant’s System – 1966
 Osborne and Lammie’s system
 McDermott’s system
 American college of prosthodontics system
 Costa’s system
 Classification for implant dentistry
Proposed by Dr.Edward Kennedy .
 Class-I : Bilateral edentulous area located posterior to the
remaining natural teeth.

 Class II : Unilateral edentulous area located posterior to

the remaining natural teeth.

 Class III : A unilateral edentulous area with natural teeth

both anterior and posterior to it.

 Class IV : Single but bilateral edentulous area located

anterior to the remaining natural teeth.
CLASS I CLASS II

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.

 Class VI: Edentulous situation in which

boundary teeth are capable of total
support of required prosthesis.
 Rule I : Classification should follow rather than precede, any
extraction of the teeth that might alter the original
classification.

 Rule II : If 3rd molar is missing, it is not considered in

classification.

 Rule III : If 3rd molar is present, and is used as abutment, it

is considered in classification.

 Rule IV : If 2nd molar missing, not replaced not considered

in classification.
 Rule V : The most posterior edentulous area always
determine classification.

 Rule VI : Edentulous area other than those determining the

classification are referred to modifications.

 Rule VII : Extent of modification is not considered; only the

number of additional edentulous areas.

 Rule VIII : There is no modification for Class IV.