Case history, diagnosis and treatment

planning in complete denture patients

Prepared by:
Dr. Amal
II year PG
Department of Prosthodontics
 Introduction
• EDENTULISM is a debilitating and irreversible
condition and is described as the “final marker of
disease burden for oral health”

Int J Dent. 2013; 2013: 498305.

The Impact of Edentulism on Oral and General Health
Elham Emami, 1 Raphael Freitas de Souza, 2 Marla Kabawat, 1 and Jocelyne S. Feine 3 , 4
 Impact of Edentulism on General Health

• Increase the risk of cardiovascular diseases

and gastrointestinal disorders.
• Increased rates of chronic inflammatory
changes of the gastric mucosa, upper
gastrointestinal and pancreatic cancer, and
higher rates of peptic ulcers
Int J Dent. 2013; 2013: 498305.
The Impact of Edentulism on Oral and General Health
Elham Emami, 1 Raphael Freitas de Souza, 2 Marla Kabawat, 1 and Jocelyne S. Feine 3
• Increased risk of non insulin-dependent diabetes mellitus
• Increased risk of electrocardiographic abnormalities,
hypertension, heart failure, ischemic heart disease, stroke,
and aortic valve sclerosis
• Increased risk of chronic kidney disease
• Association between edentulism and sleep-disordered
breathing, including obstructive sleep apnea.

Int J Dent. 2013; 2013: 498305.

The Impact of Edentulism on Oral and General Health
Elham Emami, 1 Raphael Freitas de Souza, 2 Marla Kabawat, 1 and Jocelyne S. Feine 3
 Objectives of Prosthodontic Treatment
1. The elimination of disease;
2. The preservation, restoration, and
maintenance of the health of the remaining teeth
and oral tissues (which will enhance the
removable partial denture design)
 DIAGNOSIS
• It is the act or process of deciding the nature of a diseased condition by
examination, a careful investigation of the facts to determine the nature of a
thing. Or the determination of the nature, location and cause of disease.
(Heartwell)

• It is the examination of the physical state, evaluation of the

mental or psychological makeup, and understanding the needs
of each patient to ensure a predictable result. (Winkler)

• Determination of the course of the disease (GPT 8)

 Patient evaluation

Complexio
Gait
n

Cosmetic Mental
index attitude
Veeraiyan, Deepak Nallaswamy. 2nd ed
2017. Textbook of prosthodontics.
 Gait

Physiotherapy Clinic 
List Of Abnormal Gait: Physiotherapy Treatment :
 March 2, 2019
 Age
• The decade, which the patient belongs to, is
important to predict the outcome of treatment.
• For example patients belonging to the fourth
decade of life will have good healing abilities
and patients above the sixth decade will have
compromised healing.
Veeraiyan, Deepak Nallaswamy. 2nd ed
2017. Textbook of prosthodontics.
 Sex
• Male patients are generally busy people who
appear indifferent to the treatment. They are
only bothered about comfort and nothing else.
• On the other hand, female patients are more
critical about esthetics and they usually appear
to overrule the dentist in treatment planning.
Veeraiyan, Deepak Nallaswamy. 2nd ed
2017. Textbook of prosthodontics.
 Cosmetic Index
Class I
• High cosmetic index

Class II
• Moderate cosmetic patients

Class III
• Low cosmetic index
Veeraiyan, Deepak Nallaswamy. 2nd ed
2017. Textbook of prosthodontics.
Veeraiyan, Deepak Nallaswamy. 2nd ed 2017. Textbook of
prosthodontics.
 Clinical history taking

Name Age Sex

Medical
Occupation Location
history
Veeraiyan, Deepak Nallaswamy. 2nd ed
2017. Textbook of prosthodontics.
N Identification A The decade, S Male patients are
generally busy people
a g which the e who appear
indifferent to the
m Building rapport e patient x treatment
e belongs to, is
Gaining confidence important to Female patients are
of patient more critical about
predict the esthetics and they
For data record outcome of usually appear to
overrule the dentist in
keeping treatment. treatment planning

Veeraiyan, Deepak Nallaswamy. 2nd ed

2017. Textbook of prosthodontics.
 Occupation
• It influences the degree of importance of factors like esthetics, phonetics &
general appearance.
• Job & social standing determines the value patient gives on his/her dental
health/esthetics.
• Professionals having direct people contact prefer appearance/retention more
often then efficiency.
• Public speaker / singer need perfect retention as well as proper palatal
shape/base thickness for phonetics.
• Wind instrument players need special modification for instrumental playing

Veeraiyan, Deepak Nallaswamy. 2nd ed

2017. Textbook of prosthodontics.
 Location
• Some endemic disorders like fluorosis are
confined to certain localities. People from that
locality may want characterization (pattern
staining) in their teeth for a natural
appearance.

Veeraiyan, Deepak Nallaswamy. 2nd ed

2017. Textbook of prosthodontics.
 Dental history
Chief
Expectation
complaint

Period of Pretreatment
edentulousness records
Veeraiyan, Deepak Nallaswamy. 2nd ed
2017. Textbook of prosthodontics.
 Pretreatment records
Previous Denture
• It denotes the dentures, which were worn
before the current denture. The reason for the
failure of the prosthesis should be enquired
with the patient.

Veeraiyan, Deepak Nallaswamy. 2nd ed

2017. Textbook of prosthodontics.
The denture maintenance should be evaluated. It
can be classified as:
• Good
• Fair
• Poor

Veeraiyan, Deepak Nallaswamy. 2nd ed

2017. Textbook of prosthodontics.
CLINICAL EXAMINATION OF THE
PATIENT

Extraoral

Intraoral
 Extraoral examination

Facial Muscle
Muscle Tone Complexion
Examination Development

Lip TMJ Neuromuscular Speech

Examination Examination Examination evaluation
 Facial examination
Perioral features
• Length of the lips
• Lip fullness
• Apparent support of the lips
• Philtrum
• Nasolabial fold
• Mentolabial sulcus or labiomental groove
• Labial commissures and modiolus
• Width of the vermillion border. It influences the degree of tooth display
• Size of the oral opening. It also influences the degree of tooth display
• Texture of the skin: (rough or smooth and light color).
• Rough texture skin will require the placement of rugged teeth. Wrinkles on the cheeks show decrease in
vertical dimension.
 Facial form
• House and Loop, Frush and Fisher, and Williams

Square Tapering Square tapering Ovoid

Facial profile
 Lower facial height

Normal vertical dimension Decreased vertical dimension Increased vertical

dimension
 Muscle tone
• According to House:
• Normal tension,tone and placement of the muscle of mastication and facial expression.
Class I

• Normal muscle function but slightly decreased muscle tone.

Class II

• Decreased muscle tone and function.

Class III
 Muscle development
• House classified muscle development as:
Class I:Heavy
Class II: Medium
Class III: Light.
Complexion
 Lip examination
• Lip support
• Lip mobility
• Lip thickness
• Lip length
• Health of the lips
 Lip contact
• Class I: lower lip slightly behind upper lip.
• Class II: lower lip much behind upper lip.
• Class III: lower lip ahead of upper lip.
 Lip mobility
• Class I: Normal.
• Class II: Reduced.
• Class III: Paralysis.
 TMJ examination
• Class I: Co-ordinated
• Class II: Jerky
• Class III: Restricted.
Neuromuscular examination

Type 1- Normal
Speech
Type 2- Affected
 Neuromuscula
r coordination

Class 1:
Class 2: Fair Class 3: Poor
Excellent
Intraoral examination
Hyperplastic
Existing teethtissue

Hard palate
Mucosa

Soft palate
Mucosal displaceability
and palatal throat form

Lateral throat form

Saliva

Gag reflexalveolar
Residual and palatal
ridgesensitivity

Tori defects
Ridge

Muscle andtissues
Redundant frenal attachments
Tongue

Floor of the mouth

 Condition of the mucosa
According to House
• Class I: Healthy mucosa
• Class II: Irritated mucosa
• Class III: Pathologic mucosa.

DENTAL CLINICS OF NORTH

AMERICAVOLUME 40 - NUMBER I -
Thickness of the mucosa
 Mucosal displaceability
• Type 1 : Tissues can be displaced approx 2 mm, cushion like yet no
gross positional displacement
• Type 2a: Tissue thinner than 2 mm usually unyielding often
atrophic, with smooth surface and poor for developing good
adhesion
• Type 2b: Tissue thicker than 2 mm easily displaced, poor
stress bearing (usually under ill-fitting dentures)
• Type 3: Excessively flabby to the degree that surgical excision is
needed
DENTAL CLINICS OF NORTH
AMERICAVOLUME 40 - NUMBER I -
 Saliva
• Class 1: Normal quality and quantity of saliva.
Cohesive and adhesive properties of saliva are
ideal.
• Class 2: Excessive saliva; contains much mucus.
• Class 3: Xerostomia; remaining saliva is
mucinous.
DENTAL CLINICS OF NORTH
AMERICAVOLUME 40 - NUMBER I -
Residual alveolar ridge
Arch size
 Arch form

Class I- Square Class II- Tapering Class III- Ovoid

DENTAL CLINICS OF NORTH

AMERICAVOLUME 40 - NUMBER I -
Ridge contour

Maxillary

Mandibular
 Ridge relation
• According to Angle

DENTAL CLINICS OF NORTH

AMERICAVOLUME 40 - NUMBER I -
 Ridge parallelism
Class I: Both ridges are Class II: The
parallel to the occlusal mandibular ridge diverts
plane from the occlusal
plane anteriorly
DENTAL CLINICS OF NORTH
AMERICAVOLUME 40 - NUMBER I -
Class III: Either the
maxillary ridge diverts
from the occlusal plane
anteriorly or both ridges
divert from the occlusal
plane anteriorly
Inter arch space
Class I:Ideal
inter-arch
space to
accommodate
the artificial
teeth

Class II: Class III:

Excessive Insufficient inter-
inter-arch arch space to
space accommodate
DENTAL CLINICS OF NORTH the artificial teeth
AMERICAVOLUME 40 - NUMBER I -
Hard palate

DENTAL CLINICS OF NORTH

AMERICAVOLUME 40 - NUMBER I -
Soft palate and palatal throat form
Classification of soft palates
Palatal throat form
 Lateral throat form

Class 1 Class 2

Class 3 DENTAL CLINICS OF NORTH

AMERICAVOLUME 40 - NUMBER I -
 Gag reflex and palatal sensitivity
House classified palatal sensitivity as:
• Class I Normal
• Class II Subnormal (Hyposensitive)
• Class III Supernormal (Hypersensitive)

DENTAL CLINICS OF NORTH

AMERICAVOLUME 40 - NUMBER I -
 Tori

DENTAL CLINICS OF NORTH

AMERICAVOLUME 40 - NUMBER I -
Muscle and frenal attachment

Classification of border attachment

Classification of frenal attachment

 Tongue

House's classification of tongue sizes

Wright's classification of tongue positions

Radiographic examination
Atwood
Radiographic
Classification of
Assessment of
Residual Ridge
Bone Resorption
Resorption

Radiographic
Assessment of
Bone Quantity and
Quality
DENTAL CLINICS OF NORTH
AMERICAVOLUME 40 - NUMBER I -
Radiographic Assessment of Bone Resorption
• Class I: (Mild resorption) loss of up to one-
third of the vertical height.
• Class II: (Moderate resorption) loss of up to
two-thirds of the vertical height.
• Class III: (Severe resorption) loss of more
than two-thirds of the vertical height.
DENTAL CLINICS OF NORTH
AMERICAVOLUME 40 - NUMBER I -
Atwood Classification (1963) of
Residual Ridge Resorption

DENTAL CLINICS OF NORTH

AMERICAVOLUME 40 - NUMBER I -
Radiographic Assessment of Bone Quantity and Quality
 Treatment planning
• It is the process of matching possible treatment
options with patient needs and systematically
arranging the treatment in order of priority
with a logical or technically necessary
sequence.

DENTAL CLINICS OF NORTH

AMERICAVOLUME 40 - NUMBER I -
 Steps in treatment planning
• Tissue conditioning (finger massage, soft reline)
• Pre-prosthetic surgery (if any)
• Articulator (no, manufacturer, control settings)
• Tooth selection.
• Denture base materials.
• Denture base shade.
• Anatomic palate
• Characterization.
DENTAL CLINICS OF NORTH
AMERICAVOLUME 40 - NUMBER I -
 CONCLUSION
• A sound diagnosis is very critical in the long
term success of the prosthesis.
• Extrapolation of the findings into planning of
treatment ensures a successful prosthesis.
• Failing to plan = Planning to fail
 References
• Patient evaluation and treatment planning for complete-denture therapy
Robert Engelmeier, BS, DMD, MS Dental Clinics Of North America
volume 40 - Number I - January 1996
• Veeraiyan, Deepak Nallaswamy. 2nd ed 2017. Textbook of prosthodontics.
• McCord, A. A. Grant, ”Identification of complete denture problems: a
summary” British Dental Journal 2000; 189: 128–134
• Sharry JJ. Complete denture prosthodontics. McGraw-Hill Companies;
1974 May 1
• Zarb GA, Bolender CL, Carlsson GE. Boucher's prosthodontic treatment for
edentulous patients. St. Louis: Mosby; 1997 Jan.
 Cross references
• The Impact of Edentulism on Oral and General Health
Elham Emami, Raphael Freitas de Souza, Marla Kabawat,
and Jocelyne S. Feine; Int J Dent. 2013; 2013: 498305.
• Winkler S, editor. Essentials of complete denture
prosthodontics. Year Book Medical Pub; 1988.
• Rahn, A. O., Ivanhoe, J. R., Plummer, K. D., & Heartwell,
C. M. (2009). Textbook of complete dentures. Shelton,
Conn: People's Medical Publishing House.