Transcript EXAMINATION, DIAGNOSIS AND TREATMENT PLANNING FOR

EXAMINATION, DIAGNOSIS AND
TREATMENT PLANNING FOR
FIXED PARTIAL PROSTHODONTICS
( FPD)
CONTENTS
1-DEFINITIONS
2-PERSONAL DETAILS & CHIEF COMPLAINT
3-HISTORY
• History of present illness
• Medical history
• Dental history
4-EXAMINATION
• Extra oral examination
• Intra oral examination
5-INVESTIGATIONS
6-DIAGNOSIS
7-PROGNOSIS
8-TREATMENT PLANNING
9-REFFRENCES
DEFINITION
DIAGNOSIS :
Is the determination of the nature of a disease process.
TREATMENT PLAN :
The sequence of procedures planned for the treatment of a patient following diagnosis.
Personal details :The patient’s name, address, phone number, sex, occupation, work
schedule and marital and financial status are noted.
Chief complaint :The chief complaint should be recorded, preferably in the patient’s own
words & primary reason(s) for seeking treatment should be analyzed first.
The chief complaint usually fall into one of the following categories.
Comfort (pain, sensitivity, swelling)
Function (difficulty in mastication or speech)
Social (Bad taste or odour)
Appearance (fractured or unattractive teeth or restorations, discolorations).
HistoryMedical history :The medical history should include the medications the patient is taking and
all the relevant medical conditions. Patient’s physician may be contacted if needed.
Dental history; Patient’s experience with previous partial denture can be evaluated. The
success of the future treatment can be assessed.
Examination;
Extra-oral: Head and neck, Lips, size, shape and symmetry of the face profile, skin, hair are
examined, muscles of mastication and TMJs ( Intra auricular & extra auricular method).
Intra Oral examination :
Soft tissue-Evaluate oral hygiene, periodontal status, quality and quantity of saliva
edentulous ridge, Tongue, Floor of the mouth, sulcus, mucosa, soft palate, frenum.
Hard tissue- Each tooth is examined for caries, decalcifications, erosion, abrasion,
attrition, sensitive exposed root surfaces or fractures, contour, occlusal examination,
lateral guidance (Canine guided occlusion, Group function, Mutually protected),
missing teeth & Hard palate, Edentulous ridge are examined for shape, size, contour.
Investigations;
Radiographic examination :Periapical, Digital radiography, Panoramic films, CT
scanning, MRI (magnetic resonance imaging), Digital subtraction radiography
Special radiograph for TMJs
Transcranial exposure
Serial tomography
Arthrography
PANORAMIC FILMS provide information about
•
Presence or absence of teeth
•
Third molars and impactions
•
Retained root tips.
IOPA, however provides details about
• Bone support and
trabecular patterns.
quality,
• Root number and morphology
(short, long, slender, broad,
bifurcated, fused dilacerated etc).
• Caries
• Root proximity
VITALITY TESTING : Pulpal health must be assessed by measuring the response to
•
Percussion
•
Thermal or electrical stimulation
•
Preparation of test cavity without LA
Diagnosis :The dental diagnosis includes-Determination of the periodontal health,
occlusal relationships, TMJ function, condition of the edentulous areas, anatomic
abnormalities, serviceability of existing prosthesis and status of remaining dentition –
including previous dental treatment, dental caries, defective restorations and pulpal
disease. Treatment options follow logically from the diagnosis.
TREATMENT PLANNING
Objectives of Treatment Planning:
•
Correction of existing disease
•
Prevention of future disease
•
Restoration of function
•
Improvement of appearance.
DECIDING FACTORS FOR TOOTH REPLACEMENT WITH FPD
Two important factors
•
Support (abutment teeth considerations)
•
Occlusal forces (biomechanical considerations)
Abutment teeth considerations :
•
supporting tissues
•
Crown root ratio
•
Root configuration
•
Periodontal ligament space
Biomechanical considerations :
•
•
•
Long span bridges

Bending & deflection

Torquing forces – flexing
Double abutments

Unfavorable crown-root ratio

Secondary abutment crown root ratio as much as primary abutment
Arch curvature

Pontic lever arm lying outside the inter abutment axis –
torquing movement

Additional retention by secondary abutments

Canine replacement FPD
Types of FPD for treatment plan
1.
Depending upon location
– Anterior bridges
– Posterior bridges
2.
Depending number of teeth
– 2 unit bridges
– 3 unit bridges
3.
Recent classification
– Tooth supported FPD
– Implant supported FPD
– Resin bonded FPD
Tooth supported FPD
– Conventional or rigid FPD
– Cantilever FPD
Resin bonded FPD
– Conventional
– Fiber reinforced
Implant supported FPD
– Screw retained FPD
– Cement retained FPD
•
Depending on material used
– Cast metal FPD
– All ceramic FPD
– Metal ceramic FPD
– Resin veneered FPD
•
Depending upon construction
– Cast metal FPD
– CAD CAM assisted FPD
– Direct fibre reinforced FPD
Prognosis :
The dentist should propose a treatment plan that offers a favorable prognosis.
The less disease present at the onset and the less complex the treatment, the more
favorable the prognosis.
CONCLUSION
Successful treatment is the result of a logical diagnosis and a rational
sequence to the treatment plan.
A comprehensive oral examination, distinct radiographs and well defined diagnostic
casts are essential ingredients for diagnosis. The approach to treatment planning
should be meticulous, flexible and scholarly.
REFERENCES
1.
Contemporary fixed prosthodontics – 3rd edition, Stephen F. Rosensteil, Martin F. Land,
Junhel Fujimoto.
2.
Fundaments of fixed prosthodontics – 3rd edition, Herbert T. Shillingburg, Sumiyo Hobo.