Diagnosis and tt planning in FDP-I

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Diagnosis and tt planning in FDP-I

• Dr Jitendra Rao
• Dept of Prosthodontics

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Objectives of Prosthodontic treatment

• Elimination of disease
• Preservation of health
• Restoration of lost teeth oral function in an
  esthetic manner

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Prosthodontics

• Discipline of dental sciences dealing with
  restoration of
• Oral function
• Health
• Comfort of oral and maxillofacial tissue by
  the artificial substitutes
• it includes ---
• A. Fixed- It refers to the restoration or
  replacement of tooth that can be attached to
  natural teeth and /or roots and can not be
  removed by the patient himself.
• B. Removable
• C. Maxillofacial prosthesis

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• FIXED PROSTHODONTICS -
• Is the branch of prosthodontics
  concerned with the replacement or restoration of
  teeth by artificial substitutes that not readily
  removed from the mouth.

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• Components- are
• Pontics Are artificial teeth of a fixed partial
  denture that replace missing natural teeth
• Retainers-Part of FPD that unites the abutments
  to the pontics and surrounds all or part of
  prepared crown
• Connectors-Joins the pontic and retainers
  together
• Abutments- Part of a tooth that support or
  retains the prosthesis and receives direct
  masticatory load from opposing arch
• Residual Ridge- portion of residual bone and its
  soft tissue covering

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• Fixed dental prosthesis(FDP)
• - Crown
  Bridge,Laminates
• - Dental implant
  with crown bridge
• - Implant supported
  over denture
• - Implant supported
  FPD

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Diagnosis and tt planning

• Diagnosis It is the determination of nature of
  disease process
• Treatment plan-The sequence of procedures planned
  for the treatment of a patient following
  diagnosis
• decide the prognosis of the patients
• Treatment- Is any measure designed to remedy a
  careful evaluation of all available information,
  a definitive diagnosis and a realistic treatment
  plan that offers a favourable prognosis.

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• There are seven elements to a good diagnostic
  work-up
• Chief complaint
• Vitality testing
• history
• extra-oral examination
• intra-oral examination
• diagnostic casts
• radiographic evaluation

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• 1.Chief Complaint
• It should be recorded in patients own words. The
  accuracy and significance of patients primary
  reason /reasons should be analyzed first. This
  will reveal problems and conditions of which the
  patient is often unaware
• 2.History
• A patients history should include all necessary
  information concerning the reasons for seeking
  treatment along with any personal details and
  past medical and dental experiences that are
  pertinent. A screening questionnaire is useful
  for history taking.

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• .Medical History
• An accurate and current general medical history
  should include any medication the patient is
  taking as well as all relevant medical conditions
• .Dental History
• Primarily and significantly patients
  periodontal, restorative and endodontic history
  should be noted. Orthodontic history should be an
  integral part of the assessment of a
  prosthodontic rehabilitation
• 3.Extraoral Examination
• During extraoral examinations cervical lymph
  nodes, TMJ and muscles of mastication are
  palpated.

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• Temporo-mandibular joints
• The TMJ is palpated bilaterally just anterior
  to the auricular tragic.
• During mandibular movement clicking, crepitus or
  alteration of the range of joint is noted.
• Maximum jaw opening less than 40mm indicates jaw
  restriction, because the average opening is
  greater than 50mm.
• Any deviation from the midline is also recorded.
  Maximum lateral movement can be measured (normal
  is about 12mm).
• Muscles of mastication
• A brief palpation of masseter, temporalis,
  medial pterygoid, lateral pterygoid, trapezius
  and sternocleido mastoid muscles may reveal
  tenderness. The patient may demonstrate limited
  opening due to spasm of the masseter or
  temporalis muscle.

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• 4.Intraoral Examination
• First the patients general oral hygiene is
  observed.
• The presence or absence of inflammation should be
  noted along with gingival architecture and
  stippling. The existence of pockets should be
  entered in the record and their location and
  depth chartered.
• The presence and amount of tooth mobility should
  be recorded with special attention paid to any
  relationship with occlusal prematurities and to
  potential abutment teeth

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• 5.Radiographic Evaluation
• Radiographs provide the information to help and
  correlate all the facts that have been collected
  in listening to the patient, examining the mouth
  and evaluating the diagnostic casts
• The crown-root ratio of abutment teeth can be
  calculated. The length, configuration and
  direction of these roots should also be examined.
• Any widening of periodontal ligament should be
  correlated with occlusal prematurities or
  occlusal trauma.

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• 6.Vitality Testing
• Prior to any restorative treatment, pulpal
  health must be assessed, usually by measuring the
  response to percussion and thermal and electrical
  stimulation.
• A diagnosis of non-vitality can be confirmed by
  preparing a test cavity before the administration
  of local anesthetic.
• Electric pulp tester can be also helpful in the
  assessment of vitality
• 7. Diagnostic Casts
• Articulated diagnostic casts are essential in
  planning fixed prosthodontic treatment.
• They provide critical information not directly
  available during the clinical examination, static
  and dynamic relationships of the teeth can be
  examined without interference from protective
  neuromuscular reflexes.
• They also reveal those aspects of occlusion not
  detectable within the confines of the mouth.