ByDr. Muhammad AfzalRegistrar

DIAGNOSIS AND TREATMENT

PLANNING FOR COMPLETE DENTURES

“The dentist should meet the mind of the patient before he meets the mouth of the patient”

De Van - 1942

DIAGNOSIS

Familiarity with the patient

Principles of perception

Detection

Discrimination

Recognition

Identification

Judgement

SOCIAL INFORMATION

Name. Age. Sex. Religion and race. Occupation. Address. Telephone number. Marital Status. Previous dental or denture experience.

MEDICAL STATUS

Medical history. Family history. Dental history.

CONDITIONS OF DEBILITATING NATURE

Senility

Diabetes

Tuberculosis

Joint diseases

Blood dyscrasias

Endocrine disorders

Menopause

High basal metabolic rate

Grand climacteric. In which there is

generalized loss of bone through out the body.

DENTAL HISTORY

How many dentures?

How long worn?

Age of present set?

Satisfaction with dentures?

Things patient likes - what they want changed

MENTAL HEALTH

A denture always fits better in the mouth of a satisfied patient

MENTAL HEALTH

Alan Mack classified individuals according to their mental attitude.

Ectomorph(Worrying type).

Endomorph(Care free).

Mesomorph(Passive).

MENTAL HEALTH

House divided the mental attitude into 4 major groups

Philosophic or Reasonable

Indifferent or passive

Critical or Exacting

Skeptical or Antagonistic

PHILOSOPHIC OR REASONABLE

These are normal ideal.

They understand the limitations of an artificial prosthesis.

They are ready to play their role in the perseverance and learning phase.

They do not unnecessarily criticize the operator.

They correctly interpret their problems neither overstating nor under expressing.

INDIFFERENT OR PASSIVE

Patient shows no concern. They are not interested and lack motivation.

Pays no attention to the instructions.

They are non cooperative.

They seek prosthesis at the request of family members or at the advice of the physician.

CRITICAL OR EXACTING

The patient is methodical, precise and accurate.

At time he is more demanding.

Can be managed if handled properly.

SKEPTICAL OR ANTAGONISTIC /HYSTERICAL

Emotionally unstable.

Excitable, hypertensive.

Grumbling even with little things.

Patients having family problems or psychological disturbances usually fall into this category.

GENERAL EXAMINATION

General health and constitution

Cardiovascular System Disturbances

Blood pressure, Angina, Infarction, Rheumatic fever

Respiratory System Diseases

Tuberculosis, Asthma, Dyspnoea, Edema

Gastrointestinal Tract Disturbances

Ulcers, Jaundice, Nausea, Vomiting, Diarrhea, Constipation, Cirrhosis

GENERAL EXAMINATION

Endocrine Disturbances

Diabetes , Steroids

Hematopoetic Disorders

Anemia, Bleeding disorders

Neurological Disturbances

Epilepsy, Convulsions, Paralysis, Psychiatric treatments,, Tranqulizers.

LOCAL EXAMINATION

Visual examination

Physical examination

Digital examination

Conditions of occlusion

VISUAL EXAMINATION

Oral Cavity

Inflammation, Growth, Cysts, White lesions

Character of Enamel

Rampant caries, Abrasion, Attrition, Erosion, Abfraction

Periodontal Conditions

Gingiva, Pockets, Tooth mobility

Oral Hygiene habits

CAUSES OF TOOTH LOSS

Periodontal disease

Caries

Trauma

Orthodontic indications

CONSEQUENCES OF TOOTH LOSS

Extra load on digestive organs

Impaired digestion

Systemic disturbances

General poor health

Impaired phonetics

TMJ Changes

Supra occlusion of opposing teeth

Tilting of adjoining teeth

Discomfort

Loss of confidence

DIGITAL EXAMINATION

Sharp bony spicules

Torus palatinus

Mid-palatal suture

Torus mandibularis

Ridge form

RADIOGRAPHIC EXAMINATION

BoneNature, Degree of calcification, Stress bearing quality.

PathologyCysts, Embedded roots, Unerupted teeth

RADIOGRAPHIC EXAMINATION

Foci of infectionRemaining teeth, Number and length

of roots, Interproximal caries

Foraminae - exact position

ANATOMY OF MAXILLARY DENTURE BEARING AREA

MAXILLA

EDENTULOUS MAXILLA

EDENTULOUS MAXILLA

Foundation of denture bearing area:

Stress Bearing or supporting area

Peripheral or limiting area

Supporting structures• Bone• Residual ridge• Mucous membrane

EDENTULOUS MAXILLA

Supporting structures• Bone• Residual ridge• Mucous membrane

EDENTULOUS MAXILLA

SUPPORTING STRUCTURES

Bone: Hard Palate:

PRIMARY SUPPORT AND STRESS BEARING AREA

Two maxillary and two palatine bones – Foundation for hard palate

Palatine process of two maxillae joined together at mid palatal suture.

HARD PALATE

Incisive foramen

Greater Palatine foramen

Alveolar ridge

Palatine process of Maxilla

Palatine bone

HARD PALATE

Mid Palatal suture

Buccal Frenum

Hard Palate

Maxillary tuberosity

RESIDUAL RIDGE

Alveolar ridges after removal of natural teeth are called residual ridges

Size and shape changes. Rapid at first then reduced rate throughout life

SECONDARY SUPPORTING OR STRESS BEARING AREA

During 1st year of extraction, reduction of residual ridge in Maxilla in midsagittal plane is 2-3 mm.

After that, it is reduced to 0.1 to 0.2 mm per year.

MUCOUS MEMBRANE

MUCOUS MEMBRANE

Mucosa

Connective tissueDense

Loose areolar tissue

Fat

MuscleGlandular

Transmit nerve and blood supply to mucosa

Stratified sqamous epithelium

Often Keratinized

Masticatory mucosa

Hard Palate Crest of residual ridgeResidual attached gingiva

Submucosa

SHAPE OF SUPPORTING STRUCTURE

Various factors depend on the form and size of the supporting bone:

1. Original size and consistency

2. General health of person

3. Forces developed by the surrounding musculature

4. Extent of periodontal disease

5. Effect of wearing dental prosthesis

6. Surgery at the time of extraction

7. Span of being edentulous

INFLUENCES ON SHAPE OF HARD PALATE AND RIDGE

Incisive Foramen

Maxillary tuberosity

Sharp Spiny processes

Torus Palatinus

Limiting structures

EDENTULOUS MAXILLA

Limiting structures• Labial Vestibule

• Labial frenum

• Buccal vestibule• Buccal frenum

• Vibrating line

EDENTULOUS MAXILLA

LABIAL VESTIBULE

Divided into right and left by labial frenum

Labial frenum contains no muscles

Mucous membrane lining the Labial vestibule – thin mucosa.

Submucosa thick – loose areolar tissue and elastic fibers.

Lining mucosa

Orbicualris oris

BUCCAL VESTIBULE

Lies opposite to tuberosity and extends from buccal frenum to hamular notch.

Buccal frenum – Levator anguli oris, Orbicularis oris (pulls frenum forward), Buccinator (pulls backward)

Distal to frenum lies root of zygoma.

Increasing resorption makes it prominent

VIBRATING LINE

Imaginary line drawn on soft palate that marks beginning of motion of soft palate. Extends from one hamular notch to other.

Ahhh

Midline – 2 mm anterior or posterior to Fovea palatinae

Vibrating line always on soft palate

Anterior and posterior vibrating lines