DIAGNOSIS&

TREATMENT PLANNING

Dr shabeel pn

Royal Dental College

Significance of Replacement

Dental arch is not a static entity, it is in state of dynamic equilibrium

Tooth loss – loss of structural integrity & a new equilibrium is achieved

Pathological drifting of teeth

Choices

Removable partial denture

Conventional tooth-supported FPD

Resin Bonded tooth-supported FPD

Implant supported FPD

No prosthetic replacement

Treatment Plan Purpose

Formulating a logical sequence of treatment designed to restore the patient’s dentition to good health, with optimal function and appearance

What is an Ideal Treatment plan?

Treatment plan that achieves the best possible long-term outcomes for the patient, while addressing all patient concerns and active problems, with the minimum necessary intervention

Identification of Patient Needs

Correction of existing disease

Prevention of future disease

Restoration of function

Improvement of appearance

Phase IIPhase IIDisease ControlDisease Control

Phase IIIPhase IIIRestorativeRestorative

Phase IVPhase IVMaintenanceMaintenance

Treatment Plan by PhasesTreatment Plan by PhasesDental & medical history

Clinical examination, Radiographic films

Dx Casts, Dx photographs

Dx Wax-up, Aesthetic evaluation

Periodontal Therapy

Endodontic Therapy (RCT)

Removal of existing restorations

Caries control

Phase IPhase IDiagnosisDiagnosis

Crown lengthening/Implant surgery

Gnathologic technique

Long-term provisional restorations

Permanent restorations

Recall every 6 months

Fluoride supplements

Reinforce oral hygiene

Improve diet

Diagnosis & Prognosis

Diagnosis: Dental and medical history Clinical examination Diagnostic pictures Diagnostic casts Diagnostic wax-up Radiographic films

Prognosis: General factors: age, oral environment, etc. Local factors: occlusion, access for oral hygiene

History

Patient Expectations can be understood

Medical history has Prime importanceDiabetes – effects prognosisRheumatic heart diseases – prophylaxis Infectious diseases – protection to othersPacemaker – electrosurgical dilatation Previous radiation - ORN

History

Allergies – Even AnaphylaxisMedications – Adverse drug reactionsHypertension – LA without adrenalinCardiac problems – prophylaxisEpilepsy – short appointmentsHypoglycemia – syncope or comaXerostomia – poor prognosis

Clinical examinationGeneral examinationExtra oral examination

- head & neck examination - TMJ evaluation - Muscles of Mastication

Intra oral examination - oral hygiene status - nature & quantity of Saliva - examination of teeth - occlusal examination - periodontal examination

Radiographic evaluation

Complete mouth radiographic series needed (14 IOPA & 4 bitewings)

Panoramic Radiographs

TMJ Radiographs

All of them give information that cannot be detected clinically

Radiographic evaluation

Remaining bone support & bone qualityRoot number & morphologyPeriodontal ligament & TFOResorption or Furcation involvementCarious lesionsPulpal statusPeriapical pathologiesRetained roots, calcifications, foreign bodiesOral manifestations of systemic diseases

Diagnostic Impressions/Casts

Dx impressions: Irreversible hydrocolloid (alginate)/stock trays High quality with no voids A clinical instructor must authorize impressions pouring

Type III dental stone (buff) is used for Dx-casts pouring Dx casts evaluation criteria:

Accurate reproduction of teeth and tissue Base thickness: 15-16 mm Land area width: 3-4 mm

Diagnostic Casts

*Comprehensive Care Patient Presentations, 2003-04, Dr. Mary Baechle 

Diagnostic Casts

Provide valuable preliminary information and a comprehensive overview of patient’s needs

Treatment procedures can be rehearsed on the stone cast before making any irreversible changes in the patient’s mouth

Used for diagnostic wax-up, preliminary RPD design, surgical stent (surgical procedures), etc.

Help to explain intended procedure to patient

Diagnostic Wax-up

Diagnostic Wax-up:

Casts/waxing/set-ups (denture teeth) must be completed prior to beginning any reconstructive treatment (castings/prostheses or definitive Periodontal therapy)

Diagnostic Wax-up*

*Comprehensive Care Patient Presentations, 2003-04, Dr. Mary Baechle 

Useful to show proposed treatment to the patient

Used for fabrication of provisional restorations Fabrication of final restorations against the

diagnostically waxed cast allows establishing optimum contour and occlusion

Provides specific information about desired tooth length and form or occlusal arrangement: dentist-lab technician communication

Diagnostic Wax-up

Developing Treatment Options

Factors to be considered: Patient’s expectations Systemic & Emotional Health Cost Periodontal Factors Success rate Possible complications Time involved, both total treatment time and number of visits Influence on quality of life

Summary

The patient should be considered as a human being

Successful accomplishment of dental treatment is the result of a multidisciplinary team effort.

The key of a successful dental case is the planning of the treatment at the beginning

Thank you