Diagnosis and Treatment Planning in FPD Flashcards

• DIAGNOSIS


  the determination of the nature of a disease.
• PROGNOSIS


  A forecast as to the probable result of a disease or a course of therapy.
• TREATMENT PLAN


  The sequence of procedures planned for the treatment of a patient after diagnosis.
• FIXED PARTIAL DENTURE


  any dental prosthesis that is luted, screwed, or mechanically attached or otherwise securely retained to natural teeth, tooth roots, and/or dental implants/abutments that furnish the primary support for the dental prosthesis and restoring teeth in a partially edentulous arch; it cannot be removed by the patient
• Diagnostic Aids

  PERSONAL INFORMATION: (NASACFS)

  Name

  Age

  Sex

  Address

  Contact #

  Family History

  Socio-economic status
• Chief Complaint


  The accuracy and significance of the patient's primary reason or reasons for seeking treatment should be analyzed first.
• COMFORT (pain, sensitivity, swelling)

  FUNCTION (difficulty in mastication or speech)

  SOCIAL (bad taste/odor)

  APPEARANCE (fractured/unattractive teeth, discoloration)


  Four categories of chief complaint
• History


  A patient's HISTORY should include include all necessary info concerning the reasons for seeking treatment, along with any personal details and past medical and dental experiences that are pertinent.

  
  

  Screening questionnaire is useful for history taking.
• Past Dental History


  Periodontal History

  Restorative History

  Endodonic History

  Orthodontic History

  Removable Prosthodontic History

  Oral Surgical History

  Radiographic History

  TMJ Dysfunction History
• Periodontal History


  the patients oral hygiene is assessed, current plaque control measures are discussed, as are previously received oral hygiene instructions.

  
  

  the frequency of any previous debridement should be recorded.

  
  

  nature of any previous periodontal surgery should be noted.
• Restorative history


  simple composites resin or dental amalgam fillings or may involve crowns and extensive fixed partial dentures.

  
  

  the age of previous existing restorations can help the prognosis and probable lengevity of any future fixed prosthesis.
• Endodontic history


  the findings should be reviews periodically so that periapical health can be monitored, any recurring lesions promptly detected.
• Orthodontic History


  apical root resorption subsequent to orthodontic treatment

  
  

  as the crown/root ratio is affected, future prosthodontic treatment and its prognosis may also be affected.
• Removable Prosthodontic History


  patients with removable prostheses must be carefully evaluated.

  
  

  listening to the patients comments about perviously unsuccessful in assessing whether future treatment will be more successful.
• Oral Surgical History


  missing teeth and any complications that may have occured during tooth removal is obtained.

  
  

  before any treatment is undertaken, the prosthodontic component of the proposal treatment should be fully co-ordinated with surgical component
• Radiographic History


  previous radiographs may prove helpful in judging the progress of dental disease.

  
  

  should be obtained if possible, because it is generally better to avoid exposing the patient to unnecessary ionizing radiation.

  
  

  in most instances, however, a current diagnostic radiographic series is essential and should be obtained as a part of examination.
• TMJ Dysfunction History


  a history of pain or clicking in the TMJ or neuromuscular systems. should be normally be treated and resolved before FPD treatment begins.
• Examination


  an _________ consist of the clinician's use of sight, touch and hearing to detect conditions outside the normal range.

  
  

  its critical to record what is actually observed rather than to make diagnostic comments about conditions.
• General Examination


  General appearance: gait and weight are assessed.

  Skin color: anemia or jaundice

  Vital signs: respiration, pulse, temperature and blood pressure are measured and recorded

  Vital signs outside normal ranges should be referred for a comprehensive medical evaluation
• Facial Asymmetry

  Cervical Lymph nodes

  TMJ

  Muscles of Mastication

  Mouth opening

  Lip


  Extraoral examination
• Temporomandibular Joints


  is palpated bilaterally just anterior to the auricular tragic while having the patient open and close his lower jaw.

  
  

  tenderness, clicking or pain on movement
• Muscles of Mastication


  brief palpation of masseter, temporalis, medial pterygoid, lateral pterygoid muscles may reveal tenderness.
• Palpitation


  is best accomplished bilaterally and simultaneously
• Masseter Muscle


  the patient is asked to clench their teeth and using both hands, the practitioner palpates the masseter muscles on both sides extra orally, making sure that the patient continues to clench during the procedure

  
  

  palpate the origin of the masseter bilaterally along the zygomatic arch and continue to palpate down the body of the mandible where the masseter is attached.
• Temporalis muscle


  the muscle is divided into three functional areas and therefore each area is independently palpated

  
  

  to locate the muscle, have the patient clench

  
  

  the anterior region is palpated above the zygomatic arch and anterior to the TMJ

  
  

  the middle region is palpated directly above the TMJ and superior to the zygomatic arch

  
  

  the posterior region is palpated above and behind the ear
• Lateral Pterygoid Muscle


  Placing the forefinger, or the little finger, over that buccal area of the MX third molar region and exerting pressure in a posterior, superior and medial direction behind the MX tuberosity
• Medial Pterygoid Muscle


  can be palpated by placing the finger on the lateral aspect of the pharyngeal wall of the throat, this palpation is difficult and sometimes uncomfortable for the patient.

  
  

  function manipulation is done when the muscle becomes fatigued and symptomatic

  
  

  the muscle contracts as the teeth are coming in contact

  
  

  also stretches when the mouth is open wide
• 50mm


  Average opening of the mouth
• 35mm (intracapsular changes in the joints)


  Restricted opening
• Mouth opening


  any deviation from the midline is also recorded. max lateral movement can be measured (normal is about 12mm)
• Lips


  the patient is observed for tooth exposure during normal and exaggerated smiling

  
  

  critical in treatment planning and particularly for margin placement of metal-ceramic crown

  
  

  missing teeth, diastemas and fractured or poorly restored teeth affect negative space and require correction
• NEGATIVE SPACE


  the space between MX and MN anteriors during normal smile
• INTRA ORAL EXAMINATION


  condition of the soft tissues, teeth and supporting structure

  
  

  lips

  tongue

  floor of the mouth

  gingiva

  vestibule

  cheeks

  hard and soft palate
• Gingival & periodontal examination


  First the patient's 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.

  
  

  Check for a band of attached gingiva around all the teeth.
• EXAMINATION OF TOOTH STRUCTURE:


  The presence and location of caries is noted. The amount and location of caries, coupled with an evaluation of plaque retention, can offer some prognosis for new restorations that will be placed.

  
  

  It will also help the preparation designs to be used
• OCCLUSAL EXAMINATION:


  The initial clinical examination starts with the clinician asking the patient to make a few simple opening and closing movements while carefully observing the opening and closing strokes.

  
  

  Special attention is given to;

  Initial tooth contact

  Tooth alignment

  Eccentric contacts
• Occlusal examination special attention given to:


  Special attention is given to;

  Initial tooth contact

  Tooth alignment

  Eccentric contacts
• General Alignment

  Crowding, rotation, supra-eruption, spacing, malocclusion, and vertical and horizontal overlap.

  
  

  Teeth adjacent to edentulous spaces often have shifted position slightly.

  
  

  Small amounts of tooth movement can significantly affect fixed prosthodontic treatment.
• Radiographic Examination


  can help to evaluate the following areas:

  - degree of bone loss

  - impacted teeth, residual roots

  - root morphology, crown-root ratio

  - presence of apical disease

  - caries

  - pulp chambers & canals

  - periodontal ligament and surrounding bone

  - existing restorations
• Panoramic Radiographs


  presence or absence of teeth

  
  

  assessing third molars impactions

  
  

  evaluating the bone before implant placement

  
  

  screening edentulous arches for buried root tips