DIAGNOSIS AND TREATMEN T PLANNING

A fundamental objective of the patient interview , Which accompanies the diagnostic examination ,is to Gain a clear understanding of why the patient is coming for examination ,and involves having the patient Describe the history related to the chief complaint . For complicated clinical problems,the interview and Diagnostic examination require two appointment s To allow complete gathering of all the diagnosti c Information for formulation of acomplete plan of treatment

It is important to listen carefully to what the patient has stated is their reason for coming for examination .This is because all the Subsequent information gathered will be used to discuss these concerns and torelate whether the proposed treatment will impact them in any way.Such a Discussion at the out set of patient care helps to outline realistic expectations

Although formats for sequencing the patient interview (and clinical examination )vary,to ensure thoroughness the dentist should follow a sequenc e that includes : 1.Chief complaint and its history 2.Medical history review 3.Dental history review ;especially related to previous prosthetic experience(s) 4.Patient expectations

Infection control

CLINICAL EXAMINATIO N The objectives of any prosthodontic treatment may be statedas:(1 )the elimination of disease;(2)the preservation, restoration, and maintenance of the Health of the remaining teeth and oral tissues(which Will enhance the removable partial dentur edesign); and(3 )the selected replacement of lost teeth for the Purpose of restoration of function in a manner that Ensures optimum stability and comfort in an esthetically pleasing manner. Preservation is a principle That protects dentists from placing too high apremium on cosmetic concerns.It is the dentist's obligation to emphasize the importance of restoring the Total mouth to a state of health and of preserving the Remaining teeth and surrounding tissues

Diagnosis and treatment planning for oral rehabilitation of partially edentulous mouths must take into Consideration the following: control of caries and Periodontal disease,restoration of individual teeth, Provision of harmonious occlusal relationships,and There placement of missing teeth by fixed(using natural teeth and/or implants)or removable prostheses. Because these procedures are integrally related,the Appropriate selection and sequencing of treatment Should precede all irreversible procedures.

Diagnosis and treatment planning for oral rehabilitation of partially edentulous mouths must take into Consideration the following: control of caries and Periodontal disease,restoration of individual teeth, Provision of harmonious occlusal relationships,and There placement of missing teeth by fixed(using natural teeth and/or implants)or removable prostheses. Because these procedures are integrally related,the Appropriate selection and sequencing of treatment Should precede all irreversible procedures.

The treatment plan for the removable partial denture,which is often the final step in a lengthy Sequence of treatment,should precede all but emergency treatment.This allows abutment teeth and Other areas in the mouth to be properly prepaed to support,stabilize,and retain the removable partial denture.This means that diagnostic casts,for designing and planning removable partial denture treatment,must be made be for edefinitive treatment is undertaken. After evaluation of themajor factors That create functional forces and those that resist It are understood,the removable partial denture Design is drawn on the diagnostic cast, along with a Detailed chart of mouth conditions and proposed treatment.This becomes the master plan for the Mouth preparations and the design of the removable Partial denture to follow

CONSEQUENCES OF TOOTH LOSS In general, bone loss is greater in the mandible than the maxilla, more pronounced posteriorly than anteriorly, and it produces a broader mandibular arch while constricting the maxillary arch. These anatomical changes can present challenges to prosthesis fabrication, including implant-supported prostheses and removable partial dentures.

FUNCTIONAL RESTORATION WITH PROSTHESES Individuals with a full complement of teeth report some variation in their levels of masticatory function. The loss of teeth can lead a patient to seek care for functional reasons as they notice a diminished function to a level that is unacceptable to them. The level at which a patient finds function to be unacceptable varies among individuals

A review of oral function, especially mastication, may help interested clinicians better understandissues related to the impact of removable partial denture function

Mastication involves two discrete but wellsynchronized activities: subdivision of food by applied force, and selective manipulation by the tongue and cheeks to sort out coarse particles andbring them to the occlusal surfaces of teeth for further breakdown

terminology A removable partial denture is a prosthesis that replaces some teeth in a partially dentate arch, and can be removed from the mouth and replaced at will. A complete denture is. a dental prosthesis that replaces all of the natural dentition and associated structures of the maxilla or mandible. It is entirely supported by tissues (mucous membrane, connective tissues, and underlying bone

An interim, or provisional, denture is a dental prosthesis used for a short time for reasons of esthetics, mastication, occlusal support, or convenience, or for conditioning the patient to accept an artificial substitute for missing natural teeth until a more definite prosthetic dental treatment can be provided. An abutment is a tooth, a portion of a tooth, or a portion of an implant that serves to support and/or retain a prosthesis

Height of contour defined as a line encircling a tooth, designating its greatest circumference at a selected position determined by a dental surveyor. The term undercut, when used in reference to an abutment tooth, is that portion of a tooth that lies between the height of contour and the gingiva; when it is used in reference to other oral structures, undercut means the contour or cross section of a residual ridge or dental arch that would prevent the placement of a denture

House classification Philosophical patient: this group has the best mental attitude required for complete denture treatment. The philosophical patient is well motivated and realizes his part in the success of the dentures. He cooperate with the dentist and learn to adjust Exacting patient: they are methodical and precise. He likes each step of the procedure explained in detail. Occasionally he propses treatment alternatives to the dentist and at times makes severe demand Management: extra care,effort and especially patience is required on the part of the dentist

Indifferent : indifferent patient may have a questionable prognosis Indifferent : indifferent patient may have a questionable prognosis. He lacks motivation and is not very interested in the treatment. He tries to find faults in the treatment and likley to blame the dentist for any mishaps. They tend not to cooperate or follow the instructions. These patients probably might have been coerced to come by a firend, child or relative Management: these patient are also difficult to manage . The trick is to identify such a patient before treament is started. An attempt is made educate the patient and improve his interest . However this fails it is best to postpone or refuse the treament , until some improvement is observed

Hysterical: these patient highly apprehensive Hysterical: these patient highly apprehensive. They are rarley cooperate with the dentist. They tend to have unfound complaints Management : alot of time and effort is needed to manage this group