Diagnosis and tt planning in FDP-I Dr Jitendra Rao Dept of Prosthodontics

Objectives of Prosthodontic treatment Elimination of disease Preservation of health Restoration of lost teeth & oral function in an esthetic manner

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

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. Retainer Pontic connector Abutment

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

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

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.

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

1.Chief Complaint : It should be recorded in patients own words. The accuracy and significance of patient’s primary reason /reasons should be analyzed first. This will reveal problems and conditions of which the patient is often unaware 2.History: A patient’s 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.

.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 patient’s 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.

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.

4.Intraoral 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

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.

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.