Importance of diagnosis and treatment planning in fixed prosthodontics

Noreen Mohammed Naguib5212322

G.11

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.

Medical History: An accurate and current general medical

history should include any medication the patient is taking as well as all relevant medical conditions.a) Any disorders that necessitate the use of antibiotic premedication, any use of steroids or anticoagulants and any previous allergic responses to medication or dental materials should be recorded.b) Any conditions affecting the treatment plan e.g.: various radiation therapy, haemorrahgic disorders etc. should be recorded

Dental History: Periodontal, restorative and endodontic

history are first noted.Orthodontic history should be an integral part of the assessment of a prosthodontic dentition. Occlusal adjustment may be needed to promote long term positional stability of the teeth and reduce or eliminate parafunctional activity. Restorative treatment can often be simplified by minor tooth movement. When a patient is contemplating orthodontic treatment, much time can often be saved if minor tooth movement for restorative reasons is incorporated from the start.

TMJ dysfunction historyA history of pain or clicking in the temporomandibular joints or neuromuscular symptoms, such as tenderness to palpation, may be due to TMJ dysfunction which should be treated before fixed prosthodontic treatment begins.

EXTRAORAL EXAMINATIONCervical lymph nodes, TMJ and muscles of mastication are palpated.Temporomandibular joints:

The TMJ 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 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 pteregoid, trapezius and sternocleido mastoid muscles may reveal tenderness. The patient may demonstrate limited opening due to spasm of the masseter or temporalis, muscle.Lips:Next, the patient is observed for tooth exposure during normal and exaggerated smiling. This may be critical in treatment planning and particularly for margin placement of metal-ceramic crowns.

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.

-Check for a band of attached gingiva around all the teeth, particularly around teeth to be restored with crowns. Mandibular 3rd molars frequently do not have attached gingiva around the distal segment (30% to 60% of cases).

-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.

-Finally an evaluation should be made of the occlusion. The amount of slide between the retruded position and the position of maximum intercuspation should be noted. Non-working interferences if present, should be evaluated. The presence or absence of simultaneous contact on both sides of the mouth should be observed.

Advantages of diagnostic casts:1 )For diagnosing problems and arriving at a treatment

plan.2 )Allow an unobstructed view of the edentulous

spaces and an accurate assessment of the span length, as well as occlusogingival dimension.

3 )Curvature of the arch in the edentulous region can be determined so that it will be possible to predict whether the pontic/pontics will act as a lever arm on the abutment teeth.

4 )Length of the abutment teeth can be accurately gauged to determine which preparation designs will provide adequate retention and resistance.

5 )The true inclination of the abutment teeth will also became evident, so that the problems in a common path of insertion can be anticipated.

Diagnosis and treatment planning

Why bother?The process of diagnosis and treatment planning helps us attain a comprehensive and complete guide to care for any given patient and their particular situation. It allows for the care rendered to be logical both in plan and action

Before a diagnosis is made,through data collection is necessary.RadiographsArticulated diagnostic castsMedical,social and dental historiesClinical examinationPeriodontal chartingEndodontic vitality testsPatient expectations of treatment.

Treatment planning is the intergration of data collection and diagnosis to form an omniscient and ordered guide of treatment.It can be a very complex and confusing process if the patient’s needs are great. So ,having a well-thought-out plan prior to beginning any treatment is a key to success.

Order of treatment plans:

1)Disease control phase2)Perodontal phase3)Restorative phase

4)Maintenance and prophylaxis phase

FDP treatment plan:1)Abutment evaluation

.Tooth vitality.Periodontial status.Crown to root ratio

2)Biochemical considerations.Management of destructive forces

.Length of span.pier abutments

.Cantilevered bridges

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