Diagnosis and Treatment planning Dr yasir

Diagnosis;-It is the examination of physical state , evaluating of mental or psychological makeup and understanding the needs of each patient to ensure a predictable result .Treatment options ;-It includes the different ways of treating a same problem which are suggested to the patient and leads to proper treatment plan.Treatment plan ;-It means developing a course of action that is taken to correct the problems and sequence of treatment to serve the patients needs.

>> The success of fixed partial denture depends on the health of the abutment teeth.>> Factors like dental caries, periodontal diseases can affect the health of abutment leading to total failure of treatment and failure of FPD.History ;-Various psychological and medical conditions will affect the success of prosthesis.i) Diabetes ;--- In diabetic patient risk of occurrence of periodontal lesion is very high.

-- so in patients with diabetes , a FPD will increase the risk of abutment failure.-- Patients should be made aware about this problem.

ii) Xerostomia ;--- Decreased salivary flow can predispose to caries due to accumulation of debris and decreased buffering capacity.-- In xerostomia patients anticholinergies, antihypertensive should be controlled or avoided .

iii) Cardiovascular diseases ;- -- Patients with pace maker have to be treated with caution.-- The electrosurgical procedures are contraindicated for these patient.-- Use of adrenaline should be avoided in local Anaesthesia and gingival retraction cord should be free of adrenaline . iv) Miscellaneous condition ;--- Patients should be asked about any drug allergy , nickel sensitivity.

Clinical Examination ;-It can grouped as ;-i) Systemic examinationii) Local examination a) extra-oral examination b) intra-oral examination.

i) Systemic examination ;-- A through check of his medical conditions should be made and to rule out presence of any systemic diseases.

ii) Local examination ;-

a) Extra-oral examination ;-i) TMJ evaluation ;--- Objective and Subjective symptoms of pain and discomfort in TMJ should be examined.-- Any disease of TMJ should be ruled out.-- The muscle of mastication should be examined for anatomy , physiology and any pathology. -- Tenderness on palpation .-- Any difficulty in opening the mouth less than 40 mm-- Deviation from midline while opening the mouth.

ii) Facial asymmetryiii) Cervical lymph nodesiv) Lips – smile line , negative spaces between maxillary and mandibular teeth when patient laughsv) Assessment of the midline of face and incisal curved line of maxillary anterior teeth in relation to intrapupillary line.

b) Intra- oral examination ;--- Examination of hard and soft tissues should be done .-- The patients oral hygiene should be examined and patient advised accordingly .-- Presence of attached gingiva and presence of any occlusal disharmony should be examined .-- Risk of dental caries and periodontitis should be checked-- Amount of residual ridge and presence of wear facets should be seen.-- The type of occlusion should be examined

-- Abutment tooth evaulation ;-i) Abutment teeth need to be strong enough to

withstand the forces directed to missing teeth and to be abutments.

ii) Abutment should be checked for any mobilityiii) An asymptomatic endodontically treated tooth

can be considered for an abutment provided it can withstand forces transmitted to it.

iv) The supporting tissue around the abutment should be healthy and free from inflammation.

Diagnostic Casts ;--- Diagnostic cast for both arches should be prepared before the start of treatment .-- The cast should be mounted on semi-adjustable articulator using face-bow transfer and intraocclusal records.Uses;-i) The diagnostic cast allow an unobstructed view of edentulous spaces and an accurate assessment of span length and occlusogingival dimensions.

ii) The curvature of arch in edentulous region can be seen , so as to see if pontic will act as lever arm on the abutment.iii) The length of abutment can be gauged to determine which preparation design will provide adequate retention and resistance .iv) The true inclination of abutment can be seen , so that the problem in common path of insertion can be anticipated..v) Mesiodistal drifting , rotation and faciolingual tilts of abutment teeth can be seen clearly .

Full- mouth Radiograph;--- Radiograph , is the final aspect of diagnostic procedure .-- It provides information to correlate all the facts that has been collected in listening to patient , examining the mouth and evaluating the diagnostic casts.-- The radiographs should be examined to seen any caries on both unrestored proximal surfaces and recurring around restored tooth surfaces .-- The presence of any periapical lesion and also the existence and quality of any endodontically treated teeth should be seen in radiograph.

-- The general alveolar bone level and condition should be checked and the bone supported for the abutment tooth should be assessed properly in radiograph.-- The crown-length ratio of abutment can be calculated in radiograph.-- The length , configuration and direction of roots should be examined in radiograph.-- Any remaining roots in edentulous areas should be recorded.-- The outline of soft tissue in edentulous areas can be traced in radiograph so that the thickness of soft tissue overlying the ridge can be determined.

vi) Occlusal discrepancies can be evaluated.v) Diagnostic wax-up can be made to occupy the edentulous spaces to determine the width of pontic ,is it wider or narrower than the teeth that would normally occupy the space.

Treatment options ;---Different treatment option or ways of treating a dental discrepancies is given to the patient.-- the treatment options depends on ;- i) Patients choice ii) Dentist skillsiii) Cost of the treatment – economical status of patient.iv) Time available of the patient to perform the treatment .v) End result of treatment

Treatment Planning ;---It helps to design and select the materials of choice for a particular treatment.– which depends on ;-i) Amount of tooth structure presentii) Aesthetics iii) Plaque control--It helps in sequence of treatment – which treatment to take first.

Factors to be considered in Abutment Selection;-i) Crown-Root Ratioii) Root configurationiii) Periodontal surface areaiv) The length of pontic spanv) Forcesvi) Oral hygiene measures.

i) Crown Root Ratio ;--- An abutment tooth should have a combined Peri-cemental area equal to or greater in peri-cemental area than the tooth or teeth to be replaced.>>>-( Antes” Law )-The optimum crown-root ration should be 2:3.A crown-root ratio of 1:1 at least is needed for a prospective abutment..-- if coronal portion of abutment is less , core-build up or crown lengthening is to be done to fulfill the crown root ratio.

ii) Root Configuration ;-Root shape and Angulation.a) A molar with divergent rootsb) An anterior single rooted tooth with ellipitic

cross-section ( broader labiolingually than mesiodistally )

c) A long root or multiple roots provide better support .

iii) Periodontal surface area;-d) Root surface area ;- Larger teeth will have greater

surface area and will tolerate stress bettere) Bone support ;- Teeth with vertical and horizontal

bone resorbtion gives less support

iv) The length of pontic span ;-a) Two abutment teeth can give support to two

ponticsb) Using only one abutment usually become

questionablec) Failure due to abnormal stress have been due to

increased length of span.d) An addition abutment can be added in long span

bridges.v) Forces ;-e) Varying the occlusion by altering the occlusal

plane can increase the load on Abutment teeth.vi) Oral Hygiene ;- oral hygiene has to be maintained to keep the Abutment tooth healthy