Diagnosis and treatment planning in cd

Diagnosis and Treatment Plan
for Complete Denture Patients
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

INTRODUCTION
“Examination is defined as scrutiny or investigation
for the purpose of making a diagnosis or assessment”
The goal in clinical examination is to recognize
normal anatomy and physiology, normal variations,
and early signs and symptoms of any disease. A
through, comprehensive examination also allows
modification or possible deferment of treatment when
indicated.

Importance of case History
Case history taking is important to know if the
patient has recently become edentulous or has been
edentulous for a long time. A “green ridge” may be bony
spicules remaining from the extraction sites or bony
undercuts with a thin mucosal covering. The intraoral
examination will determine if any surgical correction is
necessary, the prosthodontist must realize these
possibilities and discuss with the patient.
The examination should be carried out
meticulously. A systematic recording of case history
along with careful examination and evaluation leads to a
diagnosis, probable prognosis and the tentative plan.

History taking and
examination

Personal data
Name
Obtaining the name of the patient not only helps in
maintaining records but also helps in creating a more
personal and ambient atmosphere for the patient in the
dental clinic. Addressing the patient by his/her name gives
a rather personal touch to the dentist patient relationship.
Age
Age is an indicator of the patient’s ability to wear and
use a prosthesis. Through the fourth decade of life, tissues
heal rapidly and are resilient. Beyond fifth decade healing is
not rapid. Woman facing the physiologic and psychological
problems often present as exacting or hysterical patients
who are very conscious about esthetics. Men are pre-
occupied and present as indifferent patients who are
concerned more with comfort or function.www.indiandentalacademy.comwww.indiandentalacademy.com

Sex
Generally appearance is a higher priority for women
than for men. Though younger men often grow
indifferent to their own appearances as they age and
are concerned with comfort and function.
Occupation
A patient’s job & social training often determine the
values he or she places on oral health, as well as the
esthetics and other qualities desired in a denture.
Race
Race can be critical factor in the characterization of
dentures i.e., choice of denture base shade, denture
base stains.

Chief Complaint
The patient should be questioned regarding his or
her chief complaint such as-
1. Inability to chew
2. Impaired speech
3. Poor appearance
4. Others.
History of presenting illness
The duration of the edentulous state is of importance
in
ascertaining a proper diagnosis and treatment plan for
the patient. Also the manner in which there was a loss of
teeth helps to understand the patients personal interest
in his or her oral hygiene and other habits.

Expectations
The reason the patient seeks prosthetic treatment is
important. His or her expectations must be determined.
These should then be evaluated to determine I they are
realistic, practitioner should not make unrealistic
promises regarding treatment outcome.
Mental Attitude/ Personality
House classified patients as:
Philosophical
Exacting
Indifferent
Hysterical

Philosophical Patient
The best mental attitude for denture acceptance is the
philosophical type. This patient is rational, sensible, calm
and composed in difficult situations. These patients are
confident, easy going and cooperative. The philosophical
patient overcomes conflicts and organizes his time and
habits in an orderly manner, he eliminates frustrations and
learns to adjust rapidly. Prognosis is excellent.
Exacting Patient
The exacting type may have all of the good attributes
of the philosophical patient; however he may require
extreme care, effort and patience on Prosthodontist’s part.
This patient is methodical, precise and accurate and at
times makes several demands. Once satisfied, an exacting
patient may become the practioners greatest supporter.

Indifferent Patient
The indifferent type of patient presents a questionable or
unfavourable prognosis. This patient exhibits little concern if
any; he is apathetic and uninterested and lacks motivation. The
indifferent patient pays no attention to instructions, will not
cooperate and is prone to blame the dentist for poor dental
health.
An education program in dental conditions and dental
treatment is the recommended treatment plan before denture
construction.
Hysterical Patient
The hysterical type is emotionally unstable, excitable,
excessively apprehensive and hypertensive. The prognosis is
often unfavorable and additional professional help (psychiatric)
is required prior to and during treatment. This patient must be
made aware that his/her problem is primarily systemic and that
many of his symptoms are not result of dentures. Prognosis is
poor. www.indiandentalacademy.comwww.indiandentalacademy.com

Medical History
General health
A thorough and accurate medical history must be obtained
during the diagnostic phase of complete denture therapy
and must be updated as necessary. The medical history
provides important insights regarding the patients dental
prognosis. Not surprisingly, patients who exhibit good
health are better prosthetic risks than those in poor health.
Hence the practitioner must be aware of local and systemic
factors and must be consider them during treatment
planning.
Systemic factors that may affect complete denture therapy
include:
Anaemia, Arthritis, Bells palsy, Carcinomas, Diabetes, Lupus
erythematosus, Nicotinic stomatitis, Pagets disease,
Parkinsons disease, Pemphigus vulgaris, Plummer- Vinson
syndrome, Scleroderma, TB, Xerostomia.www.indiandentalacademy.comwww.indiandentalacademy.com

Dental History
Chief complaint:
According to DeVan, “ the dentist should meet the mind of
the patient before he meets the moutg of the patient.”
hence the dentist must determine the reason the patient is
seeking prosthodontic treatment.
Reasons For Loss Of Teeth:
The patient should be questioned regarding the
cause of teeth loss (e.g. periodontal, caries, congenital,
trauma etc)
Duration Of Edentulousness
The maxillary/mandibular responses to the question
proves about bone resorption patterns and progression.

Previous Denture Experience:
The patient should be questioned regarding the
number & types of previous dentures; patients should be
made to comment on the reasons for replacement and
should be educated regarding the realistic limitations. A
patient with a history of several dentures over a short
time is a poor prosthodontic risk.
Existing Or Current Dentures:
The patient should be questioned about the length
of time for which the dentures have been worn. Careful
clinical observation may provide valuable information
about denture experience, dental care, knowledge,
parafunctional habits etc.

Denture success:
The patient should be asked about the estheitics and function
of existing dentures. Responses indicate the patients ability to
wear or adjust to complete dentures. Denture success should
be rated as “favorable” or “unfavorable”.
Pre-extraction records:
Pre-extraction photographs, radiographs, casts and facial
measurements may prove helpful in denture therapy. These
adjuncts may be used to recreate anterior esthetics and facial
support and aid in evaluation of vertical dimension of
occlusion.

CLINICAL EVALUATION
Extraoral Examination
Facial Form:
Classification according to House & Loop, Frush &Fisher
& Williams.
 Square
 Tapering
 Ovoid
 Different combinations

Facial Profile (Acc. To Angle):
The facial profile is examined by viewing the patient from the
side. This helps in diagnosing gross deviations in the maxillo-
mandibular relationship.
Profile is obtained by joining the two reference lines, line
joining the forehead and the deepest point in curvature of upper
lip (A).
Line joining point A & most anterior point on the chin (B).
Based on Relationship of these lines
a. Straight/orthognathic: The two lines form a nearly straight
line
b. Concave/prognathic: The two references lines form an
angle with the convexity towards the tissue. This is
associated with a prognathic mandible or a retrognathic
maxilla as in Class III malocclusions
c. Convex/retrognathic: The two lines form an angle with the
concavity facing the tissue. This profile occurs as a result
of a prognathic maxilla or a retrognathic mandible as seen
in Class II malocclusion.

Facial Symmetry:
It is examined to determine disproportions in
transverse and vertical plane. In most patients, the
right and left sides are not identical which is also
termed as normal asymmetry. Some degree of
asymmetry is accepted as normal whereas gross
asymmetries are recorded.

Complexion:
As all of us are aware that our aim is to achieve a
harmonious blending of shape, shade, arrangement and
position so that the final result is a “removable restoration that
creates an illusions of being what it is not” so as to get an
Esthetic denture which is defined as “the cosmetic effect
produced by a dental prosthesis which affects the desirable
beauty, attractiveness character and dignity of the individual.
These shades should be comparable with the patient’s general
facial coloration & complexion.
Pallor may indicate anaemia, hyperthyroidism or nephrosis,
systemic disease such as TB.
Ruddy complexion sign of polycythemia or neoplasm.
Bronzed skin occurs in Addison’s disease.
Diffuse, bluish purple color may indicate Vit B2 deficiency.
Lemon-yellow complexion of jaundice is associated with
gallbladder, liver or bile duct disorders.
Complexion marred by ulcerated lesions may be due to basal
cell and squamous cell carcinoma.

Skin Dark Skin, hair and eye
color
Fair Along with patient’s age
Medium Helps in determining the
tooth shade.
Hair Black
Brown
White
Grey
Eye Black
Brown
Green
Grey

Lip support:
If tissues around the mouth has wrinkles and rest of the
face does not, significant improvement can be done. If
present anterior teeth are set lingually, the lip will lack
support and plans to bring new teeth forward can be made.
The long standing wrinkles do not disappear at once.
Lip Thickness:
Thin Lips: Patients with thin lips present special problems.
Any slight change in the labiolingual tooth position makes a
sudden change in lip contour. Even overlapping of teeth
may distort the surface of lips.
Thick Lips: Variations in the arch form and individual tooth
arrangement do not make obvious changes.

Lip Length:
Patients with short upper lips will expose all the
upper anterior teeth, much of labial flange as well. Care
must be taken to select color and form of denture base.
Long lip shows less of anterior teeth.
Lip Fullness:
This is directly related to the support it gets from
the mucosa or denture base and the teeth behind it. An
existing denture with thick labial flange could make the
lip appear to be too full rather than displaced. If the
existing dentures have the teeth set to far palatally, the
patient may feel that the new and corrected tooth
arrangement makes the lip too full.

Lip Mobility:
Class I – normal
Class II – reduced mobility
Class III – paralysis
Some stroke patients may have paralysis of half the lip
leading to unilateral mouth droop and facial asymmetry
and counseling should be done regarding treatment
limitations as they might have unrealistic expectations
regarding function and esthetics.
Lips should be examined for cracking, fissuring at the
corners and ulceration. These changes could be caused by
Vit B complex deficiency or infections from organisms
such as candida albicans.

Muscle Tone:
Classification According to House:
Class I: The patient exhibits normal tension tone and
placement of the muscles of mastication and facial
expression.
No degenerative changes are apparent.
Majority of edentulous patients have experienced some
degree of degeneration and usually only immediate denture
patients have normal musculature.
Class II: The patient displays approximate normal function
but slightly impaired muscle tone. Maximum muscle function
cannot be used following the loss of all natural teeth.
Class III: The patient exhibits greatly impaired muscle tone
and function. This is usually coupled with poor health,
inefficient dentures, and loss of vertical dimension, wrinkles,
decreased biting force and drooping commissures.

EXAMINATION OF THE TEMPOR MANDIBULAR JOINT:
Good prosthodontic treatment bears a direct relation to the
temporomandibular articulation since occlusion is one of the most
important parts of the treatment of complete dentures. The TMJ affects
the dentures which further affect the health and function of the joints.
CLINICAL EXAMINATION OF THE TEMPOROMANDIBULAR JOINT:
The examination should include the auscultation and palpation
of the TMJ and the musculature associated with mandibular
movements as well as the functional analysis of the mandibular
movements.
PALPATION: lateral palpation, posterior palpation
Lateral Palpation: Exert slight pressure on the condyloid process with
the index fingers, palpate both sides simultaneously. Register any
tenderness to palpation of joint and any irregularities in condyloid
movement during opening and closing maneuvers. The co-ordination
of action between the left and right condylar heads should be
assessed at the same time. www.indiandentalacademy.comwww.indiandentalacademy.com

Posterior palpation: Position the little fingers in the external auditory
meatus and palate the posterior surface of the condyle during
opening and closing movements of the mandible. Palpation should
be carried out in such a way that the condyle displaces the little
finger when closing.
MOVEMENTS OF THE MANDIBLE
Opening movement
Closing
Protrusive excursion
Retrusive
Lateral
All these are examined as part of the functional analysis. The
amount and direction of these actions are recorded during the clinical
examinations. Deviations in speed can only be registered with electronic
devices e.g. Kinesiograph. The first signs of initial temporomandibular joint
problem include deviations of the mandibular opening and closing paths in
the sagittal and frontal planes. The characteristic movement deviations
include incongruency of the opening and closing and uncoordinated zigzag
movements. The ‘C’ and ‘S’ types of deviations are typical signs of
functional disturbances.

Neuro muscular evaluation
Speech :
Patients who are capable of articulate speech with existing
dentures usually have no problems producing articulate speech
with new dentures. Patients with speech impediments require
special attention when the dentist places the anterior teeth and
forms the palatal portion of the denture base. Speech is
classified as : “normal” or “affected”.
Coordination:
Patients with good neuromuscular coordination can be expected
to learn to manipulate dentures relatively quickly. Whereas
patients with poor coordination may never adapt to a denture
completely. Neuromuscular coordination is classified as:
Class 1: Excellent
Class 2: Fair
Class 3: Poor www.indiandentalacademy.comwww.indiandentalacademy.com

Intra oral examination
Arch size
The size of the maxilla and mandible ultimately will
determine the amount of basal seat available for denture
formation. The greater the size: greater the support, larger
the contact surface, greater the retention.
If discrepancy is present, in the size of maxilla and
mandible, it should be noted. This condition may arise from a
developmental source, trauma, and early loss of teeth in one
arch with resultant increase in resorption or from a severe
Class II or Class III malocclusion. This may lead to a poor
relationship of teeth in one arch to the other.
Class 1: Large ( best for retention and stability)
Class 2: Medium (good retention and stability but not ideal)
Class 3: Small (difficult to achieve good retention and
stability)

Arch form
The arch may be
Class 1: Square
Class 2: Tapered
Class 3: Ovoid
and opposing arch may or may not have the same form.
The form of the arch will influence the support of the
denture. If the arch form is not same in both the arches
some problems in tooth arrangement can be anticipated.

Residual ridge contour / form
Ridge form is characterized traditionally as by its cross-
sectional contour as a whole arch.
Maxillary ridge and vault form is classified as:
Class 1: U shaped arch is generally favorable for supporting
a denture since it has broad base for occlusal stresses and
parallel sides that enhance adhesion and resistance to
displacement as well as encourage border seal.
Class 2: V-shaped has a narrow crest that is not conducive
to the reception of masticatory stresses without irritation and
discomfort. Less favorable for retention because of its sloping
sides and has a tendency to progress towards narrowness. The
thin sharp mandibular ridge presents difficulty in prosthetic
management.

Class 3: Flat residual ridge is the most difficult for
restoration by the prosthodontist. The normal pattern of
resorption for maxillary arch is upward and inward as
compared to the downward and outward progression of
bone loss of the mandibular ridge. (Lack of vertical height
produces less resistance to horizontal forces)
Jaw relationship thus normally progresses to cross-bite
situations and complicate the distribution of prosthetic
stress to the basal support.

Mandibular ridge form
Class 1: Inverted U shaped (parallel walls from medium to tall
with broad crest)
Class 2: Inverted U shaped (short with flat crest)
Class 3: Unfavorable
Inverted W
Short inverted V
Tall, thin inverted V
Undercut

Ridge relation
Laney Smith described ridge relationship as the
anteroposterior position of the mandibular ridge relative to the
maxillary residual ridge when the jaws are in centric relation and
separated by the distance they will be separated by the prosthesis.
CLASSIFICATION BY ANGLE:
Angle Class I (Normal): - Anterior segment of the mandibular ridge
is directly below or slightly posterior to the maxillary anterior ridge
segment.
Angle Class II (Retrognathic): - Anterior segment of the mandibular
ridge is retruded beyond the normal position as it relates to the
maxillary anterior ridge segment.
Angle Class III (Prognathic): - Anterior segment of the mandibular
ridge is protruded beyond the normal position as it relates to the
maxillary anterior ridge segment.www.indiandentalacademy.comwww.indiandentalacademy.com

Ridge parallelism
Classification according to Angle
Class I – Both ridges are parallel to the occlusal plane
Class II – The mandibular ridge is divergent from occlusal
plane anteriorly
Class III – The maxillary ridge is divergent from the
occlusal plane anteriorly and/or both ridges are divergent
anteriorly
Importance: Ridges that are not parallel to each other will
cause movement of the bases when teeth occlude because
of an unfavorable direction of forces

Intermaxillary space
This is the space between the maxillary and the
mandibular arches. Normally it should be 20mm. If the
space is less than 20mm it is difficult to obtain stability
of the denture base, which is compromised as the teeth
are set away from the basal seat.
Class I: Ideal interarch space to accommodate the
artificial teeth
Class II: Excessive interarch space
Class III: Insufficient interarch space to accommodate
the artificial teeth

MUCOSA:
Mucosal displaceability
Classification by House
Class 1: Normal uniform density of mucosal tissue (approx 1mm
thick). Investing membrane is firm but not tense and forms an
ideal cushion for the basal seat of the denture
Class 2a: Soft tissues have thin investing membrane and are
highly susceptible to irritation under pressure
Class 2b: Soft tissues have mucous membrane twice the noraml
thickness.
Class 3: Excessively flabby to the degree that surgical excision
is indicated

HARD PALATE
SHAPE OF PALATAL VAULT
U Shaped: It is most favorable for retention and lateral
stability
V Shaped: It is less favorable for retention because
slightest movement of denture base will cause the
seal to be broken with a resultant loss of retention
Flat palatal vault: Is unfavorable. Usually accompanied
by resorbed ridges and although retention may be
satisfactory in a downward direction, any lateral or
rotatory forces results in poor resistance and less
retention

SOFT PALATE
Classification is based upon the angle formed with the
hard palate. The more acute angle of the soft palate in relation
to the hard palate, the more muscle activity that is necessary
for velopharyngeal closure (closing of nasopharynx). More the
soft palate is markedly displaced in function, the less can be
covered by the denture base.
CLASS I: Indicates a soft palate that is rather horizontal as
it extends posteriorly with minimal muscle activity.
When the vibrating muscle is located, a few mm
separate the anterior and posterior vibrating lines allowing for
wide posterior palatal seal but not very deep.
Considered as most favorable as more tissue surfaces
can be covered leading to more retentive denture base.

CLASS III: Indicates the most acute contour in relation to
the hard palate, creating marked elevation of the
musculature to create velopharyngeal closure.
Seen usually in configuration with a high V-shaped
palatal vault. As there is greater elevation of the soft
palatal musculature in function a few mm separate the
vibrating lines and so, smaller area for the posterior
palatal seal is there than class I. Along with being
smaller, it is also deeper than class I configuration.
CLASS II: Designates those palatal contours that lie
between class I and class III
Position of the patient:
The classification of soft palate are determined when the
patient is in upright position and the head is held erect.

MAXILLARY TUBEROSITY:
Extremely large maxillary tuberosities make it necessary to locate
the back end of the occlusal-plane too low, omit some posterior teeth or
shorten the denture bases from their correct border extent and contour.
Pendulous fibrous maxillary tuberosities are frequently
encountered. They occur unilaterally or bilaterally and may interfere with
denture construction by excessive encroachment on or obliteration of the
interarch space. Surgical treatment is the choice and occasionally
maxillary bone must be removed.
Absence of maxillary tuberosities and loss of pterygomaxillary notch:
Advanced bone resorption or excessive surgical resection of the
tuberosity area can lead to absence of one or both tuberosities. This is
frequently accompanied with obliteration of the pterygomaxillary notch
area which is essential for enhancing for maximum breath to the
posterior palatal seal area and the patient should be informed as the
maxillary denture will not be as resistant to posterior downward
dislodgement when incising takes place.

TONGUE:
Smith described two anatomic tongue types:
Long, narrow, tapered
Short, broad and thick
The first type presents fewer problems but while making
impression; it might jeopardize lingual border seal.
The second fills more of space in the floor of mouth so as
to provide posterior denture flange and hence better border
seal.
Classification of tongue size according to House:
CLASS I: Normal in size, development and function,
sufficient teeth are present to maintain normal form and
function.
CLASS II: Teeth have been absent long enough to permit
a change in the form and function of the tongue.
CLASS III: Excessively large tongue. All teeth have been
absent for an extended period of time, allowing for abnormal
development of a class III tongue.

Tongue position
Classified according to Wright
Normal : the tongue fills the floor of the mouth and is confined by
mandibular teeth. Lateral borders rest on the occlusal surfaces of
the posterior teeth and apex rests on the incisal edges of the
anterior teeth.
Class 1: Retracted – the tongue is retracted. The floor of the mouth
pulled downward, is exposed back to the molar area. The lateral
borders are raised above the occlusal plane and the apex is pulled
down into the floor of the mouth.
Class 2: Retracted – the tongue is very tense and pulled backward
and upward. The apex is pulled back into the body of the tongue
and almost disappears, the lateral borders rest above the
mandibular occlusal plane. The floor of the mouth is raised and
tense.

Saliva
Class 1: Normal quantity and quality of saliva. Cohesive and
adhesive properties of saliva.
Class 2: Excessive saliva, contains much mucous.
Class 3: Xerostomia, remaining saliva is mucinous.

FLOOR OF THE MOUTH
It presents a wide variation in anatomy and
functional relation to the ridge crest. If the floor is near
the crest, at rest or the magnitude of movement is
great, magnitude of retention and stability is poor. The
floor of the mouth in the sublingual gland and
mylohyoid areas can be very high and close to the
ridge crest at times may spill over the ridge and
eliminate alveolingual sulcus. If there tissues cannot
be placed selectively by the denture flange than the
prognosis of mandibular denture is poor.

LATERAL THROAT FORM
Niel described soft palate configuration throat form
but distinguished this category from lateral throat form. He
defined lateral throat form as the contour of the hard lingual
surfaces of the mandibular ridge in the molar area and the
velum like tissue distal to the mylohyoid ridge in the
retromylohoid fossa as it functions under the influence of
tongue.
Lateral throat form is classified according to the
extent of anterior movement of the retromylohoid curtain as
the tongue is extended anteriorly beyond the vermillion
border of the lower lip.
Examination:
With the index finger passively contacting the curved
wall of mucosa in the retromolar fossa with the tongue at
rest, patient is instructed to protrude the tongue.www.indiandentalacademy.comwww.indiandentalacademy.com

Classification Acc to Niel
CLASS I: If the lateral throat form changes configuration
so as to place heavy pressure on the finger.
CLASS III: If the pressure is minimal or no pressure is
exerted.
CLASS II: Any position of the tissue between these two
extremes
Overextension in the retromylohyoid areas results
in loss of border seal, displacement of denture or
soreness that readily radiates to the floor of the mouth,
throat and neck

TORI
CLASS I: Tori are absent or minimal in size and do not
interfere with existing denture.
CLASS II: Clinical examination shows several tori of
moderate size, often mild difficulties in denture
construction and use of surgery not required.
CLASS III: Large tori are present. These tori
compromise the function of dentures. These tori
require surgical removal.

FRENUM ATTACHMENTS
Classification according to House:
CLASS I: High in the maxilla or low in the mandible with
respect to the crest of the ridge
CLASS II: Medium
CLASS III: Freni encroach on the crest of the ridge may
interfere with the denture seal. Surgical correction may
be required

EXISTING DENTURES
- Anterior tooth shade, mould and material
- Posterior tooth shade, mould and material
Existing dentures should be evaluated to determine physical,
aesthetic and anatomic characteristics.
- Aesthetics, phonetics, retention, stability, extensions and
contours.
- Centric relation and vertical dimension of occlusion.
- Occlusal plane orientation.
- Palate of the existing denture should be examined.
- Post dam
- Base adaptation
- Midline
- Buccal vestibule
- Cross bite
- Comfort and hygiene www.indiandentalacademy.comwww.indiandentalacademy.com

Diagnosis
The word diagnosis is derived from Greek word dia
(thorough) and gnosis (knowledge) and is defined as “to
know apart or to distinguish”.
For our purposes diagnosis is defined as
1) The act or process of deciding the nature of a
diseased condition by examination
2) A careful investigation of the facts to determine the
nature of things or
3) The determination of the nature, location and causes
of the disease - by Charles Heartwell.
According to glossary of prosthodontics – diagnosis
is defined as determination of the nature of disease.www.indiandentalacademy.comwww.indiandentalacademy.com

The ability to make diagnosis is predicted on
several different factors. The knowledge of how to
conduct a careful and thorough investigation of a
problem is important, but still more important is the
knowledge of the system and the problems that might
affect it.
A correct diagnosis is the basis for the
appropriate and adequate treatment of the patient with
the problem. The prosthodontist will know the natural
history of the problem and the most effective form of
therapy. This information in turn then provides the
basis for a prognosis.

DIAGNOSTIC AIDS
1. Pre-extraction records
Old diagnostics casts are invaluable aids in determining tooth
size, position and arrangement.
Old radiographs are also helpful in determining tooth size and
bony changes.
Photographs showing natural teeth can also relay much
information regarding tooth size, position etc; and be helpful in
achieving proper esthetics and patient’s satisfaction.
2. Radiographic Examination Of Edentulous Patients
Radiograph examination of edentulous patients is advisable prior
to the construction of dentures.
Use of the orthopantomograph for routine examination of
prosthetic patients. Such an examination will often reveal the
presence of residual roots, unerupted teeth or other abnormalities in
patients who are otherwise free from signs or symptoms that might
suggest existence of a pathologic condition.www.indiandentalacademy.comwww.indiandentalacademy.com

3. Diagnostics Casts
On occasion, ridge relationships, inter-ridge
distance or ridge shape and forces cannot be
adequately determined by clinical examination alone.
It may be necessary to make preliminary impressions
and a maxillo mandibular relation record to mount the
casts on the articulator. The centric relation and
occlusal vertical dimensions records must be viewed
around the entire arch. Sufficient space may not be
available for both denture bases between the
tuberosities of the maxillae and retromolar pad of
mandible.

TREATMENT PLANNING
-Tissue conditioning: List proposed therapy as finger massage,
prescribed medications, type of tissue treatment material to be
used and frequency of soft reline changes, etc.
-Preprosthetic sugery: List any proposed preprosthetic
procedures along with the staging of these procedures.
-Articulator
-Tooth selection
-Denture base material
-Denture base shade
-Anatomic palate
-Characterization
PROGNOSIS
Give the prognosis and list the reasons for the prognosis

Conclusion
The acquisition of knowledge is one of man’s
greatest accomplishments. Putting that knowledge to use
is the fuel that turns the wheel of progress. Research
works may develop mathematical models, devise
predictive procedures and test them satisfactorily, but the
practicing prosthodontic treating the patient at a time will
prove the ultimate worth of any suggestive method.
So equipped with the knowledge and understanding of
examination and diagnosis, we can become skilled hands
to intervene during treatment planning.

References
1. The Dental Clinics of North America – Complete
dentures
2. Charles M. Heartwell – Syllabus of complete
dentures.
3. Boucher’s – Prosthodontic treatment for edentulous
patients. Pg: 51.
4. Sheldon Winkler – Essentials of complete denture
prosthodontics. Pg: 39.

Diagnosis and treatment planning in cd

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