treatment plan.pptx
Transcript of treatment plan.pptx
-
7/27/2019 treatment plan.pptx
1/31
History, Laboratory and Examination
Alaa Al-Otaibi
Diagnosis And Treatment In Prosthodontics, Chapter 3
By: William R.Laney
-
7/27/2019 treatment plan.pptx
2/31
Patient Data interpretation:
Successful treatment
physical
Lab test
History
-
7/27/2019 treatment plan.pptx
3/31
A-History
Recording the history can be the first step in resolving a
patients problem.
The art of history taking lies in the ability to subtly directthe conversation with the patient.
Universal system of checkboxes is not satisfactory to
document a patients subjective description of
symptoms.
This Questionnaires may be indicated for some patients,
particularly those entering a practice for the first time.
-
7/27/2019 treatment plan.pptx
4/31
A- History
Guideline for logical sequence of history:
1- Initial Onset
2- Anatomical location of pain
3- Characteristics of pain
4- Factors that aggravate or relieve pain
5- Previous consultation, diagnosis and treatments
-
7/27/2019 treatment plan.pptx
5/31
II- Laboratory Data:
Although the prosthodontist may not routinely
order laboratory tests, its important that clinician
have a working knowledge of laboratory data.(why?)
This information assists in disease differentiation.
Determination od definitive diagnosis.
Provides parameters for treatment planning and
management.
-
7/27/2019 treatment plan.pptx
6/31
II- Laboratory Data:
Basic tests:
Complete blood count (CBC).
Hemostasis and coagulation studies
- Prothrombin time (PT)
- International Normalized ratio (INR)
Comprehensive metabolic panel
-
7/27/2019 treatment plan.pptx
7/31
II.Lab test
CBC:
A CBC incudes 5 measures:
1- WBC Concentration
2- RBC concentration
3- Hematocrit
4- Platelets count
5- Hemoglobin
-
7/27/2019 treatment plan.pptx
8/31
II. laboratory
Hemostasis and coagulation studies:
Requested for:
- patient who have medical condition that requireanticoagulant.
- Or medical condition that affect clotting include ( liverdisease, uremia, some cancers, bone marrow disorder orvit K deficiency)
PT: measure the activity of factor II, VII,X and fibrinogen
INR: (PT/PT normal)ISI
-
7/27/2019 treatment plan.pptx
9/31
II.Labratory:
C. Comprehensive metabolic panel (CMP):
Consists of14 specific tests
Provide an overview of:
- kidney function, electrolyte and acid-base balance.
- blood sugar, Ca, protein level.
-
7/27/2019 treatment plan.pptx
10/31
III- Physical
A- Extra-Oral
B- Intra-Oral
-
7/27/2019 treatment plan.pptx
11/31
III. Physical
A- Extra-Oral Examination:
1- patients relative body proportions, weight, posture, gait, degree offunctional coordination, any obvious abnormalities.
2- head a neck region:
Facial composition, asymmetries, skin texture, complexion, expression inthe eyes, breathing
3- perioral region:
Abnormality like swelling, deformities. Lesion, discoloration.
Lips, ears, nose
4- Digital palpation to examine the( lymph nodes, salivery gland, thyroid glandand muscle of mastication).
-
7/27/2019 treatment plan.pptx
12/31
III. Physical
B- Intra-Oral examination:
1- soft tissue ( tongue, floor of mouth, mucosa, palate)
2- Occlusal analysis and vertical dimension determine.
3- esthetic evaluation.
4- dentition:
(number, color, accretions, alignment, location in the arch,individual position mobility, migration, crown root ratio, cariesincidence, morphology fracture, erosion, attrition, inter-proximality contact)
-
7/27/2019 treatment plan.pptx
13/31
III. Physical
B- Intra-Oral Examination:
5- Dentition in function
- The horizontal relationship of mandible to the
maxilla and all functional occlusal conntact should
be visualized.
- -diagnostic mounting should be made using acentric relation recording
-
7/27/2019 treatment plan.pptx
14/31
II. Physical
6- functional analysis of mandibular movement.
Classification of mandibular movement :
Cyclic, vertical, bruxing
Cyclic pattern
- Smooth surfaces on
marginal ridge
- Inclined planes- Flattened triangular
ridges
- Widened fossae
with moderate to
minimal cuspal
wear
Vertical mastication
- Relatively steep
- Sharp cusp
- -excessive wear onbuccal or labial cuspal
inclines and surface of
manibular teeth
- exessive wear in lingual
surface of the maxillary
teeth
Bruxing
- Flat occlusal and
incisal surface.
- - anti monson or
reverse curve withinarch.
- The occlusal table
generally appears
widened and th
incisal edges beveled
-
7/27/2019 treatment plan.pptx
15/31
Beyron categorized mandibular movement patterns as:
a- multidirectional gliding movement.
b- predominantly bilateral movements.
c-predominantly unilateral movements.
d- predominantly unilateral movement
-
7/27/2019 treatment plan.pptx
16/31
III. Physical
The Edentulous mouth :
The approach of examination according to the Patient experience with
prostheses :-
I. with no prior experience for prosthesis
look for primary reason for extraction .
Periodontal cause for tooth loss :
Expect reduced bone support thus reducedability to respond to prosthesis stress.
Caries as causes for tooth loss:
Bone has not reduced and denture bas
support expected to be optimal .
II. Patient with previous experience :
-Observe tissue response to
prostheses stress .
- Using diagnostic cast ,Radiograph
To determine appropriateness for
complete denture.
-
7/27/2019 treatment plan.pptx
17/31
The edentulous mouth:
1- Arch size and oral aperture:
Discrepancy between maxillary and mandibular arch or opening to oral cavity.
These condition can be seen in patient treated surgically, burns ,traumatic injury ect.
Difficulties can be encountered in impression ,maxillomandibular relation and teeth
arrangement
Solution:
1- Longer appointments 2- Staged clinical procedure
3- Premedication or sedation
4- Use of topical lubricant
5- Less bulky retracting instrument
-
7/27/2019 treatment plan.pptx
18/31
The edentulous mouth:
2- Ridge form:
Examination of the Ridge form should include :
Evaluation of ridge bony support and potential stability and
retention
Development of desirable occlusal scheme and esthetic
arrangements of tooth.
-
7/27/2019 treatment plan.pptx
19/31
The edentulous mouth:
2- Ridge form:
Ridge form is the cross sectional contour specially the maxillary form and its relation to
palate is very critical
U shape: The most
favorable arch form is
the provide broad base
to support the occlusalstresses and parallel
sides enhance adhesion
and resistance to
displacement
V shape ridge: Has
narrow crest that
cannot absortmasticatory stress
without irritation or
discomfort .
Flat ridge: most
frequently seen andmost difficult to
restore .
-
7/27/2019 treatment plan.pptx
20/31
The edentulous mouth:
2- Ridge form:
Ridge resorption ranges from minimal to extreme, the pattern
of resoroption vary depends on the local influences .
Parasthesia and ridge soreness is common complaint when
the Ridge are resorbed .
Variation within typical ridge forms can occur, exostoses ,lingual tori, irregular bony resorption , sharp spicules ,bulky or
flared ridge , undercut complicate insertion and removal of
prosthesis .
-
7/27/2019 treatment plan.pptx
21/31
The edentulous mouth:
3- Palate:
Palatal configuration is interrelated to maxillary ridge form to theextent .
When the hamulus is prominent , the mucosal covering can beeasily irritated by over extension of the denture.
Soft palate:
The form of soft palate can be classified into Class I,II,III Accordingthe slop of the palate , which can be covered by the denture base.
Soreness and loss of border seal can be seen in class III palate whichdrop abruptly from the hard palate.
-
7/27/2019 treatment plan.pptx
22/31
4- Lateral throat form:
- This observation is important ascertain the opportunity fordenture base extension area
70% class I
25% class II
5% class III
- The recommendation is to use implant depth gauge todetermine length of lateral throat form and aid in customimpression tray fabrication .
-
7/27/2019 treatment plan.pptx
23/31
The edentulous mouth:
5- Maxilla mandibular relashionship:
A critical evolution of arch alignment and the
interarch ridge relationship is necessary to
formulate a treatment approach that enhances the
strength and minimize the weaknesses of the
structure .
Factor such as tray selection , impression technique
, tooth forms and position , division of interarch
space , occlusal scheme and base material
-
7/27/2019 treatment plan.pptx
24/31
The edentulous mouth:
6- Tongue:
I. Morphology
long narrow and tapered short broad and thick
Not problematic in taking impression Provide positive contact surface for the
lingual denture flange and better border seal
Less effective in providing lingual seal - Complicate impression procedure.- More susceptible to irritation and occlusal
trauma from teeth
Smith E,1951
-
7/27/2019 treatment plan.pptx
25/31
The edentulous mouth:
Tongue position:
- According to Wright et al :
75% normal position
25% retracted position classified class I ,II
normal tongue position enhance retention and stability of maxillaryand mandibular denture
retracted tongue result in looseness of the denture
Tongue must be respected and accommodated adequately in theprostheses design .
Poor tongue habits usually result in unsuccessful denture experience
-
7/27/2019 treatment plan.pptx
26/31
The edentulous mouth:
7- Mucosa:
Divided into masticatory , lining and specialized mucosa
Masticatory
mucosa:
Examination of
masticatory mucosa
allows
determination the
degree of stability of
the prostheses that
might be expected
Lining mucosa :
The vestibule
Mucobuccal fold
Floor of the mouth
When functional space
and appearance permit,
increased width of the
denture flanges enhance
the border seal.
Specialized mucosa:
Covering the dorsal
and lateral surface of
the tongue
-
7/27/2019 treatment plan.pptx
27/31
III.Physical
Implant therapy:
Examination of patient needing implant therapy ,particular
attention :
Ridge morphology ,
Interocclusal relationship ,
Parafunction occlusal habits ,location of available bone ,
Esthetic consideration that needs gingival recontouring,and psychological profile of the patient
-
7/27/2019 treatment plan.pptx
28/31
III. Physical
Taste:alterations in taste sensation is a complaint for denture wearers
Henkin and chrestenson found that person wearing complete maxillary denturehad significant elevation of taste for bitter and sour .
Which is similar phenomenon happened for anesthetized palate region.
In contrast ,other study found the taste perception was slightly enhanced.
Other investigation suggested that neither the contour nor the denture basematerial affected the ability to perceive taste of a solution at room temperature.
Hyposmia : decreased sensitivity to odor. But patient demonstrate high thresholdfor bitter and sour taste s and have high arched palate .
Patient with surgical defects reported to have loss of taste sensation. However, thisfound to be enhanced when prostheses in place.
-
7/27/2019 treatment plan.pptx
29/31
III. Physical
Malignant lesions
- 25 % of oral cancer occur in patient without known risk factors
- Early lesion and premalignant lesion are difficult to detect due to subtle changes to
mucosa.
- Lesions present initially as either leukoplakia or erythroplakia and pregress nonhealing ulceration.
- In advance stage, other manifestation such as bleeding, lossening of teeth,dysphagia, dysarthria, development of neck masses
- The use of oral cancer diagnostic tools as an alternative to biopsy:
Oral cytology
light detection of mucosal abnormality
-
7/27/2019 treatment plan.pptx
30/31
IV. Informed Concent
Is thought appropriate for all non reversible procedures and those involve risk of the
patient
Proper informed consent should contain the key principles:
Informed consent is not substitute for patient education .
Clinician should have open discussion with patient to ensure the communication is clear .
The forms should be written in language that average person would understand.
Patient should actively participate in discussion .and provide the opportunity to discuss theconcerns
Verbal provision of information to patient about the risks , benefits and alternative to treatment
and subsequent documentation of the dcussion in the medical records may be an acceptable
substitute for a formal signed consent form
Brenner etal,2009
-
7/27/2019 treatment plan.pptx
31/31