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EXAMINATION, DIAGNOSIS AND TREATMENT PLANNING FOR FIXED PARTIAL PROSTHODONTICS ( FPD) CONTENTS 1-DEFINITIONS 2-PERSONAL DETAILS & CHIEF COMPLAINT 3-HISTORY • History of present illness • Medical history • Dental history 4-EXAMINATION • Extra oral examination • Intra oral examination 5-INVESTIGATIONS 6-DIAGNOSIS 7-PROGNOSIS 8-TREATMENT PLANNING 9-REFFRENCES DEFINITION DIAGNOSIS : Is the determination of the nature of a disease process. TREATMENT PLAN : The sequence of procedures planned for the treatment of a patient following diagnosis. Personal details :The patient’s name, address, phone number, sex, occupation, work schedule and marital and financial status are noted. Chief complaint :The chief complaint should be recorded, preferably in the patient’s own words & primary reason(s) for seeking treatment should be analyzed first. The chief complaint usually fall into one of the following categories. Comfort (pain, sensitivity, swelling) Function (difficulty in mastication or speech) Social (Bad taste or odour) Appearance (fractured or unattractive teeth or restorations, discolorations). HistoryMedical history :The medical history should include the medications the patient is taking and all the relevant medical conditions. Patient’s physician may be contacted if needed. Dental history; Patient’s experience with previous partial denture can be evaluated. The success of the future treatment can be assessed. Examination; Extra-oral: Head and neck, Lips, size, shape and symmetry of the face profile, skin, hair are examined, muscles of mastication and TMJs ( Intra auricular & extra auricular method). Intra Oral examination : Soft tissue-Evaluate oral hygiene, periodontal status, quality and quantity of saliva edentulous ridge, Tongue, Floor of the mouth, sulcus, mucosa, soft palate, frenum. Hard tissue- Each tooth is examined for caries, decalcifications, erosion, abrasion, attrition, sensitive exposed root surfaces or fractures, contour, occlusal examination, lateral guidance (Canine guided occlusion, Group function, Mutually protected), missing teeth & Hard palate, Edentulous ridge are examined for shape, size, contour. Investigations; Radiographic examination :Periapical, Digital radiography, Panoramic films, CT scanning, MRI (magnetic resonance imaging), Digital subtraction radiography Special radiograph for TMJs Transcranial exposure Serial tomography Arthrography PANORAMIC FILMS provide information about • Presence or absence of teeth • Third molars and impactions • Retained root tips. IOPA, however provides details about • Bone support and trabecular patterns. quality, • Root number and morphology (short, long, slender, broad, bifurcated, fused dilacerated etc). • Caries • Root proximity VITALITY TESTING : Pulpal health must be assessed by measuring the response to • Percussion • Thermal or electrical stimulation • Preparation of test cavity without LA Diagnosis :The dental diagnosis includes-Determination of the periodontal health, occlusal relationships, TMJ function, condition of the edentulous areas, anatomic abnormalities, serviceability of existing prosthesis and status of remaining dentition – including previous dental treatment, dental caries, defective restorations and pulpal disease. Treatment options follow logically from the diagnosis. TREATMENT PLANNING Objectives of Treatment Planning: • Correction of existing disease • Prevention of future disease • Restoration of function • Improvement of appearance. DECIDING FACTORS FOR TOOTH REPLACEMENT WITH FPD Two important factors • Support (abutment teeth considerations) • Occlusal forces (biomechanical considerations) Abutment teeth considerations : • supporting tissues • Crown root ratio • Root configuration • Periodontal ligament space Biomechanical considerations : • • • Long span bridges Bending & deflection Torquing forces – flexing Double abutments Unfavorable crown-root ratio Secondary abutment crown root ratio as much as primary abutment Arch curvature Pontic lever arm lying outside the inter abutment axis – torquing movement Additional retention by secondary abutments Canine replacement FPD Types of FPD for treatment plan 1. Depending upon location – Anterior bridges – Posterior bridges 2. Depending number of teeth – 2 unit bridges – 3 unit bridges 3. Recent classification – Tooth supported FPD – Implant supported FPD – Resin bonded FPD Tooth supported FPD – Conventional or rigid FPD – Cantilever FPD Resin bonded FPD – Conventional – Fiber reinforced Implant supported FPD – Screw retained FPD – Cement retained FPD • Depending on material used – Cast metal FPD – All ceramic FPD – Metal ceramic FPD – Resin veneered FPD • Depending upon construction – Cast metal FPD – CAD CAM assisted FPD – Direct fibre reinforced FPD Prognosis : The dentist should propose a treatment plan that offers a favorable prognosis. The less disease present at the onset and the less complex the treatment, the more favorable the prognosis. CONCLUSION Successful treatment is the result of a logical diagnosis and a rational sequence to the treatment plan. A comprehensive oral examination, distinct radiographs and well defined diagnostic casts are essential ingredients for diagnosis. The approach to treatment planning should be meticulous, flexible and scholarly. REFERENCES 1. Contemporary fixed prosthodontics – 3rd edition, Stephen F. Rosensteil, Martin F. Land, Junhel Fujimoto. 2. Fundaments of fixed prosthodontics – 3rd edition, Herbert T. Shillingburg, Sumiyo Hobo.