The pathway to formulate treatment plan Information gathering Patient history Radiograph examination Clinical examination Special test Diagnostic aids: study model, diagnostic wax up Evaluation of findings Identify the significant of finding Identify the problems Diagnosis Formulation of treatment plan based on diagnosis
Information gathering First: concentrate on patient’s complaint and concern: Emergency management needed/necessary? Concern on aesthetic, social well being.
Information gathering Next: move on according to clinical findings: toothwear, old denture, radiographic findings, tooth mobility after wearing denture. Based on the findings: what are the other informations that you need to gather that will direct you to your diagnosis.
Information gathering: case 1 Patient come your clinic and request for replacement of his old denture. On examination: there is inflammation on the denture bearing area. What are the important information that you need?
Information gathering: case 2 Patient concern about her discolouration of her teeth and teeth look short and missing posterior teeth On examination: it appear to be tooth wear on palatal area of her incicors, free end saddle What are the important information that you need?
Information gathering: case 3 Patient request for bridge on her back teeth On examination: there is overeruption of opposing teeth. The missing area was her last 3 rd and 2 nd molars. What are the important information that you need?
Information gathering Assessment of diagnostics aids: lab test, wax up: study model etc. Benefits of creating diagnosis and problem list: Show organization Professional competency Patient education
DIAGNOSIS Allow us to: Direct management Give indication and prognosis Communicate with patient and other professional colleagues Record in notes(medico legal) Patient might want to know what is wrong with them.
Explaining the diagnosis May be Discussing a different diagnosis (what it would be) and reaching a provisional diagnosis (what it most likely is) Explaining a definitive diagnosis
Explaining the diagnosis Simple language and lay-man term Tailor it to patient level of understanding May have to keep it simple Allow opportunity to ask questions Reassure/show empathy
Discussing treatment options Why discuss treatment option? In some conditions it may only one options/approach Treatment outcome may be varies Patient needs to be informed of all options Treatment plan will be influenced by patients’ priority
In Prosthodontics: developing an options list Things to consider: Patient factors General factors and assessment Risks/benefits of treatment (evidence based) Limitations/prognosis of treatment Operator clinical skills, consider referral
Continuous learning is essentials! BENEFITS MUST OUTWEIGHT THE RISKS Do not claim about the benefits which go beyond the evidence based.
Construction of definitive denture will take place at the later stage. Replacing missing tooth incorporated with crown/bridge work and denture; It best to milled the crown with rest seat, clasp rest for denture. Then, final co-cr denture shall be constructed.
Problem with Co-cr denture: REST occlusal interference due to insufficient rest seat preparation
Formulation of treatment planning need multiple visits Patient should understand the treatment plan and the condition. Incorporated of milled crown and removable partial denture can improve the longevity of the treatment. The treatment plan for a denture should be done at early stage but the construction of denture should be done at the last stage.