1. Integrated Treatment plan
Year 5
Prosthodontics
Dr Norlela Yacob

2. In 15 minutes:
Small group Discussion 7 group.

3. Crown
Indication
contraindication

4. Crown
Advantages
Disadvantages

5. Bridge (conventional)
Indication
contraindication

6. Bridge (conventional)
Advantages
Disadvantages

7. Bridge (adhesive)
Indication
contraindication

8. Removable Prosthesies
advantages
Disadvantages

9. Removable Prostheses
Indication
contraindication

10. 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

11. Information gathering
First: concentrate on patient’s complaint and concern:
Emergency management needed/necessary?
Concern on aesthetic, social well being.

12. 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.

13. 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?

14. 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?

15. 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 3rd and 2nd molars.
What are the important information that you need?

16. 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

17. 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.

18. 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

19. 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

20. 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

21. 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

22. Continuous learning is essentials!
BENEFITS MUST OUTWEIGHT THE RISKS Do not claim about the benefits which go beyond the evidence based.
Continuous learning is essentials!
Example: evolution of resin cement

23. In prosthodontics
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.

24. Problem with Co-cr denture: REST occlusal interference due to insufficient rest seat preparation

25. Problem with Co-cr denture: REST occlusal interference due to insufficient rest seat preparation

26. Milled Crown

27. Milled Crown

28. Conclusion 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.

29. Thank you.