1. DIAGNOSIS & TREATMENT PLANNING DR MAYANK SINGH
DEPTT. OF PROSTHODONTICS

2. PATIENT INTERVIEW
Establish rapport with the patient
Gain insight into the psychological makeup of the patient
Explore any physical condition that may effect the treatment
Ascertain the patient expectations of treatment

3. STRUCTURE OF INTERVIEW
Dental history - In the dental history it is important to find out why teeth have been lost.
If lost by caries If lost by periodontal
disease
Presence of removal partial
Dentures will increase the possibility of further carious activity
Every effort must be made to discover and eliminate its cause

4. DIET
The patient diet should be evaluated
If the patient have sugar containing diet a change must be effected.
The problem caused by the sugar is compounded by the wear of removal partial dentures because the prosthesis shield the microorganism from the cleansing and buffering action of patient saliva.

5. HABITS
Patient habit should be evaluated to determine whether the effect the prognosis of the treatment.
Bruxism and clenching
Tongue thrusting

6. EVALUATION OF ORAL HYGIENE
It is critical to the prognosis of the patient treatment
Inadequate oral hygiene must be recognized early in the diagnostic procedure so that a preventive dentistry programme can be evaluated.

7. EVALUATION OF CARIES SUSCEPTIBILITY
The presence of large number of restored teeth
Sign of recurrent caries
Evidence of decalcification

8. ORAL PROPHYLAXIS
Supragingival calculus should be removed and oral prophylaxis should be performed
The diagnostic cast and definitive intraoral examination will be more accurate if teeth are cleaned

9. RADIOGRAPH
Complete series of periapical and a full mouth radiograph is essential for definitive examination of partially edentulous patient
Full mouth radiograph is ideal for screening for pathological condition

10. Periapical radiographs helps in determining
1. Crown root ratio of remaining teeth
2. Status of periodontal ligament space
3. Lamina dura of abutment teeth
4. Quantity of bone on the residual ridge in edentulous area

11. DIAGNOSTIC IMPRESSION AND CAST
A diagnostic procedure for a partially edentulous patient must be considered incomplete unless it includes the evaluation of accurate diagnostic cast.

12. MOUNTED DIAGNOSTIC CAST
Uses includes the following :
Extruded teeth, low hanging tuberosities, lack of inter arch space, malposed teeth and defective restoration are readily apparent.
They provide a detail analysis of patient occlusion
Aid in the education of the patient and in presentation of the treatment planning.
They provide a permanent dental record of the patient condition before treatment.

13. Centric jaw relation record
Bone to bone relation
Recorded repeatedly and verified Best reference point

14. Methods of determining centric jaw relation
Conventional method
Bilateral manipulation of the mandible
Alteration of protrusion and retrusion

16. Media for recording centric jaw relation
Wax
Impression pastes
Plaster of paris
Dental stone
Acrylic resin
Modeling plastic
waxes
Soft wax
Hard wax

19. Definitive oral examination
Evaluation of caries and existing restoration

20. Evaluation of sensitivity to percussion
Tooth movement caused by-prosthesis or occlusion
Traumatic occlusion
Periapical or pulpal abscesses
Acute pulpitis
Gingivitis or periodontitis
Cracked tooth syndrome

21. Evaluation of mobile teeth
Traumatic occlusion
Inflammatory changes in periodontal ligament
Loss of alveolar bone support

22. Splinting of abutment teeth
Indications
Remaining teeth have reduced support-periodontal disease
Teeth with short ,tapered roots
Presence of two or three widely spaced retainable teeth

23. Evaluation of periodontium
Pocket depth in excess of 3mm
Furcation involvement
Deviation from normal color and contour of gingiva
Marginal exudate
Abutment teeth have less than 2mm of attached gingiva
Treatment
Root scaling and planning
Gingivectomy
Periodontal flap procedures
Free gingival grafts

24. Evaluation of hard tissue abnormalities
Torus palatinus
Torus mandibularis
Exostosis and undercuts
Mandibular tuberosity

25. Evaluation of soft tissue abnormalities
Labial frenum
Hypertrophic lingual frenum
Unsupported and hypermobile gingiva

27. Evaluation of radiographic survey
Caries
Existing restorations
Root fragments and other foreign bodies
Unerupted third molars
Abutment teeth
Root length,size ,form
Crown/root ratio
Lamina dura
Periodontal ligament space
Bone index areas

29. Evaluation of mounted diagnostic casts
Interarch distance
Occlusal plane

30. Occlusal plane Enameloplasty Extracoronal cast metallic restorations
Irregular occlusal plane
Enameloplasty
Extracoronal cast metallic restorations
Extraction

31. Occlusal interferences
Bruxism
Excessive wear of teeth
Chipping or fracture
Increased mobility
Tooth migration
Injury to TMJ-muscle spasm,pain and joint symptoms

32. Occlusal equilibration
Selective grinding or coronal reshaping of tooth with the intent of equalizing occlusal stress

33. Treat at centric relation or centric occlusion?
Coincidence of centric relation or centric occlusion
Absence of posterior tooth contacts
Situation in which all posterior tooth contacts are to be restored with cast restorations
Only a few posterior contacts
Clinical symptoms of occlusal trauma

34. Diagnostic wax-up Provide a guide for tooth preparation
Indicate problems that may be encountered during treatment

35. Development of treatment plan
Phase1
Collection and evaluation of diagnostic data
Immediate treatment to control pain and infection
Biopsy or referral of patient
Development of treatment plan
Education and motivation of patient

36. Phase 2 Removal of deep caries followed by temporary restoration
Extripation of inflamed pulp
Removal of nonretainable teeth
Periodontal treatment
Occlusal equilibration

37. Phase 3 Preprosthetic surgical procedures
Definitive endodontic procedures
Fixed partial denture construction

38. Phase 4 Removal partial denture
Reinforcement of education and motivation

39. Phase 5
Postinsertion care
Periodic recall

40. Q1. The first step in the diagnostic mounting procedure is the mounting of the maxillary cast on a
Fully adjustable articulator
Semi-adjustable articulator
Denar articulator
d)Free plane articulator

41. Q2. Face bow which requires styli to be placed on selected points on the face is
Whip mix
Hanau spring bow
Hanau SM
d)Hanau H2

42. Q3. Beyron’s point is located _ mm anterior to the posterior margin of the tragus of the ear on a line to the outer canthus of the eye 11 12 13
d)14

43. Q4. While adjusting the articulator, the following setting are followed for condylar guidance, Bennett guide and incisal table respectively
30, 15, 0
0, 30, 15
15, 30, 0
30, 0, 15

44. Q5. Ramfjord and Ash (1971) have stated that three factors must be controlled in order to succeed in determining centric jaw relation. Which one is not among them?
Psychologic stress
Pain in temporomandibular joints
Muscle memory
Systemic illness

45. Q6. In which method of recording jaw relation does the operator place all four fingers of his hand on the lower border of the mandible and thumbs over the symphysis?
Bilateral manipulation of the mandible
Alternate protrusion and retrusion
Both a and b
Use of an occlusal splint

46. Q7. Which of the following is not used to record centric jaw relation
Acrylic resin
ZoE paste
Dental stone
All of the above are used

47. Q8. While using metal impregnated wax, water bath temperature kept is
40°C
43°C
45°C
37°C

48. Thank you

49. ANSWERS
1. B
2. D
3. C
4. A
5. D
6. B
7. A
8. B