2. Assessment of the partialy edentulous patient Flashcards by Nicky Tahpee

Edentulous patient has ____ & _____ disorders

functional and esthetic

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What are the three hippocratic questions?

What happened to you
since when?
What do you think the cause is?

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What do you ask when assessing the patients oral hygiene?

How many times a day they brush
How many oral checkups in a year
What the patient uses

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What do we examine in the physical exam extraorally? (5)

Postural habits
Paralysis / asymmetries
OVD
Pain upon touch
Opening=closing path deviation

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What do we examine in the physical exam extraorally with postural habits? (2)

Spinal column deviation

- Postural tension/relaxation

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What do we examine in the physical exam extraorally with OVD? (3)

musculature
muscular coordination
hypertrophy

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What do we examine in the physical exam extraorally with opening-closing of the mandible? (2)

Opening range limittion

- Opening-closing path deviation

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What do we examine in the physical exam intraorally? (5)

Oral hygiene
Shape and color of oral structures
Mobility of oral structures
Inspection
Palpation

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What do we examine in the physical exam intraorally with oral hygiene? (2)

Dental Plaque

- Dental calculus

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What do we examine in the physical exam intraorally with shape and color of oral structures?

If theres a suspicious lesion we biopsy it

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What do we examine in the physical exam intraorally with mobility of oral structures?

Frenuli

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What do we inspect in the intraoral physical exam? (4)

Bone tissue - Torus
Number of remaining teeth
Position and condition of remaining teeth to see if needs restorative treatment is
Edentulous space morphology

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What do we palpate in the intraoral physical exam palpation? (4)

Painful points
Assess supporting mucosa
Tooth mobility
Periodontal probing

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What do we palpate for painful points? (2)

Supporting tissues

- Muscular insertions

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What do we palpate to asses the supporting mucosa? (2)

Hypertrophic

- Resilient

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What is the significance of palpating for tooth mobility?

Determines the kind of support for the denture

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What is the significance of palpating for periodontal probing

Very important in assessing abutment teeth

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What destabilizes dental arches?

tooth loss

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What happens to the arch after tooth loss? (2)

arch interuption

- arch shortening

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What is arch interruption? (4)

tooth movement
loss of interproximal contacts = food impaction
arches rearrange to close the gap
stability comes after a long time

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What happens with arch shortening? (3)

Happens because of mesialization of teeth
Tooth may have to be extracted if it extrudes
if only the 2nd molars are lost, arches may remain stable

What complementary tests are used? (3)

orthopantomography
full mouth series
occlusal analysis

What do we see with orthopantomopgraphy? (4)

cysts
remaining roots
malign and benign tumors (ex. odontomas)
location of inferior alveolar nerve and mental foramen relative to edentulous space

Orthopantomography is used for …?

general view of the mouth

Full mouth series is used for...?

assesment of teeth and periodontium

What do we see with full mouth series? (11)

- Remaining teeth - Caries - Previous dental resorations - Number, shape and size of roots - Previous endodontic therapies - Root resoption - root fracture - periapical granuloma - apicoectomy (i.e. root end surgery) - Cementoma - Occlusal trauma

What is the ideal/good/minimum crown to root ratio? (3)

- Ideally: 1/2 - Good: 2/3 - Minimum 1/1

How do we analyze occlusion?

- impression + casting - facebow trasnfer - upper moutning - intermaxillary transfer - lower mounting - usually magnetic split cast to be able to carry casts to the surveyor

What do we analyze with static occlusion assessment? (5)

- dental arches morphology - intermaxillary relationships - Overbite/over jet - Occlusal plane - teeth

What do we analyze with dynamic occlusal assessment? (3)

- Prematurities - Interferencies - Type of disocclusion

Static occlusion assessment: Arch morphology? (3)

- triangular - oval - parabolic

Static occlusion assessment: intermaxillary relationships? (3)

- Angle's class - Open bite - Cross bite

Static occlusion assessment: Overbite/overjet of partially edentulous patients? (2)

- Increased overbite | - Decreased OVD

Static occlusion assessment: occlusal plane? (4)

- unevenness - curve of spee - curve of wilson - location and span of edentulous areas

Static occlusion assessment: teeth? (4)

- migrations - inclinations - rotations - wear

Last step of preprosthetic procedure?

Rehabilitation by means of RPD

What are the preprosthetic procedures? (6)

- periodtonal treatment - surgical treatment - restorative treatment - fixed partial denture - orthodontic treatment - final assessment

What is the preprosthetic surgical treatments? (5)

- extractions - osteotomy - soft tissue surgery (vestibuloplasty, lesion exersis)

What is the preprosthetic restorative treatments? (2)

- restorations | - endodontic therapy

What is the purpose of preprosthetic orthodontic treatments? (3)

Improves: - occlusion - occlusal load over abutment teeth - path of insertion for RPD

What is the final assessment in pre prosthetic procedures? (2)

- new occlusal analysis / contacts - radiographs / probing fives info about where is the better location of occlusal rests (so they dont interfere with occlusion), etc - tooth preps for rest seats

What is a surveryor?

- paralleling instrument used in contruction of prosthesis to locate and delineate contours and relative positions of abutment teeth and associated structures

What does the surveyor help with?

- to locate path of insertion - to prepare guiding planes - to prepare rest seats * all with minimum interference with occlusion - stability and retention of denture

Surveryor and the path of insertion?

-certain paths have tooth surfaces in a certain inclination relative to that path

Surveyor and guiding planes? (2)

- can be prepared at vertical tooth surfaces | - will improve path of insertion facilitating a single favorable path

Surveryor and retention?

retention distributed evenly so no abutment tooth is overloaded

To record path of insertion at the surveryor we need to...

draw three lines or point over the cast

What do we do after tooth preparation? (4)

- new impressions to record changes - custom trays with spacer - best with impression silicones - assess casts again in surveyor

Objective of tooth preparation? (3)

- Achieve appropriate path of insertion - Achieve appropriate retention - Avoid interferences with occlusion or tissues (ex torus)

How is the guiding plane made? (2)

with the blade of the surveyor | *only a simulation

What can we prepare in the surveyor?

- rest seats - every prp ahs to be written down - later preps in the cast have to be made into pateints mouth according to the notes