2. Assessment of the partialy edentulous patient Flashcards
Edentulous patient has ____ & _____ disorders
functional and esthetic
What are the three hippocratic questions?
- What happened to you
- since when?
- What do you think the cause is?
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
What do we examine in the physical exam extraorally? (5)
- Postural habits
- Paralysis / asymmetries
- OVD
- Pain upon touch
- Opening=closing path deviation
What do we examine in the physical exam extraorally with postural habits? (2)
- Spinal column deviation
- Postural tension/relaxation
What do we examine in the physical exam extraorally with OVD? (3)
- musculature
- muscular coordination
- hypertrophy
What do we examine in the physical exam extraorally with opening-closing of the mandible? (2)
- Opening range limittion
- Opening-closing path deviation
What do we examine in the physical exam intraorally? (5)
- Oral hygiene
- Shape and color of oral structures
- Mobility of oral structures
- Inspection
- Palpation
What do we examine in the physical exam intraorally with oral hygiene? (2)
- Dental Plaque
- Dental calculus
What do we examine in the physical exam intraorally with shape and color of oral structures?
- If theres a suspicious lesion we biopsy it
What do we examine in the physical exam intraorally with mobility of oral structures?
Frenuli
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
What do we palpate in the intraoral physical exam palpation? (4)
- Painful points
- Assess supporting mucosa
- Tooth mobility
- Periodontal probing
What do we palpate for painful points? (2)
- Supporting tissues
- Muscular insertions
What do we palpate to asses the supporting mucosa? (2)
- Hypertrophic
- Resilient
What is the significance of palpating for tooth mobility?
Determines the kind of support for the denture
What is the significance of palpating for periodontal probing
Very important in assessing abutment teeth
What destabilizes dental arches?
tooth loss
What happens to the arch after tooth loss? (2)
- arch interuption
- arch shortening
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
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
