treatment plan.pptx

7/27/2019 treatment plan.pptx

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History, Laboratory and Examination

Alaa Al-Otaibi

Diagnosis And Treatment In Prosthodontics, Chapter 3

By: William R.Laney


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Patient Data interpretation:

Successful treatment

physical

Lab test

History


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A-History

Recording the history can be the first step in resolving a

patients problem.

The art of history taking lies in the ability to subtly directthe conversation with the patient.

Universal system of checkboxes is not satisfactory to

document a patients subjective description of

symptoms.

This Questionnaires may be indicated for some patients,

particularly those entering a practice for the first time.


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A- History

Guideline for logical sequence of history:

1- Initial Onset

2- Anatomical location of pain

3- Characteristics of pain

4- Factors that aggravate or relieve pain

5- Previous consultation, diagnosis and treatments


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II- Laboratory Data:

Although the prosthodontist may not routinely

order laboratory tests, its important that clinician

have a working knowledge of laboratory data.(why?)

This information assists in disease differentiation.

Determination od definitive diagnosis.

Provides parameters for treatment planning and

management.


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II- Laboratory Data:

Basic tests:

Complete blood count (CBC).

Hemostasis and coagulation studies

- Prothrombin time (PT)

- International Normalized ratio (INR)

Comprehensive metabolic panel


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II.Lab test

CBC:

A CBC incudes 5 measures:

1- WBC Concentration

2- RBC concentration

3- Hematocrit

4- Platelets count

5- Hemoglobin


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II. laboratory

Hemostasis and coagulation studies:

Requested for:

- patient who have medical condition that requireanticoagulant.

- Or medical condition that affect clotting include ( liverdisease, uremia, some cancers, bone marrow disorder orvit K deficiency)

PT: measure the activity of factor II, VII,X and fibrinogen

INR: (PT/PT normal)ISI


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II.Labratory:

C. Comprehensive metabolic panel (CMP):

Consists of14 specific tests

Provide an overview of:

- kidney function, electrolyte and acid-base balance.

- blood sugar, Ca, protein level.


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III- Physical

A- Extra-Oral

B- Intra-Oral


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III. Physical

A- Extra-Oral Examination:

1- patients relative body proportions, weight, posture, gait, degree offunctional coordination, any obvious abnormalities.

2- head a neck region:

Facial composition, asymmetries, skin texture, complexion, expression inthe eyes, breathing

3- perioral region:

Abnormality like swelling, deformities. Lesion, discoloration.

Lips, ears, nose

4- Digital palpation to examine the( lymph nodes, salivery gland, thyroid glandand muscle of mastication).


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III. Physical

B- Intra-Oral examination:

1- soft tissue ( tongue, floor of mouth, mucosa, palate)

2- Occlusal analysis and vertical dimension determine.

3- esthetic evaluation.

4- dentition:

(number, color, accretions, alignment, location in the arch,individual position mobility, migration, crown root ratio, cariesincidence, morphology fracture, erosion, attrition, inter-proximality contact)


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III. Physical

B- Intra-Oral Examination:

5- Dentition in function

- The horizontal relationship of mandible to the

maxilla and all functional occlusal conntact should

be visualized.

- -diagnostic mounting should be made using acentric relation recording


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II. Physical

6- functional analysis of mandibular movement.

Classification of mandibular movement :

Cyclic, vertical, bruxing

Cyclic pattern

- Smooth surfaces on

marginal ridge

- Inclined planes- Flattened triangular

ridges

- Widened fossae

with moderate to

minimal cuspal

wear

Vertical mastication

- Relatively steep

- Sharp cusp

- -excessive wear onbuccal or labial cuspal

inclines and surface of

manibular teeth

- exessive wear in lingual

surface of the maxillary

teeth

Bruxing

- Flat occlusal and

incisal surface.

- - anti monson or

reverse curve withinarch.

- The occlusal table

generally appears

widened and th

incisal edges beveled


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Beyron categorized mandibular movement patterns as:

a- multidirectional gliding movement.

b- predominantly bilateral movements.

c-predominantly unilateral movements.

d- predominantly unilateral movement


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III. Physical

The Edentulous mouth :

The approach of examination according to the Patient experience with

prostheses :-

I. with no prior experience for prosthesis

look for primary reason for extraction .

Periodontal cause for tooth loss :

Expect reduced bone support thus reducedability to respond to prosthesis stress.

Caries as causes for tooth loss:

Bone has not reduced and denture bas

support expected to be optimal .

II. Patient with previous experience :

-Observe tissue response to

prostheses stress .

- Using diagnostic cast ,Radiograph

To determine appropriateness for

complete denture.


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The edentulous mouth:

1- Arch size and oral aperture:

Discrepancy between maxillary and mandibular arch or opening to oral cavity.

These condition can be seen in patient treated surgically, burns ,traumatic injury ect.

Difficulties can be encountered in impression ,maxillomandibular relation and teeth

arrangement

Solution:

1- Longer appointments 2- Staged clinical procedure

3- Premedication or sedation

4- Use of topical lubricant

5- Less bulky retracting instrument


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2- Ridge form:

Examination of the Ridge form should include :

Evaluation of ridge bony support and potential stability and

retention

Development of desirable occlusal scheme and esthetic

arrangements of tooth.


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2- Ridge form:

Ridge form is the cross sectional contour specially the maxillary form and its relation to

palate is very critical

U shape: The most

favorable arch form is

the provide broad base

to support the occlusalstresses and parallel

sides enhance adhesion

and resistance to

displacement

V shape ridge: Has

narrow crest that

cannot absortmasticatory stress

without irritation or

discomfort .

Flat ridge: most

frequently seen andmost difficult to

restore .


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2- Ridge form:

Ridge resorption ranges from minimal to extreme, the pattern

of resoroption vary depends on the local influences .

Parasthesia and ridge soreness is common complaint when

the Ridge are resorbed .

Variation within typical ridge forms can occur, exostoses ,lingual tori, irregular bony resorption , sharp spicules ,bulky or

flared ridge , undercut complicate insertion and removal of

prosthesis .


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3- Palate:

Palatal configuration is interrelated to maxillary ridge form to theextent .

When the hamulus is prominent , the mucosal covering can beeasily irritated by over extension of the denture.

Soft palate:

The form of soft palate can be classified into Class I,II,III Accordingthe slop of the palate , which can be covered by the denture base.

Soreness and loss of border seal can be seen in class III palate whichdrop abruptly from the hard palate.


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4- Lateral throat form:

- This observation is important ascertain the opportunity fordenture base extension area

70% class I

25% class II

5% class III

- The recommendation is to use implant depth gauge todetermine length of lateral throat form and aid in customimpression tray fabrication .


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5- Maxilla mandibular relashionship:

A critical evolution of arch alignment and the

interarch ridge relationship is necessary to

formulate a treatment approach that enhances the

strength and minimize the weaknesses of the

structure .

Factor such as tray selection , impression technique

, tooth forms and position , division of interarch

space , occlusal scheme and base material


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6- Tongue:

I. Morphology

long narrow and tapered short broad and thick

Not problematic in taking impression Provide positive contact surface for the

lingual denture flange and better border seal

Less effective in providing lingual seal - Complicate impression procedure.- More susceptible to irritation and occlusal

trauma from teeth

Smith E,1951


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Tongue position:

- According to Wright et al :

75% normal position

25% retracted position classified class I ,II

normal tongue position enhance retention and stability of maxillaryand mandibular denture

retracted tongue result in looseness of the denture

Tongue must be respected and accommodated adequately in theprostheses design .

Poor tongue habits usually result in unsuccessful denture experience


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7- Mucosa:

Divided into masticatory , lining and specialized mucosa

Masticatory

mucosa:

Examination of

masticatory mucosa

allows

determination the

degree of stability of

the prostheses that

might be expected

Lining mucosa :

The vestibule

Mucobuccal fold

Floor of the mouth

When functional space

and appearance permit,

increased width of the

denture flanges enhance

the border seal.

Specialized mucosa:

Covering the dorsal

and lateral surface of

the tongue


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III.Physical

Implant therapy:

Examination of patient needing implant therapy ,particular

attention :

Ridge morphology ,

Interocclusal relationship ,

Parafunction occlusal habits ,location of available bone ,

Esthetic consideration that needs gingival recontouring,and psychological profile of the patient


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III. Physical

Taste:alterations in taste sensation is a complaint for denture wearers

Henkin and chrestenson found that person wearing complete maxillary denturehad significant elevation of taste for bitter and sour .

Which is similar phenomenon happened for anesthetized palate region.

In contrast ,other study found the taste perception was slightly enhanced.

Other investigation suggested that neither the contour nor the denture basematerial affected the ability to perceive taste of a solution at room temperature.

Hyposmia : decreased sensitivity to odor. But patient demonstrate high thresholdfor bitter and sour taste s and have high arched palate .

Patient with surgical defects reported to have loss of taste sensation. However, thisfound to be enhanced when prostheses in place.


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III. Physical

Malignant lesions

- 25 % of oral cancer occur in patient without known risk factors

- Early lesion and premalignant lesion are difficult to detect due to subtle changes to

mucosa.

- Lesions present initially as either leukoplakia or erythroplakia and pregress nonhealing ulceration.

- In advance stage, other manifestation such as bleeding, lossening of teeth,dysphagia, dysarthria, development of neck masses

- The use of oral cancer diagnostic tools as an alternative to biopsy:

Oral cytology

light detection of mucosal abnormality


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IV. Informed Concent

Is thought appropriate for all non reversible procedures and those involve risk of the

patient

Proper informed consent should contain the key principles:

Informed consent is not substitute for patient education .

Clinician should have open discussion with patient to ensure the communication is clear .

The forms should be written in language that average person would understand.

Patient should actively participate in discussion .and provide the opportunity to discuss theconcerns

Verbal provision of information to patient about the risks , benefits and alternative to treatment

and subsequent documentation of the dcussion in the medical records may be an acceptable

substitute for a formal signed consent form

Brenner etal,2009


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