Diagnosis and Treatment

planning for Complete

denture patients

FATEEMA PRIYAM
SECOND YR P.G 1
Contents `
 Introduction
 Important terminologies
 Diagnostic procedure
 Patient evaluation
 History taking
 Personal data
 Chief complaint and dental history
 Medical history
 Clinical evaluation 2
 Radiographic examination
 Prognosis
 Treatment planning
 Prosthodontic diagnostic index
 Discussion
 Summary
 References

3
4
Success in complete denture
prosthetics
1.The patient’s attitude to dentures and
his ability and willingness to learn to use
them.
2. The condition of the mouth.
3. The skill of the clinician.
4. The technical assistance available.

5
IMPORTANT TERMINOLOGIES

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 Examination: Scrutiny or investigation
for the purpose of making a diagnosis or
assessment.
GPT-9

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 Diagnosis: is the examination of the physical
state, evaluation of the mental or psychological
makeup, and understanding the needs of each
patient to ensure a predictable result.
-SHELDON Winkler
 The determination of the nature of a disease
-GPT-9

8
 Diagnosis is the act or process of deciding
the nature, location and cause of a diseased
condition by examination and careful
investigation.
Heartwell

9
 Treatment plan: is the sequence of procedures
planned for the treatment of a patient after
diagnosis.
-GPT-9
 Means developing a course of action that
encompasses the ramification and sequelae of
treatment to serve the patient needs
-Sheldon Winkler

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 Prognosis: A forecast as to the probable result of a
disease or a course of therapy.
-GPT-9
 To forecast the likelihood of a successful outcome
to prosthetic treatment
- D J Neil

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 To gain the necessary information about the
patient, the clinician should:
– Conduct a thorough examination
– Listen to what the patient has to say
– Be alert to things patient may leave unsaid
– Record details of information in a logical sequence

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 Diagnostic procedure can be broadly
divided into:
Patient evaluation
History taking
Clinical evaluation
Extraoral
Intraoral

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 Physical characteristics
 Appearance and presentation
 Handshake
– Dead fish handshake
– Normal firm
– Vicelike handshake
– Sweaty,clammy and cold hands

Kranti,Meena et al
Psychological considerations for edentulous patients
JIPS 2007 16
 Gait
 Insight into patients motor skills and systemic diseases
Stooped shoulder-Spinal changes
Tremor of head-Parkinson disease
Dragging of one leg-Stroke
Staggering-Alcohol(excessive)
Damage to brain and spinal cord,
medications

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Motor skills
 Whether patient is able to move alone or
with assistance
 Dizziness
 Vertigo
 Breathing
 Facial movements
 Speech defects

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Mental Attitude/ Personality

House classified patients as:

 Philosophical
 Exacting
 Indifferent
 Hysterical

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Philosophical

• The best mental attitude for denture acceptance

• Rational, sensible, calm and composed in
difficult situations.
• Confident, easy going and cooperative.
• Overcomes conflicts and organizes his time
and habits in an orderly manner.
• Eliminates frustrations and learns to adjust
rapidly.

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Exacting

• He may require extreme care, effort and

patience on clinician’s part.
• Methodical, precise and accurate and at
times makes several demands.
• Once satisfied, an exacting patient may
become the practitioner’s greatest
supporter.

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Indifferent Patient

• Presents a questionable or unfavourable

prognosis.
• Exhibits little concern if any; he is
uninterested and lacks motivation.
• Pays no attention to instructions, will not
cooperate and is prone to blame the dentist
for poor dental health.
• An education program in dental conditions
and dental treatment is the recommended
treatment plan
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Hysterical

• Emotionally unstable, excitable,

excessively apprehensive and
hypertensive.
• This patient must be made aware that
his/her problem is primarily systemic and
that many of his symptoms are not result
of dentures.
• Prognosis is poor.

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 Reasons that the House
classification requires reevaluation
Some of the terminology is antiquated, falling out of
use, or no longer carries the same meaning within
psychiatry eg: hysterical
House classification pertains to the patient in isolation.
House provided little attention to how the patient’s
reactions and behaviors are codetermined by the
treatment and behavior of the dentist.

Simon Gamer et al
“M. M. House mental classification revisited: Intersection of particular
patient types and particular dentist’s needs”
J Prosthet Dent 2003;89:297-302
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PROPOSED CLASSIFICATION
Based on 2 factors:
 the level and quality of the engagement or
involvement of the patient toward the dentist
(including such issues as domination, submission, and
idealization and devaluation of the dentist) and
 the level of willingness to submit (trust) to the dentist.

Gamer et al 2003

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IPWCDO CLASSIFICATION

FACTORS PRODUCING ADAPTIVE RESPONSE

 Confidence in the dentist
 Previous favorable experiences
 Positive attitude
 Good physical health and coordination
 Realistic expectations
 Good learning capacity and cooperative
 Awareness to the limitations of a complete denture

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MALADAPTIVE RESPONSE

 Lack of trust in the dentist

 Poor communication
 Previous negative experience
 Inadequate tissue tolerance and muscle
coordination
 Disapproval to dentures by people who are important
to the patient

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WINKLERS CLASSIFICATION

 HARDY ELDERLY
 SENILE AGED SYNDROME
 SATISFIED OLD DENTURE WEARERS
 GERIATRIC PATIENTS WHO DO NOT WANT
DENTURES

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ALAN MACK’S CLASSIFICATION

 Ectomorph-worrying types
 Endomorph-Care free type
 Mesomorph-Passive type

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BLUMS CLASSIFICATION

 REASONABLE OR REALISTIC
 UNREASONABLE OR UNREALISTIC

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FRANKELS CLASSIFICATION

 DEFINITELY NEGATIVE BEHAVIOUR

 NEGATIVE
 POSITIVE
 DEFINITELY POSITIVE

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 Personal Data
 NAME
 AGE
 SEX
 OCCUPATION

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 Address
 Helps in future communication
 Socio-economic status
 Setting up appointments
 Endemic diseases

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 Habits
– Pan chewing, smoking, chronic alcoholism
– Habits like pencil and nail-biting
– Para functional habits

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 Nutritional history

– Record dietary history

• Well-nourished patient

• Mal-nourished patient

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DENTAL HISTORY

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 Chief complaint
 The patient should be questioned regarding his or
her chief complaint such as-
 Inability to chew
 Impaired speech
 Poor appearance
 Others.

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History of presenting illness/
Dental history
 Duration and sequence of the edentulous
state:
Gives information about bone resorption
patterns and progression, as well as the
timing of tooth loss.

 Reasons for loss of teeth:

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 Previous Denture Experience:

The patient should be questioned regarding the

number & types of previous dentures
 Patients should be made to comment on the
reasons for replacement and should be educated
regarding the realistic limitations.

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 Existing Or Current Dentures:

• The patient should be questioned about the length

of time for which the dentures have been worn.

• Careful clinical observation may provide valuable

information about denture experience

• patient should be asked about the esthetics and

function of existing dentures

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 The existing denture should be checked for tooth
shade,mold and material .
 Eshetics,phonetics,retention,stability,extensions,
contours,vertical dimension of occlusion and
orientation of the occlusal plane.
 Characterization or staining,comfort of the patient.
 Motivation to clean dentures must be assessed.

Ashok.K et al
Journal of Orofacial sciences-2010

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MEDICAL HISTORY

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Debilitating diseases
 Diabetes, tuberculosis, blood dyscrasias etc
should be under medical control.
 Diabetes: An uncontrolled diabetic or poorly
controlled diabetics may pose problems of:
(i) Bacterial, viral and fungal infections – including
candidiasis.
(ii) Xerostomia:

46
 Poor wound healing,increased bone
resorption,muscle atrophy,xerostomia.
 Appointments should be short and should not
interfere with meal times.
 Tissues need functional rest so patients should be
advised less denture wear.
 Frequent relining and rebasing may be required.

Ashok .K et al
Journal of Orofacial Sciences-2010

47
 Tuberculosis
Deep fissures in the tongue; the mucosa of
check; round, undermined ulcers that are very
painful and firm nodules.

Efficient dentures are necessary as diet is

important in treatment.

Oral hygiene is important

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. Blood dyscrasias:
 proper history should be taken
 blood tests/ consultation prior to treatment
 care to be taken while planning for pre
prosthetic surgery
 these patients get easily bruised

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Cardio vascular diseases:

 Prophylactic antibiotic coverage for all

dental procedures .
– Convenient morning, short appointment.
– Premedication with diazepam 5-10 mg to
reduce apprehension.
– Nitroglycerine tablets to be made available
in dental office

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Diseases of joints:
 Particularly osteoarthritis.
 Under the age of 45, men and women
are affected in the ratio of 2 : 1.

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Considerations

 When terminal joints of fingers are arthritic it is

difficult to insert & clean dentures.

 Osteoarthritis of TMJ presents problem in CD

construction as mandibular movements are painful
and jaw relation records are difficult to record and
repeat.

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 Occlusal correction must be made often
because of subsequent changes in joints.
 Special impression trays necessary due to
limited access from reduced ability to open
jaws.

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Diseases of skin:
 Pemphigus - extremely painful.
 Constant use of dentures is
contraindicated - primarily indicated for
mental comfort.
 Vesicles and bullae on the mucous
membrane as well as on skin.

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Neurological disorders:
 Patients with Bell’s palsy and Parkinson’s disease
etc. can be given prosthetic treatment.
 Denture retention, maxillo-mandibular relation
records and supporting musculature pose denture
problems.

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Epilepsy
 The base of complete dentures should be
metal or should be reinforced with metal as
acrylic base may fracture ,increasing the
risk of aspiration or dislodgement into the
esophagus

Taskin Gurbuz
Novel aspects of Epilepsy,2011

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Radiation treated patients

 Patients treated by radiation of head and neck tend

to develop problems like
i) Mucositis
ii) Xerostomia
iii) Loss of taste
iv) Constricture of muscles (trismus)
v) Secondary infections (Candidiasis)

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 If prognosis is favorable,but still the tissues have a
bronze color and lack tonus-delay denture
construction.
 Watch for tissue necrosis.
 Use on a limited time basis-depending on the
reaction of the tissues.

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CLIMACTERIC
 Females-menopause
 Generally seen as osteoarthritis,mental
disabilities,burning palate,burning
tongue,tendency to gag,vague areas of pain.
 Medications,psychiatric treatment.

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Allergies and Angioneurotic edema

 H/o of allergy -drugs or denture materials

 Edematous swelling of lips, cheek etc after contact
with an antigen like acrylic / metal.
 Emergency treatment: 0.3 – 0.5 ml epinephrine
1:1000 1M, support respiration / obtain medical
assistance.

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Extra oral examination
 The head and neck region is examined for the
presence of any pathological condition relating
to non dental or systemic condition
 Face and neck palpated to check for enlarged
nodes or masses.

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 Facial form
 Put forward by House & Loop, Frush &Fisher &
Williams.
 Williams claims that the shape of upper Central
Incisor bears a definite relation with the shape of
the face.

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Facial Profile (Acc. To Angle):

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Facial Symmetry
 Gross asymmetries are recorded.
 Can be due to:
– Congenital defects
– Hemifacial atrophy
– Unilateral condylar ankylosis and hyperplasia.

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Muscle tone (According to House)

• Class I: The patient exhibits normal tone and

placement of the muscles of mastication and facial
expression.

• Class II: The patient displays approximate normal

function but slightly impaired muscle tone.

• Class III: The patient exhibits greatly impaired

muscle tone and function.
• .
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 Complexion
 Skin colour also indicates the presence of underlying
systemic diseases:

– Pallor may indicate anaemia

– Ruddy complexion: sign of polycythemia or neoplasm.
– Bronzed skin occurs in Addison’s disease.
– Lemon-yellow complexion of jaundice

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Lip
 Lips are examined in relation to

 Lip support
 Lip mobility
 Lip thickness
 Lip length
 Lip health

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 Lip support
 Lack of proper lip support - collapsed
appearance and wrinkling.
 A rolled-in vermilion border - inadequate lip
support.
 Adequately supported/unsupported

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Lip health

 Lips should be examined - cracking

fissures at corners and ulceration.

 Candidal infection, vitamin deficiency,

incomplete or over closure, either due to
existing dentures / edentulous, or
neoplasm

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 Lip thickness

 A thin lip presents special problems as a slight

change in labiolingual tooth position alters the lip
fullness/ support.
 A thick lip gives more freedom to the dentist in
teeth setting

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 Lip length
Normal- 19-22mm
Short- <18mm
Long- >23mm

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 Lip mobility

Class I-Normal
Class II-reduced
Class III-Paralysis

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Temporomandibular joint:

 Good prosthodontic treatment bears a direct

relation to the temporomandibular articulation
since occlusion is one of the most important parts
of the treatment of complete dentures.

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Patient presenting with one / more of the
following symptoms are considered to be
suffering from TMJ disorder.
(1) Pain and tenderness in muscles of
mastication and TMJ.
(2) Sounds during condylar movements
(3) Limitations of mandibular movements

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 Examination

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 Prosthetic considerations:
- Unhealthy TMJ complicates jaw relation records.
- Centric relation depends on structural and functional
harmony of osseous structures, intra articular tissue
and capsular ligaments.
- Difficulty to give correct & repeatable centric relation.
- Occlusal corrections often needed.
 Patient educated

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Speech :

• Patients who are capable to articulate speech with

existing dentures usually have no problems
producing articulate speech with new dentures.

• Speech is classified as : “normal” or “affected”.

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 Sometimes speech aids in classification of a
patient
 -Rapid, jerky speech-hysterical patient
 Forcefulness and abrupt speech,demanding-
Exacting patients
 Monotone ,lack of interest,absence of enthusiasm-
Indifferent patients

JIADS 2010;1(2):15

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Intraoral examination
Oral mucosa:
 Color of mucosa ranges from healthy pink to fiery
red indicating:
 inflammation,
 ill-fitting denture,
 infections,
 systemic disease or
 chronic smoking.

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 Mucosa thickness: (Classification by
House)

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 Mucosa condition
Class I: healthy
Class II: irritated
Class III: pathological

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Arch size: (According to House)

 The size of the maxilla and mandible

ultimately will determine the amount of
basal seat available for denture
formation.
 The greater the size, greater the
support, larger the contact surface,
greater the retention.
 Also, arch size provides a quick
estimate of the tooth size required.
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 Class 1: Large ( best for retention
and stability)
 Class 2: Medium (good retention and
stability but not ideal)
 Class 3: Small (difficult to achieve
good retention and stability)

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Arch form (according to House)

 Class 1: Square
 Class 2: Tapered
 Class 3: Ovoid

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 The opposing arch may or may not have the same
form.

 If the arch form is not the same in both the arches

some problems in tooth arrangement can be
anticipated.

 The arch form influences support of denture by

offsetting rotational movement of denture base.

89
Ridge form(arch contour)
 cross-sectional contour as a whole arch.
 The ridge form affects the retention and stability.
 Its height resists lateral displacement, and the
parallelism of its sides maintains the seal for a
considerable distance to resist vertical
displacement

90
Maxillary ridge form is classified as:
(According to House)
 Class 1: U shaped

 Class 2: V-shaped

 Class 3: Flat residual ridge

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 Mandibular ridge form
Class 1: Inverted U shaped (parallel walls
from medium to tall with broad crest)
Class 2: Inverted U shaped (short with flat
crest)
Class 3: Unfavorable
Inverted W
Short inverted V
Tall, thin inverted V
Undercut

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Atwood & Howels classification
 Order I: pre-exraction
 Order II: post extraction
 Order III: high- well rounded
 Order IV: knife- edged
 Order V: low well rounded
 Order VI: Depressed

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Defects:

 Ridge defects, such as exostoses, may

pose problems for complete denture
patients or may warrant pre-prosthetic
surgery.

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Hyperplastic tissue

 Papillary hyperplasia

95
 Epulis fissuratum

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Tori:
 Benign bony enlargements
 Found at midline of hard palate or on lingual
aspect of mandible mostly in premolar region.
 Small ones may be accommodated
by relief of denture base.
 Large enough to interfere with denture design are
surgically removed.

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 Torus palatinus:
 Ridge resorption can cause denture to settle over
torus palatinus causing rocking of prosthesis and
soreness.

 A torus in midline of maxilla can be relieved but if

it fills palate to occlusal level, or extends beyond
vibrating line, it should be removed / reduced in
size.

99
 Mandibular tori :
 Occur just above floor of mouth.
 Difficult to provide relief without breaking border
seal of denture.
 Surgical removal is necessary for successful
denture construction

100
 Class I: Tori absent or minimal in size. Do not
interfere with denture construction

 Class II: Tori of moderate size. Pose mild

difficulties in denture construction. Surgery
not required.

 Class III: Tori large, compromise the

fabrication and function of dentures. Require
surgical recontouring or removal.

101
Interarch Space
 Space between the maxillary and the mandibular
arches. Normally it should be 20mm.
 Excessive amount of space due to resorption
results in poor stability and retention.
 Reduced interarch distance will make teeth setting
and free way space maintenance difficult.

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Ridge parallelism:

104
Ridge relationship:

 Laney Smith described ridge relationship as the

antero-posterior position of the mandibular ridge
relative to the maxillary residual ridge when the
jaws are in centric relation and separated by the
distance they will be separated by the prosthesis.

105
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Lateral throat form:
 Ewell Niel defined lateral throat form as the
contour of the hard lingual surfaces of the
mandibular ridge in the molar area and the velum
like tissue distal to the mylohyoid ridge in the
retromylohoid fossa as it functions under the
influence of tongue.

107
 Examination:
With the index finger passively
contacting the curved wall of mucosa in
the retromolar fossa with the tongue at
rest, patient is instructed to protrude the
tongue.

108
Class I: 0.5 inch of space
exists between mylohyoid
ridge & floor of mouth.
Class II: Less than 0.5 inch
space exists
Class III: Mylohyoid fold is
at the same level as
mylohyoid ridge.
Retention of lower denture
is difficult.

109
Lateral throat form- design of a measuring instrument
Sadhvi K.V., Chandrasekharan Nair K., Jayakar Shetty

KDJ - Vol.33, No. 1, January 2010

110
Palatal throat form (Classification according
to House)

111
Milsap’s classification
 Class I: it is horizontal & and makes 10o
angle to the hard palate &most
advantageous
 Class II: soft palate makes a 45o angle to
the hard palate
 Class III: soft palate makes a 70o angle to
the hard palate.
Milsap C H
“ The posterior palatal seal area for complete dentures”
DCNA 1964; 1: 663-73.

112
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Hard Palate:
 U Shaped: It is most favorable for retention
and lateral stability

 V Shaped: It is less favorable for retention

because slightest movement of denture base
will cause the seal to be broken with a
resultant loss of retention

 Flat palatal vault: Is unfavorable. Usually

accompanied by resorbed ridges

115
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Palatal sensitivity: (According to
House)
Gag reflex is a normal defense mechanism
designed to prevent foreign bodies from entering
the trachea.
 Can be caused by
(1) Systemic disorders
(2) Psychological factors
(3) Extra and intra oral physiologic factors
(4) Iatrogenic factors.
 Assessed by
(1) oral examination
(2) medical history
117
Class I: normal
Class II: subnormal (hyposensitive)
Class III: supernormal
(hypersensitive)

118
Border attachments: (According to
House)
Class I: attachments are high in maxilla or low in
mandible with relation to ridge crest (0.5 inches or
more between the level of attachment and the crest
of the ridge).

Class II: attachment height in relation to the crest of

the ridge is between 0.25 and 0.5 inches.

Class III: attachment height is less than 0.25 inches

from the ridge crest.
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Frenum attachments:(Classification
according to House)

Class I: High in the maxilla or low in the mandible

with respect to the crest of the ridge

Class II: Medium

Class III: Freni encroach on the crest of the ridge

may interfere with the denture seal. Surgical
correction may be required

121
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Saliva:
 Amount and Consistency of saliva
affects denture construction and
retention.
 Saliva consistency:
 thin, serous or
 thick ropy.
 Quantity
 Dry mouth-increased potential for
soreness
 Excessive saliva -complicates denture
construction, especially impression making
123
 Saliva can be classified as: (House)
Class I: Normal quality and quantity of
saliva. Cohesive and adhesive
qualities of saliva are normal.
Class II: Excessive; contains much
mucus
Class III: Xerostomia; remaining saliva
is mucinous.

124
Tongue:
 Tongue size: (Classification according to
House)
Class I: Normal in size, development and function.
Class II: Teeth have been absent long enough to
permit a change in the form and function of the
tongue.
Class III: Excessively large tongue. All teeth have
been absent for an extended period of time-
abnormal development of the size of the tongue.

125
 The large tongue completely
- fills floor of mouth and
- Covers alveolar ridges
- Making of impression difficult
- Denture stability difficult to attain because
dentures move with movement of tongue
 A small tongue on the other hand facilitates
impression making but might jeopardize the
lingual seal.

126
 Tongue position:
 In 1949 Wright classified tongue position as
follows:
 Class I: Normal
• The tongue fills the floor of the mouth and is
confined by the mandibular teeth.

• The lateral borders rest on the occlusal surfaces of

the posterior teeth and the apex rests on the incisal
edges of the anterior teeth.

127
 Class II: Retracted

• The tongue is retracted. The floor of the

mouth pulled downward is exposed back to
the molar area.

• The lateral borders are raised above the

occlusal plane and the apex is pulled down
into the floor of the mouth.

128
 Class III: Retracted
• The tongue is very tense and pulled
backward and upward.
• The apex is pulled back into the body of
the tongue and almost disappears.
• The lateral borders rest above the
mandibular occlusal plane.

129
DIAGNOSTIC AIDS

130
Pre-extraction records:

• Pre-extraction photographs, radiographs,

casts and facial measurements may prove
helpful in denture therapy.
• These adjuncts may be used to recreate
anterior esthetics and facial support and
aid in evaluation of vertical dimension of
occlusion.

131
Radiographic examination
 It is an essential part of diagnosis and treatment
planning in patients seeking prosthodontic care.

 Panoramic radiographs offer an advantage over

periapical radiographs as they are:
(1) Faster
(2) Reduce patient exposure to radiation
(3) Image the entire maxilla and mandible

132
 Interpretation of panoramic radiograph
should follow a 5-step analysis as outlined
by Chomenko:
 Step I: Screening the jaw for

 Defects in structure and reactive new bone

formation
 Bone enlargements / expansion
 Displacement of jaw parts
 Unerrupted teeth / retained root fragments
 Foreign bodies
 Radiolucencies and radiopacities, rarefaction or
sclerosis
 Well-defined or ill-defined lesions
133
Step 2: Appearance of lesion, physical bony changes
including location, size, shape, number and
radiographic pattern is elaborated.
Step 3: Radiographic findings correlated with
clinical, historical and lab findings.
Step 4: Differential diagnosis is done.

134
Step 5: Rate of growth of lesion estimated
- Slow growing shows sclerosis,
expansion and displacement of
adjacent structures.
- Fast growing shows gross bone
destruction and lack of
proliferative response.

135
 Wical and Swoope described a useful system of
classification.
Class I: Mild resorption – Loss of 1/3 of original
height
Class II: moderate – loss of 1/3rd to 2/3rd of original
height
Class III: Severe – Loss of 2/3rd or more of original
height

Wikal,Swoope C.C
Studies of residual ridge resorption
J Prosthet Dent 1974
136
PROGNOSIS

137
 Defined as the forecast as to the probable result of a
disease or a course of therapy.

 After all the intra oral and general physical and dental
conditions have been recorded and radiographs, casts
and other visual aids are at hand, they can be
interpreted and diagnosis arrived at.

138
139
 It is the process of matching
possible treatment options with
patient needs and systematically
arranging the treatment in order of
priority but in keeping with a logical
or technically necessary sequence.

140
Treatment plan
Addresses patient’s needs Informed consent
Lists specific treatment Enables patient to Treatment
Specifies logical sequence Time
Fees

Enables Patient
dentist to receives

Estimate
Operating time Delivered care
Laboratory time Dentist delivers Patient specific
Fees

141
 Adjunctive care
– Elimination of infection
– Elimination of pathology
– Preprosthetic surgery
– Tissue conditioning
– Nutritional counseling
 Prosthodontic care

142
Elimination of Infection:

 Sources of infection like infected necrotic

ulcers, periodontally weak teeth, and nonvital
teeth should be removed.

 Infective conditions like candidiasis, herpetic

stomatitis, and denture stomatitis should be
treated and cured before the commencement
of treatment.

143
Elimination of pathology
 Pathologies like cysts and tumors of the jaws
should be removed or treated.
 Some pathologies may involve the entire
bone. In such cases, after surgery, an
obturator may have to be placed along with
the complete denture.

144
Pre-prosthetic surgery
 Enhance the success of the denture.
 Some of the common preprosthetic
procedures are:
Frenectomy, Excision of denture
granulomas, Excision of flabby tissue,
Reduction of enlarged tuberosity,
Vestibuloplasty, Alveoloplasty,
Alveolectomy etc.

145
TISSUE CONDITIONING

 The patient should be requested to stop wearing the

previous denture for at least 72 hours before
commencing treatment.

 Should be taught to massage the oral mucosa

regularly.

 Denture relining material should be applied on the

tissue side of the denture to avoid denture
irritation.

146
Nutritional counseling

 Patients showing deficiency of particular minerals

and vitamins should be advised a proper balanced
diet.

 Patients with vitamin B2 deficiency will show

angular cheilitis. Prophylactic vitamin A therapy
is given for xerostomic patients.

 Nutritional counseling is also done for patients

showing age-related changes such as osteoporosis.

147
PROSTHODONTIC DIAGNOSTIC INDEX

148
 Developed by American college of
prosthodontics.
 4 diagnostic criteria
– Mandibular bone height
– Maxillomandibular relationship
– Maxillary residual ridge morphology
– Muscle attachments

149
 Class I (ideal or minimally
compromised)
 Residual mandibular bone height of
21mm
 Maxillomandibular relationship
permitting normal tooth articulation and
an ideal ridge relationship
 Maxillary ridge morphology
 Muscle attachments conducive

150
 Class II (moderately compromised)

 Residual mandibular height- 16-20mm

 Maxillomandibular relationship- normal
tooth articulation and appropriate ridge
relationship
 Maxillary residual ridge morphology
 Muscle attachments that exert limited
compromise

151
 Class III (substantially
compromised)
 Residual mandibular height – 11-15mm.
 Limited interarch space
 Maxillary residual ridge morphology
providing minimal resistance
 Muscle attachment results in
compromised denture stability and
retention

152
 Class IV ( severely
compromised)
 Residual mandibular height – 10mm or
less
 An angle class I ,II or III relation with
compromised interarch space
 Maxillary residual ridge morphology
provides no resistance
 Muscle attachment that significantly
compromises denture base.
153
154
155
SUMMARY

156
REFERENCES

157
Text books
1. Zarb Bolender, “Prosthodontic Treatment for
Edentulous Patients” ,2004,12 Ed,Mosby Inc
2. Winkler ,”Essentials of Complete Denture
Prosthodontics” 1996,2nd Ed,AITBS Publishers.
3. Sharry , “Complete Denture Prosthodontics”
,1962,Mcgraw-Hill Book Company
4. Heartwell, “Syllabus of Complete Dentures”,1992,4th
Ed,Varghese Publishing House.

158
5. Arthur O.Rahn, John.R. Ivanhoe, Kevin D.Plummer,
“ Textbook of complete dentures” 2009, 6th Edition,
Peoples medical publishing house- USA.
6. Deepak Nellaswamy.”Textbook of
Prosthodontics”2nd edition
7. V Rangarajan, T V Padmanabhan, “ Textbook of
prosthodontics” 2013, 1st Edition, Elsevier.
8. Alexander. R . Halperin, Gerald. N Graser, Gary. S.
Rogoff , “ Mastering the art of complete denture”
1988, 1st edition, Quintessence publishing

159
Journal references

1. Robert L Engelmeir and Rodney, “ Patient

evaluation and treatment planning for
complete- denture therapy” DCNA Vol 40(1),
1997: 1-19
2. M.M House, “ The relationship of oral
examination to dental diagnosis” J Prosthet
Dent , vol 8(2): 208-219,1958

160
 P.F Johnson, G.M.Taybos, R.J Grisius et al,
“Diagnostic, treatment planning and
prognostic considerations” DCNA vol
30(3):503-517, 1986.

 Kranti,Meena et al, “Psychological

considerations for edentulous patients”JIPS
2007

 J. F Mc Cord and A.A Grant, “ Clinical

assessment” Br Dent J. vol 188(7):375-
380,2000. 161
 Wical,Swoope.”Studies of residual ridge
resorption”.Journal of Prosthetic dentistry-
1970
 Milsap C H“ The posterior palatal seal area
for complete dentures”DCNA 1964; 1: 663-
73.
 Sadhvi,Chandrashekhar Nair.”A device for
lateral throat measurement”.KDJ vol 10

162
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