DR / WESAM BADR

BDS, MDS &PHD

LECTURER OF REMOVABLE
PROSTHODONTICS
• At the end of the lecture we should know:
I. History taking
II. Examination
extraoral,
intraoral (visual& digital),
old denture &
X ray
 HISTORY TAKING
• Personal data

• Medical Status

• Mental Attitude

• Dental Status
 1-PERSONAL DATA
• Name
• The patient's age (new habit& efficiency)
• The patient's occupation
• The patient's attitude to appearance
• Address and Telephone Number .
• Sex:
• Cosmetics and esthetics would be much more important
in females.
• Males are more interested in the comfort and efficiency of
mastication of the dentures.
• Also during menopausal state, there would be intolerance
to treatment and burning of mouth, vague pains and
psychological disturbances.
• The Patient's Occupation:
• For professionals, appearance and retention may be more
important than efficiency.
• Public speakers and singers require not only perfect
retention but also particular attention to palatal shape and
thickness because of the importance of these in phonation
 2-MEDICAL STATUS
• Systemic diseases as diabetes, blood dyscrasias
and avitaminosis affect the mucosa/ response to
dentures.
• It is thus preferable to postpone prosthetic
treatment until the acute phases of these disorders
are under control.
How to deal…….
• Extra instructions in oral hygiene.
• Eating habits.
• Tissue rest.
• Frequent recall appointments.
 3-MENTAL ATTITUDE

De Van stated,
"Meet the mind of the patient
before
meeting the mouth of the patient"
 PATIENTS MAY ALSO BE CLASSIFIED UNDER THE
FOLLOWING CATEGORIES

• Philosophical patient
• Exacting patient.
• Indifferent patient.
• Hysterical patient.
 PHILOSOPHICAL PATIENT
• They have the best mental attitude caring, kind, cheerful and
cooperative
• Definite way of thinking and ability to adjust rapidly.
• They accept their oral situation and accept the dentist's advice

good prognosis.
 EXACTING PATIENT
• Not easy to please as the philosophical ones.
• They need great care, effort and explanations.
• They usually criticize what is done for them and might doubt
the ability of the dentist to provide a good prosthesis.
• A firm control of these patients is essential to obtain
successful treatment and good prognosis.
 INDIFFERENT PATIENTS (UNCARING, COOL)
• Passive, uninterested, uncooperative, depressed
and lack motivation.
• Have little concern for their teeth
• They are usually pushed for treatment by their
families Little appreciation for the dentist's effort
Prognosis is unfavorable
 HYSTERICAL PATIENTS (PANIC • STRICKEN)
• Unstable, excitable, apprehensive and nervous.
• They are always in poor health.
• These patients usually need kind help. Sometimes they need
medical consultation during and after treatment.
 4-Dental History:
• a- Chief complain:
The chief complaint is recorded in patient’s own words.
• b-Patient’s desires and expectations:
• It is important to find out what the patient expects from the
treatment.
• Patient education regarding what is possible is very
important in such cases.
• C-Past dental history
• i- Reason for tooth loss: If periodontal disease was the reason, more
• bone loss is anticipated.
• ii-Period and sequence of edentulousness : Longer the period, more will be
the bone loss and development of habitual mandibular protrusion. By
understanding the sequence, bone resorption pattern can be identified.
• iii- If the patient has worn partial dentures with comfort and efficiency, prior
to being rendered edentulous, the same will be expected of complete
dentures.
• iv-Previous dental and denture experience: Traumatic
experiences will affect the attitude of the patient towards dental
treatment and they will require more counselling and education.
• v- If no previous denture experience exists : The patient should
understand the use, probable difficulties and success of the
treatment.
 • Extra-oral examination
1-Head and neck: region should be first examined for the
presence of any pathological condition related to nondental
or systemic disease.
• Any nodules and ulcerations on the face are noted.
2-The lips
• i- Lip health: The lips should be examined for cracking,
fissuring at the corners of the mouth, and ulceration.
ii-Lip support:
The apparent support of the lip is noted. The philtrum, nasolabial fold and
mentolabial grooves are observed for fullness. Loose wrinkled skin may be
impossible to properly support with artificial anterior teeth.
iii-Lip Thickness: Thick/average/thin
Thickness of the lip is an important factor for tooth placement. Thin lip is
highly sensitive to the position of anterior teeth. A thick lip gives more freedom
in setting the teeth before changing the lip contour.
iV-Lip Length: Short/average/long
The length of the lip will affect how much tooth will be exposed. In short lip,
teeth become visible even with slight movement.
3- Facial examination:
a- Hair and eyes color and complexion:
• i- Color of hair: Black/brown/grey/white
• ii- Color of eyes: Black/brown/white/grey
• iii- Complexion: Dark/fair/medium/ruddy
• These factors, along with the patient’s age, are important in determining the teeth
shade.
b- Face form: Square/Tapering/Ovoid.
• Square: If the biangular width is equal to the bizygomatic width.
• Tapering: If the biangular width is lesser than the bizygomatic width.
• Ovoid: If the bizygomatic width is lesser than the biangular width.
This helps in selecting the shape of the artificial tooth for the patient.
Face forms: (a) Square, (b) Tapering, (c) Ovoid
• C- Face profile: Normognathic/ retrognathic/ prognathic.
• Class I: Normognathic or straight profile
• Class II: Retrognathic or convex profile
• Class III: Prognathic or concave profile.
• This helps in selection and arrangement of artificial teeth and can be an
early indicator of the patient’s jaw relation. A patient’s vertical face height
can easily be seen in profile.
4-Temporomandibular joint examination (TMJ):
• The TMJ and muscles of mastication should be evaluated for pain
by palpation or mandibular movement.
• As the mandible is opened and closed, the range of opening, any
deviation or joint sound should be noted. The presence of any of
theses symptoms is indicator of TMJ disorder.
III- INTRA-ORAL EXAMINATION

• Visual examination
• Digital examination
VISUAL EXAMINATION
• Color of the mucous membrane
• Size and shape of the arches and alveolar ridges
• Shape of the hard palate
• Depth of the sulci
• Interference factors
• Ridge relations
• Unextracted roots
• sinuses
• Unilateral swellings
III- INTRAORAL EXAMINATION (VISUAL):

• 1- Mucosa:
The mucosa of the cheeks, lips, floor of the mouth, residual ridge, hard palate and soft
palate is evaluated for color and thickness, and the condition is noted.
• a- Color of the mucosa:
i-Redness is a sign of inflammation, which could be due to ill-fitting dentures, infections,
smoking, and systemic diseases such as diabetes.
(eliminate the cause and allow the tissues to return to normal before impression making).
ii- White patches and brown/blue pigmented spots should be noted.
• If the cause is uncertain, a biopsy is indicated.
COMMON PROSTHETIC CAUSES FOR COLOR VARIATION
• Overextension of the periphery of the denture:
This is frequently seen as a bright red line, which may break down to ulceration if the
irritation is continued
• Dirty, ill-fitting dentures: -
The inflammation usually appears as an ill-defined red area which varies with the extent
of the mucous membrane most constantly in contact with the denture.
• Continuous wearing of the denture:
It may cause a chronic inflammation of the underlying mucosa.
• Faulty articulation of teeth:
Inflammation may be found on the crest of the alveolar ridge if the occlusion is too heavy
in one particular spot or on the sides of the ridge if there is a lateral drag caused by
cuspal interference.
• Traumatic injury:
from sharp pieces of food such a crusts or small bones.
• Small spicules of alveolar bone:
• Allergy:
It is very rare. Most of the cases are due to dirty, ill-fitting
dentures.
• b- Thickness and Firmness of the Ridge Mucosa : This is most conveniently
tested by placing a finger on each side of the ridge and applying alternate
lateral pressure. House has classified mucosa thickness as follows:
• Class 1: Normal uniform density of mucosal tissue (approximately 1mm
thick). Investing membrane is firm but not tense and forms an ideal cushion
for the basal seat of a denture.
• Class 2: Soft tissues have thin investing membranes, hard and are highly
susceptible to irritation under pressure.
• Class 3: Soft tissues have excessively thick investing membranes (Flabby).
At the very least, this requires tissue treatment. Such conditions may
require surgical correction.
• 2- Residual alveolar ridge
• Residual alveolar ridge should be evaluated for the following:
• a- Arch size: Small/Medium/large.
• Greater the arch size larger is the contact and support, hence greater is the
retention.
• Discrepancy in the size of the maxillary and mandibular ridges can create
problems with denture stability in the smaller arch due to poor relationship of the
teeth.
• b- Arch form: Square/Tapering/Ovoid.
• Arch form influences support and tooth selection. If opposing arches do not have
the same form, difficulty in tooth arrangement can be anticipated.
Arch form. A, Square b, Tapering and c, Ovoid
• C- Residual ridge contour:
• High well rounded/Low well rounded/Knife-edge/Flat/Depressed

Residual ridge form: (A) High well rounded (B) Low well rounded, (C)
Knife edge, (D) Flat
• D-Interarch distance:
• i- Adequate: Normal: 16-20 mm
• ii- Inadequate: It will cause mechanical interference leading to biological
damage.
• iii- Excessive: It may be due to increased resorption of residual alveolar
ridge.
• e- Ridge relations:
• This affects tooth arrangement and denture stability. The
positional relation can be:
• normal (class I), retrognathic (class II), prognathic (class
III)

Jaw (ridge) relationship. 1 .Normal, 2. Inferior retrusion (protruding

maxilla), 3. Inferior protrusion (protruding mandible).
• f- Bony undercuts location:
• The favorable undercuts should be detected that aid in retention and the unfavorable
undercuts should be planned for surgical correction .
• Undercuts may be present in both maxillary and mandibular ridges.
• i-Maxillary undercuts, present in anterior ridge and lateral to maxillary tuberosity.
These may be selectively relieved without any surgery.
• ii-Mandibular undercuts, prominent sharp mylohyoid ridge produces undercut. Surgical
reduction and reattachment may be beneficial.
• Ridge undercuts. A, undercut in anterior region can be tackled by changing the path of denture insertion. B, bilateral
tuberosity undercuts require surgical correction on one side to enable comfortable denture insertion
• G-Irregularities of the Alveolar Ridge:
• Alveolar absorption is never uniform and hard nodules, sharp
edges, spikes and irregularities are frequently felt and pain on
pressure over these areas is common .

• H-Depth of the Sulci:

• Whenever a very shallow sulcus is encountered a special
impression technique will be required in order to obtain an
adequate peripheral seal and so utilize atmospheric pressure to the
full as a retentive force.
• 3- Shape of the Hard Palate:
• It is classified according to the shape as:
• a- U-shaped: Provides good retention and stability. b- V-shaped: Provides
least retention. c- Flat: Provides poor retention and stability.
• 4-Soft palate:
• Junction of hard and soft palate may be classified as class I, class II or class
III
• a- Class I: The hard and the soft palate are at the same level. In class I soft
palate, the posterior extent of the denture is not critical. It allows a wide
posterior palatal seal (more than 5mm)
• b- Class II: The soft palate gradually slopes from the hard palate. It allows a
posterior palatal seal less than class I (3-5mm).
• c- Class III: The soft palate abruptly slopes from the hard palate.
Least favorable as it allows least tissue coverage (less than 3mm).
• Usually associated with V-shaped palate.
Junction of hard and soft palate. A, Class I. B, Class II. C, Class III
• 5- Interference Factors:
• The size of the tongue, tightness of the lips and any abnormal muscular
or frenal attachments must be noted as they will influence the design of the
dentures and the type and position of the artificial teeth used.
• 6- Unextracted Roots:
• These may be flush with, or protruding above, the surrounding mucous
membrane, with or without an obvious area of inflammation round them.
They may be loose or firm, and in the latter case it is always wise to take X-
ray photograph.
• 7-Sinuses:
• An infected area in the bone, such as surrounds the retained broken off apex of a tooth,
usually communicates with the surface through a channel known as a sinus.
• 8-Unilateral Swellings:
• Any abnormal swellings in the mouth must be investigated and diagnosed, and when
found only on one side they are much more likely to be pathological than when they are
bilateral.
• 9-Lingual Pouch:
• The extent of the pouch with the tongue at rest and with tongue protruded sufficiently
to lick the lips and also during the act of swallowing should be noted. This is most
conveniently done by gently inserting the index finger into the pouch and asking the
patient to perform the above actions when the alterations in the extent of the pouch can
be felt.
DIGITAL EXAMINATION
• Firmness of the Ridge
• Irregularities of the Alveolar Ridge
• Variations of mucous membrane
• Maxillary tuberosities
• Mylohyoid ridges
• Lingual pouch
IV- EXAMINATION OF OLD DENTURE:

• Denture age and condition. & Denture extension.

• Vertical dimension of occlusion and interocclusal distance.
• Retention and stability.
• Esthetics and soft tissue support.
• Masticatory stability.
• Hard and soft microbial deposit on the denture.
• Phonation. & Pattern of tooth wear.
V- X-RAY EXAMINATION
• As a panoramic or cephalometric X-ray examination.
• to confirm or assist in diagnosis in the following cases:
• Buried roots. -Sinuses.
• Unilateral swellings. -Rough alveolar ridges.
• Areas painful to pressure. -Impacted teeth.
• Cysts.
Best wishes&
thank you