PATIENT EVALUATION AND
TREATMENT PLANNING FOR
COMPLETE-DENTURETHERAPY
Robert L. Engelmeier, BS, DMD, MS,
and Rodney D. Phoenix, BA, DDS, MS
PRESENTED BY
DR. JENNIFER VINCENT
PG 1ST YEAR
DEPARTMENT OF PROSTHODONTICS
INTRODUCTION
• Evaluation of patients for complete-denture
therapy should be thorough and well
documented. A logical method to accomplish
this is to use a checklist. The checklist format
makes the form quick and convenient to use.
Once completed, this form can be added to the
patient's dental record for future reference.
INSTRUCTIONS FOR COMPLETING THE
DIAGNOSTIC RECORD FOR COMPLETE
DENTURES
1. PERSONAL DATA
2. MEDICAL HISTORY
3. DENTURE HISTORY
4. CLINICAL EVALUATION
5. EXISTING DENTURES
6. TREATMENT PLANNING
7. PROGNOSIS
PERSONAL DATA
• NAME
• AGE/SEX: an indicator of the patient's
ability to wear and to use dentures.
• fourth decade of life (Tissues heal rapidly and
are relatively resilient)
• fifth decade:
• WOMEN: menopausal, post menopausal;
hysterical and exacting; concerned with esthetics
• MEN: preoccupied with careers; indifferent;
function and comfort
FACIAL FORM (PROFILE)
• According to Angle
MUSCLE TONE(House)
• Class 1: The patient exhibits normal tension, tone,
and placement of the muscles of mastication and
facial expression. Usually, seen only in
immediate-denture patients.
• Class 2: Normal function but slightly impaired
muscle tone.
• Class 3: Greatly impaired muscle tone and
function. Usually is coupled with poor health,
inefficient dentures, and loss of vertical
dimension, wrinkles, decreased biting force, and
drooping commissures.
LIP
• CONTOUR:
• Adequately supported
• Unsupported
• LIP MOBILITY:
• Class 1 (normal)
• Class 2(reduced mobility)(visibility of anterior teeth)
• Class 3(paralysis)(stroke; unilateral mouth droop,
facial assymetry)
• LIP LENGTHS: (visibility)
• Long
• normal or medium
• short
TEMPOROMANDIBULAR JOINT
• Crepitus
• Clicking
• discomfort or locking
• Deviation
• Severe joint pain can indicate a severe
discrepancy in the VDO
NEUROMUSCULAR EVALUATION
• SPEECH:
• Normal
• Affected (accustomed)
• COORDINATION: (adapt)
• Class 1: Excellent
• Class 2: Fair
• Class 3: Poor
ORAL CAVITY
• Arch Size:
• 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)
• Arch Form: Classify according to House:
• RACE: choice of denture base shade, placement of
denture base stains, etc.
• OCCUPATION: A patient's job and social standing
often determine the value he or she places on oral
health, as well as the esthetics and other qualities
desired in a denture.
• COSMETIC INDEX:
• Class 1 (high cosmetic index); Exacting; usually are
appreciative and cooperative
• Class 2 (moderate cosmetic index)
• Class 3 (low cosmetic index); Indifferent; uncooperative,
and place little value on the efforts of the prosthodontist.
PERSONALITY(House)
• PHILOSOPHIC: Easygoing, congenial,
mentally well-adjusted, cooperative, and
confident in the dentist. Prognosis is excellent.
• EXACTING: Precise, above average in
intelligence, immaculate in dress and
appearance, often dissatisfied with past
treatment, doubt the ability of the practitioner to
satisfy him or her, and often want written
guarantees or remakes at no additional charge.
PERSONALITY(House)
• HYSTERICAL: Treatment as a last resort, have a
negative attitude, are often in poor health, are poorly
adjusted, often appear "exacting" but with unfounded
complaints, have failed at past attempts to wear
dentures, and have unrealistic expectations (hysterical
patients often demand esthetics and function equal to
or greater than natural teeth). Prognosis is poor.
• INDIFFERENT: Not concerned with appearance,
often go without dentures for years (or wear poor or
worn-out dentures), do not persevere, and do not adapt
well. Such patients have no desire to wear dentures and
do not value the efforts or skills of the dentist.
MEDICAL HISTORY
• The practitioner must be aware of local and
systemic factors and must consider them during
treatment planning.
• Systemic factors that may affect complete-
denture therapy include: anemia; arthritis; Bell's
palsy; carcinomas; diabetes; lupus
erythematosus; nicotinic stomatitis; Paget's
disease; Parkinson's disease; pemphigus vulgaris;
Plummer-Vinson syndrome; scleroderma;
tuberculosis; and diseases, conditions, or
therapies leading to xerostomia.
DENTURE HISTORY
• CHIEF COMPLAINT:
• The chief complaint may be overlooked during therapy
• Assess patients expectations
• EXPECTATIONS:
• determine if they are realistic and attainable
• Personality classification
• YEARS EDENTULOUS, MAX/MAN:
• the reasons for tooth loss
• information about bone resorption patterns and progression,
as well as the timing of tooth loss
• PREVIOUS DENTURES, MAX/MAN:
• the number and types of previous dentures.
• reasons for replacement.
• EXISTING OR CURRENT DENTURES:
• length of time he or she has worn the current dentures.
• valuable information about denture experience, denture
care, dental knowledge, parafunctional habits, etc.
• DENTURE SUCCESS:
• Favorable
• Unfavorable
• PRE-EXTRACTION RECORDS:
• Pre-extraction photographs, radiographs, casts, and facial
measurements may prove helpful in denture therapy
• Aid in evaluation of vertical dimension of occlusion.
CLINICAL EVALUATION
FACIAL FORM (FRONTAL): (House and Loop, Frush
and Fisher and Williams)
RIDGE FORM (Maxilla)
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TORI
• Class 1:
• Tori are absent or minimal in size.
• Dont interfere with denture construction.
• Class 2:
• Tori of moderate size
• Mild difficulties in denture construction and use.
• Surgery is not required.
• Class 3:
• Large tori.
• Compromise the fabrication and function of dentures.
• Surgical recontouring or removal necessary.
INTERACH SPACE
RIDGE PARALLELISM
RIDGE RELATIONSHIP(Angle)
BONE QUANTITY(Branemark)
BONE QUALITY(Branemark et al)
LATERAL THROAT FORM(Neil)
PALATAL THROAT FORM(House)
FRENUM ATTACHMENTS(House)
• Class 1: High in the maxilla or low in the mandible
with respect to the crest of the ridge.
• Class 2: Medium
• Class 3: Freni encroach on the crest of the ridge and
may interfere with tile denture seal. Surgical
correction may be required.
SALIVA
• Class 1: Normal quality and quantity of saliva.
• Class 2: Excessive saliva; contains much mucus.
• Class 3: Xerostomia; remaining saliva is mucinous.
TONGUE(House)
• Class 1: Normal in size, development, and
function. Sufficient teeth are present to maintain
normal form and function.
• Class 2: Teeth have been absent long enough to
permit a change in the form and function of the
tongue.
• Class 3: Excessively large tongue. All teeth have
been absent for an extended period of time,
allowing for abnormal development of the size of
the tongue. Inefficient dentures sometimes can
lead to the development of a class 3 tongue.
EXISTING DENTURES
• TOOTH SHADE, MOLD, AND
MATERIAL:
• Evaluate to determine physical, esthetic, and
anatomic characteristics.
• Shade, mold, and material should be recorded
for both anterior and posterior teeth.
• If the mold cannot be determined, the general
shape of the teeth should be recorded (e.g.,
square, square-tapering, tapering, ovoid, etc.).
ESTHETICS, PHONETICS, RETENTION,
STABILITY, EXTENSIONS, AND
CONTOURS
• Good
• Fair
• Poor
CENTRIC RELATION AND VERTICAL
DIMENSION OF OCCLUSION
• Acceptable
• Unacceptable: VDO is
• inadequate
• excessive
OCCLUSAL PLANE ORIENTATION
• Improper orientation as a result of tooth setting or
changes in bony architecture often creates a "reverse
smile line." This condition is characterized by teeth
that slope downward as one progresses posteriorly.
Consequently, the anterior teeth assume a curvature
that does not follow the arc of the lower lip.
PALATE
• The palate of the existing maxillary denture
should be examined.
• The denture base material and thickness should
be noted.
• Anatomic features should be assessed.
• The practitioner should listen to speech patterns,
and determine whether appropriate "valving" is
taking place.
• Placement of rugae or a change in thickness may
affect pronunciation.
MIDLINE
• The existing maxillary midline should be
evaluated using intraoral (e.g., incisive papilla)
and extraoral landmarks (e.g., nasion, filtrum,
middle of the chin).
• Deviations of the maxillary midline should be
recorded by direction and amount (e.g., maxillary
midline 2 mm to the right of the facial midline).
• Classify:
• Acceptable
• Unacceptable
HYGIENE
• The patient should be questioned about his
or her denture cleansing regimen. These
factors may affect denture-base contouring
(e.g, closed interdental contours versus open
interdental contours) and tooth arrangement
(e.g., presence or absence of diastemata)
• Hygiene should be classified as
• Good
• Fair
• Poor
WEAR
• It often is an indicator of parafunctional habits or an
abrasive diet. And be assessed with respect to time.
• Classify
• Minimal
• Moderate
• Severe
TREATMENT PLANNING
Tissue conditioning:
• List proposed therapy as finger massage, prescribed
medications, type of tissue treatment material to be used
and frequency of soft reline changes, etc.
Preprosthetic surgery:
• List any proposed preprosthetic procedures along with the
staging of these procedures.
Tooth Selection:
• The shade, mold, and material of the maxillary anterior,
mandibular anterior, maxillary posterior, and mandibular
posterior should be selected.
PROGNOSIS
Give the prognosis and list the reasons for
the prognosis.
SUMMARY
A checklist is presented for use in
evaluating and planning the treatment of
patients for complete-denture therapy. A
thorough explanation of each item and
classification included in the checklist list
also is presented. Classifications from the
classic prosthodontic literature are used
wherever possible and their sources are
referenced appropriately
CRITICAL APPRAISAL
• 1996
• Too detailed, time consuming
• Studies
• No pre prosthetic corrections mentioned
