Examination and diagnosis of complete denture patients

Examination And Diagnosis Of
Complete Denture Patients

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According to Glossary of Prosthodontic Terms
“Examination is defined as scrutiny or investigation for
the purpose of making a diagnosis or assessment”
The goal in clinical examination is to recognize
normal anatomy and physiology, normal variations,
and early signs and symptoms of any disease. A
through, comprehensive examination also allows
modification or possible deferment of treatment when
indicated.


Importance of case History
Case history taking is important to know if the
patient has recently become edentulous or has been
edentulous for a long time. A “green ridge” may be bony
spicules remaining from the extraction sites or bony
undercuts with a thin mucosal covering. The intraoral
examination will determine if any surgical correction is
necessary, the prosthodontist must realize these
possibilities and discuss with the patient.
The examination should be carried out
meticulously. A systematic recording of case history
along with careful examination and evaluation leads to a
diagnosis, probable prognosis and the tentative plan.


Prosthodontic Approach to edentulous patients
Examination of edentulous patients should be
divided into two steps:
Getting acquainted: Seat the patient comfortably,
don’t hurry, let him talk, one can learn much by listening.
Establish rapport with the patient and the spouse or the
person accompanying the patient. Develop mutual
understanding.
Technical analysis: (Do visual and digital oral
examination, add x-ray and panorex apparatus). Make
diagnostic impressions for visual explanation to the
patient, guidance for oral surgeon, note correctable
abnormalities and record all adverse factors, make plans
for their management.

History taking and
examination


Name
Obtaining the name of the patient not only helps
in maintaining records but also helps in creating a more
personal and ambient atmosphere for the patient in the
dental clinic. Addressing the patient by his/her name
gives a rather personal touch to the dentist patient
relationship.
Age
Age is an indicator of the patient’s ability to wear
and use a prosthesis. Through the fourth decade of life,
tissues heal rapidly and are resilient. Beyond fifth
decade healing is not rapid. Woman facing the
physiologic and psychological problems often present
as exacting or hysterical patients who are very
conscious about esthetics. Men are pre-occupied and
present as indifferent patients who are concerned more
with comfort or function.

Sex
Generally appearance is a higher priority for
women than for men. Though younger men are often
grow indifferent to their own appearances as they age
and are concerned with comfort and function.
Occupation
A patient’s job & social training often determine
the values he or she places on oral health, as well as
the esthetics and other qualities desired in a denture.
Race
Race
can
be
critical
factor
in
the
characterization of dentures i.e., choice of denture
base shade, denture base stains.

Chief Complaint
The
questioned regarding his or
her chief complaint such as1. Inability to chew
2. Impaired speech
3. Poor appearance
4. Others.

patient

should

be

HOPI
The duration of the edentulous state is of importance
in ascertaining a proper diagnosis and treatment plan
for the patient. Also the manner in which there was a
loss of teeth helps to understand the patients personal
interest in his or her oral hygiene and other habits.

Expectations
The reason the patient seeks prosthetic treatment is
important. His or her expectations must be
determined. These should then be evaluated to
determine I they are realistic, practitioner should not
make unrealistic promises regarding treatment
outcome.
Mental Attitude
House classified patients as:
Philosophical
Exacting
Indifferent
Hysterical

Philosophical Patient
The best mental attitude for denture acceptance is
the philosophical type. This patient is rational, sensible,
calm and composed in difficult situations. The
philosophical
patient
overcomes
conflicts
and
organizes his time and habits in an orderly manner, he
eliminates frustrations and learns to adjust rapidly.
Exacting Patient
The exacting type may have all of the good attributes
of the philosophical patient; however he may require
extreme care, effort and patience on Prosthodontist’s
part. This patient is methodical, precise and accurate
and at times makes several demands: if the patient is
intelligent and understanding, he can give the best time.

Indifferent Patient
The indifferent type of patient presents a questionable or
unfavourable prognosis. This patient exhibits little concern if
any; he is apathetic and uninterested and lacks motivation. The
indifferent patient 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 before denture
construction.
Hysterical Patient
The hysterical type is emotionally unstable, excitable,
excessively apprehensive and hypertensive. The prognosis is
often unfavorable and additional professional help (psychiatric)
is required prior to and during treatment. This patient must be
made aware that his/her problem is primarily systemic and that
many of his symptoms are not result of dentures.

Dental History
Reasons For Loss Of Teeth:
The patient should be questioned regarding the cause of teeth
loss (e.g. periodontal, caries, congenital, trauma etc)
Duration Of Edentulousness
The maxillary/mandibular responses to the question proves
about bone resorption patterns and progression.
Previous Denture Experience, Max/Mand:
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. A patient with a history of several dentures
over a short time is a poor prosthodontic risk.
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, dental
care, knowledge, parafunctional habits etc.

Medical History
Debilitating diseases
A) Diabetes:
Oral Manifestations: Dry feeling in mouth, coated tongue with swollen
edges, fissures on the tongue, small abscesses throughout the
mouth, a faint odour of acetone may be prevalent in advanced cases
and should be treated because dentures can be debased by the action
of acetone.
The patient should have medical control for the dental procedures to
start. Non- pressure impression should be used for maximum
physiologic compatibility of denture base with supporting tissues.
Care should be taken as not to traumatize the tissues because healing
in diabetic patients takes a longer duration e.g. diabetic ulcers.
If patient has an insulin shock while treating place some sugar in his
mouth. Instructions on eating habits and oral hygiene should be
given.

B) Anemia:
Oral Manifestation: changes in the mucous membrane,
Pallor of the tongue and lips, burning, smooth, glossy
tongue, usually pain in tongue and supporting areas.
The patient should be placed under good medical
care. Dentist must achieve good oral hygiene, efficient
dentures, i.e, small food table with maximum
supporting area to keep supporting tissues from being
over stimulated. Careful patient instruction should be
given.


C) Tuberculosis:
Oral Manifestation: Oral lesions are not common in TB but
when present they show long, deep fissures in the tongue;
lesions on the mucosa of check; round, undermined ulcers
that are very painful and firm nodules.
Cautions & Procedure TB:
Efficient dentures are necessary as diet is important in
treatment.
 Mouth hygiene is important as oral infections add to the
load of general resistance.
 Irritating projections on the dentures must be removed
so that they will not erode the skin and start tubercular
lesions.
 Denture should be checked often for infection.
 Dentist should protect himself by using mask, gloves
and make a thorough scrub of face.

Diseases of the Joint:
Diseases involving the joint particularly osteoarthritis is seen in
37 out of 100 adults approximately. Osteoarthritis of the TMJ
presents a problem in complete denture constructions as
mandibular movements are painful.
Oral Manifestation:
Limited movement and opening due to TMJ, generalized pain
throughout the side of face, abnormal chewing procedures and
changing occlusal relations are seen.
In extreme cases, surgery must be indicated & oral surgeon
consulted. Osteoarthritis is more prevalent in woman than in
men. It becomes difficult in opening of mandible during
impression may necessitate special trays and procedures.
Occlusal corrections must be made often because of arthritic
changes in TMJ.


Cardiovascular Diseases:
Consultation with the patient’s cardiologist is
indicated for a patient with CVS disease.
Denture procedures of any kind may be
contra-indicated.
Pre-medication may be required before any
procedure.


Diseases of the skin
Pemphigus:
It is the most fatal of the dermatologic diseases.
O/M: Vesicles and bullae on the mucous membrane as well as on
skin. When the vesicles rupture they leave areas and ulcerations
& the resulting condition causes discomfort and pain.
Foul odour is usually present in the oral cavity and loss of
body weight is apparent. Medical treatment is necessary
Supporting tissues are too painful to wear dentures which
should be worn only for mastication & mental comfort.
Lupus Erythematosis:
It is a type of dermatitis and often thought to be lichen
planus or leukoplakia, presents dermatitis on the face.
Dry and atrophic area, scales over the lesions generally,
sharply demarcated white patches, bases that are red with some
edema. Dentures can be worn as lesions are not usually on the
denture bearing area. Occasionally, some lesions are present on
hard palate and need only relief.
Good oral hygiene is required & periodic check-up to
minimize irritation is required. Polished surfaces of dentures
should not irritate the lesions.

Leukoplakia:
Term applied to smooth, white, diffuse patches on the
membranes of the lips, tongue and cheeks, biopsy is
the method of diagnosis. If specimen shows
premalignant lesion then the affected area should be
removed.
If the report says that the patch on the membrane is
heaped up keratin, no surgery is required & can be
covered with a denture.


Oral Malignancies
Most oral malignances are detected by the dentist.
Oral lesions that cannot be readily diagnosed should be
further studied by biopsy. Eradication of the lesion by
surgery or radiation is a must and subsequent
prosthodontic treatment is best handled by maxillofacial
prosthodontists.
Climacteric
It is one of the periods in the life of both the male &
female when an important change in bodily functions
occur. In females, this period is termed as menopause.
O/M – Desquamative stomatitis, apthosis (canker sores),
herpes labialis (fever blisters), taste-aberrations
(bitterness, metallic, saltiness), Xerostomia, burning
tongue generalized muscle and joint pain, hot flushes,
headaches, etc.

Radiation
Recent radiations show bronzing and burning of
external layers of the skin at the site or loss of hair at
area.
I/O diffuse scaring & slightly pale tissues are seen
which are firm on examination.
If dentures are to be worn, no abrasion or irritation
should be present on supporting tissues. It is best not
to use dentures at all over radiated tissues.


Nutrition
Complete denture prosthesis also depends upon the
health and integrity of the denture bearing tissues for
successful function and comfort to patient. Careful
impaction of the oral tissues and the oral environment is
therefore important before making the final diagnosis and
prognosis for the prosthesis
Patients should also be asked about the vegetarian
or non vegetarian status of their diet as this will also
emphasis on the amount of forces the patient is
accustomed to exert.
Habits
Information regarding the habits such as smoking,
pan chewing etc should be taken. Also, habits such as
bruxism can jeopardize the success of the even properly
fabricated denture so the patient should be motivated and
educated regarding these

The Physical Examination
The face and mouth are relatively simple to
examine since their component structures are readily
accessible to visual inspection, digital palpation, and
percussion and Roentgenographic examination.


Extraoral Examination
Facial Form:
Classification according to House & Loop, Fisher &
Williams.
a.
b.
c.
d.

Square
Tapering
Ovoid
Different combinations.


Facial Profile (Acc. To Angle):
The facial profile is examined by viewing the patient from the
side. This helps in diagnosing gross deviations in the maxillomandibular relationship.
Profile is obtained by joining the two reference lines, line
joining the forehead and the deepest point in curvature of upper
lip (A).
Line joining point A & most anterior point on the chin (B).
Based on Relationship of these lines
a. Straight/orthognathic: The two lines form a nearly straight
line
b. Concave/prognathic: The two references lines form an
angle with the convexity towards the tissue. This is
associated with a prognathic mandible or a retrognathic
maxilla as in Class III malocclusions
c. Convex/retrognathic: The two lines form an angle with the
concavity facing the tissue. This profile occurs as a result
of a prognathic maxilla or a retrognathic mandible as seen
in Class II malocclusion.

Facial Symmetry:
It is examined to determine disproportions in
transverse and vertical plane. In most patients, the
right and left sides are not identical which is also
termed as normal asymmetry. Some degree of
asymmetry is accepted as normal whereas gross
asymmetries are recorded.
Gross asymmetries can be due to:
a. Congenital defects
b. Hemifacial atrophy
c. Unilateral condylar ankylosis and hyperplasia.


Complexion:
As all of us are aware that our aim is to achieve a harmonious
blending of shape, shade, arrangement and position so that the
final result is a “removable restoration that creates an illusions of
being what it is not” so as to get an Esthetic denture which is
defined as “the cosmetic effect produced by a dental prosthesis
which affects the desirable beauty, attractiveness character and
dignity of the individual. These shades should be comparable
with the patient’s general facial coloration & complexion.
a. Pallor may indicate anaemia, hyperthyroidism or nephrosis,
systemic disease such as TB.
b. Ruddy complexion sign of polycythemia or neoplasm.
c. Bronzed skin occurs in Addison’s disease.
d. Diffuse, bluish purple color may indicate Vit B2 deficiency.
e. Lemon-yellow complexion of jaundice is associated with
gallbladder, liver or bile duct disorders.
f. Complexion marred by ulcerated lesions may be due to basal
cell and squamous cell carcinoma.

Skin
color

Dark

Skin, hair and eye

Fair

Along with patient’s age

Medium
Hair

Black
Brown
White
Grey

Eye

Helps in determining the
tooth shade.

Black
Brown
Green
Grey

Lip support:
If tissues around the mouth has wrinkles and rest of the
face does not, significant improvement can be done. If
present anterior teeth are set lingually, the lip will lack
support and plans to bring new teeth forward can be
made. The long standing wrinkles do not disappear at
once.
Lip Thickness:
Thin Lips: Patients with thin lips present special
problems. Any slight change in the labiolingual tooth
position makes a sudden change in lip contour. Even
overlapping of teeth may distort the surface of lips.
Thick Lips: Variations in the arch form and individual
tooth arrangement do not make obvious changes.

Lip Length:
Patients with short upper lips will expose all the
upper anterior teeth, much of labial flange as well. Care
must be taken to select color and form of denture base.
Long lip shows less of anterior teeth.
Lip Fullness:
This is directly related to the support it gets from
the mucosa or denture base and the teeth behind it. An
existing denture with thick labial flange could make the
lip appear to be too full rather than displaced. If the
existing dentures have the teeth set to far palatally, the
patient may feel that the new and corrected tooth
arrangement makes the lip too full.

Lip Mobility:
Class I – normal
Class II – reduced mobility
Class III – paralysis
Some stroke patients may have paralysis of half the
lip leading to unilateral mouth droop and facial
asymmetry and counseling should be done regarding
treatment limitations as they might have unrealistic
expectations regarding function and esthetics.
Lips should be examined for cracking, fissuring at
the corners and ulceration. These changes could be
caused by Vit B complex deficiency or infections from
organisms such as candida albicans.

Muscle Tone:
Classification According to House:
Class I: The patient exhibits normal tension tone and
placement of the muscles of mastication and facial
expression.
No degenerative changes are apparent.
Majority of edentulous patients have experienced some
degree of degeneration and usually only immediate denture
patients have normal musculature.
Class II: The patient displays approximate normal function
but slightly impaired muscle tone. Maximum muscle function
cannot be used following the loss of all natural teeth.
Class III: The patient exhibits greatly impaired muscle tone
and function. This is usually coupled with poor health,
inefficient dentures, and loss of vertical dimension, wrinkles,
decreased biting force www.indiandentalacademy.com
and drooping commissures.

EXAMINATION OF THE TEMPOR MANDIBULAR 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. The TMJ affects
the dentures which further affect the health and function of the joints.
CLINICAL EXAMINATION OF THE TEMPOROMANDIBULAR JOINT:
The examination should include the auscultation and palpation
of the TMJ and the musculature associated with mandibular
movements as well as the functional analysis of the mandibular
movements.
PALPATION: lateral palpation, posterior palpation
Lateral Palpation: Exert slight pressure on the condyloid process with
the index fingers, palpate both sides simultaneously. Register any
tenderness to palpation of joint and any irregularities in condyloid
movement during opening and closing maneuvers. The co-ordination
of action between the left and right condylar heads should be
assessed at the same time.

Posterior palpation: Position the little fingers in the external auditory
meatus and palate the posterior surface of the condyle during
opening and closing movements of the mandible. Palpation should
be carried out in such a way that the condyle displaces the little
finger when closing.
MOVEMENTS OF THE MANDIBLE
Opening movement
Closing
Protrusive excursion
Retrusive
Lateral
All these are examined as part of the functional analysis. The
amount and direction of these actions are recorded during the clinical
examinations. Deviations in speed can only be registered with electronic
devices e.g. Kinesiograph. The first signs of initial temporomandibular joint
problem include deviations of the mandibular opening and closing paths in
the sagittal and frontal planes. The characteristic movement deviations
include incongruency of the opening and closing and uncoordinated zigzag
movements. The ‘C’ and ‘S’ types of deviations are typical signs of
functional disturbances.

Intra oral examination
Arch size
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.
If discrepancy is present, in the size of maxilla and mandible,
it should be noted. This condition may arise from a developmental
source, trauma, and early loss of teeth in one arch with resultant
increase in resorption or from a severe Class II or Class III
malocclusion. This may lead to a poor relationship of teeth in one
arch to the other.
Arch form
The arch may be (i) square (ii) ovoid or (iii) tapered and
opposing arch may or may not have the same form. The form of the
arch will influence the support of the denture. If the arch form is not
same in both the arches some problems in tooth arrangement can be
anticipated.

Residual ridge contour / form
Ridge form is characterized traditionally as by its crosssectional contour as a whole arch.
i) U shaped

ii) V shaped

iii) Flat

U shaped arch is generally favorable for supporting a
denture since it has broad base for occlusal stresses and
parallel sides that enhance adhesion and resistance to
displacement as well as encourage border seal.
V-shaped has a narrow crest that is not conducive to the
reception of masticatory stresses without irritation and
discomfort. Less favorable for retention because of its sloping
sides and has a tendency to progress towards narrowness. The
thin sharp mandibular ridge presents difficulty in prosthetic
management.

Flat residual ridge is the most difficult for restoration by the
prosthodontist. The normal pattern of resorption for
maxillary arch is upward and inward as compared to the
downward and outward progression of bone loss of the
mandibular ridge. (Lack of vertical height produces less
resistance to horizontal forces)
Jaw relationship thus normally progresses to crossbite situations and complicate the distribution of prosthetic
stress to the basal support.


Ridge relation
Laney Smith described ridge relationship as the
anteroposterior 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.
CLASSIFICATION BY ANGLE:
Angle Class I (Normal): - Anterior segment of the mandibular ridge
is directly below or slightly posterior to the maxillary anterior ridge
segment.
Angle Class II (Retrognathic): - Anterior segment of the mandibular
ridge is retruded beyond the normal position as it relates to the
maxillary anterior ridge segment.
Angle Class III (Prognathic): - Anterior segment of the mandibular
ridge is protruded beyond the normal position as it relates to the
maxillary anterior ridge segment.

Ridge parallelism
Classification according to Angle
Class I – Both ridges are parallel to the occlusal plane
Class II – The mandibular ridge is divergent from occlusal
plane anteriorly
Class III – The maxillary ridge is divergent from the
occlusal plane anteriorly and/or both ridges are divergent
anteriorly
Importance: Ridges that are not parallel to each other will
cause movement of the bases when teeth occlude because
of an unfavorable direction of forces

Intermaxillary space
This is the space between the maxillary and the
mandibular arches. Normally it should be 20mm. If the
space is less than 20mm it is difficult to obtain stability
of the denture base, which is compromised as the teeth
are set away from the basal seat.
Class I: Ideal interarch space to accommodate the
artificial teeth
Class II: Excessive interarch space
Class III: Insufficient interarch space to accommodate
the artificial teeth

MUCOSA:
Mucosal displaceability
Classification by House
Class 1: Normal uniform density of mucosal tissue (approx 1mm
thick). Investing membrane is firm but not tense and forms an
ideal cushion for the basal seat of the denture
Class 2a: Soft tissues have thin investing membrane and are
highly susceptible to irritation under pressure
Class 2b: Soft tissues have mucous membrane twice the noraml
thickness.
Class 3: Excessively flabby to the degree that surgical excision
is indicated


HARD PALATE
SHAPE OF PALATAL VAULT
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 and although retention may be
satisfactory in a downward direction, any lateral or
rotatory forces results in poor resistance and less
retention

SOFT PALATE
Classification is based upon the angle formed with the
hard palate. The more acute angle of the soft palate in relation
to the hard palate, the more muscle activity that is necessary
for velopharyngeal closure (closing of nasopharynx). More the
soft palate is markedly displaced in function, the less can be
covered by the denture base.
CLASS I: Indicates a soft palate that is rather horizontal as
it extends posteriorly with minimal muscle activity.
When the vibrating muscle is located, a few mm
separate the anterior and posterior vibrating lines allowing for
wide posterior palatal seal but not very deep.
Considered as most favorable as more tissue surfaces
can be covered leading to more retentive denture base.

CLASS III: Indicates the most acute contour in relation to
the hard palate, creating marked elevation of the
musculature to create velopharyngeal closure.
Seen usually in configuration with a high V-shaped
palatal vault. As there is greater elevation of the soft
palatal musculature in function a few mm separate the
vibrating lines and so, smaller area for the posterior
palatal seal is there than class I. Along with being
smaller, it is also deeper than class I configuration.
CLASS II: Designates those palatal contours that lie
between class I and class III
Position of the patient:
The classification of soft palate are determined when the
patient is in upright position and the head is held erect.

MAXILLARY TUBEROSITY:
Extremely large maxillary tuberosities make it necessary to locate the
back end of the occlusal-plane too low, omit some posterior teeth or shorten
the denture bases from their correct border extent and contour.
Pendulous fibrous maxillary tuberosities are frequently encountered.
They occur unilaterally or bilaterally and may interfere with denture
construction by excessive encroachment on or obliteration of the interarch
space. Surgical treatment is the choice and occasionally maxillary bone must
be removed.
Absence of maxillary tuberosities and loss of pterygomaxillary notch:
Advanced bone resorption or excessive surgical resection of the
tuberosity area can lead to absence of one or both tuberosities. This is
frequently accompanied with obliteration of the pterygomaxillary notch area
which is essential for enhancing for maximum breath to the posterior palatal
seal area and the patient should be informed as the maxillary denture will not
be as resistant to posterior downward dislodgement when incising takes place.


TONGUE:
Smith described two anatomic tongue types:
Long, narrow, tapered
Short, broad and thick
The first type presents fewer problems but while making
impression; it might jeopardize lingual border seal.
The second fills more of space in the floor of mouth so as
to provide posterior denture flange and hence better border
seal.
Classification of tongue size according to House:
CLASS I: Normal in size, development and function,
sufficient teeth are present to maintain normal form 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, allowing for abnormal
development of a class www.indiandentalacademy.com
III tongue.

FLOOR OF THE MOUTH
It presents a wide variation in anatomy and
functional relation to the ridge crest. If the floor is near
the crest, at rest or the magnitude of movement is
great, magnitude of retention and stability is poor. The
floor of the mouth in the sublingual gland and
mylohyoid areas can be very high and close to the
ridge crest at times may spill over the ridge and
eliminate alveolingual sulcus. If there tissues cannot
be placed selectively by the denture flange than the
prognosis of mandibular denture is poor.


LATERAL THROAT FORM
Niel described soft palate configuration throat form
but distinguished this category from lateral throat form. He
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.
Lateral throat form is classified according to the
extent of anterior movement of the retromylohoid curtain as
the tongue is extended anteriorly beyond the vermillion
border of the lower lip.
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.

Classification Acc to Niel
CLASS I: If the lateral throat form changes configuration
so as to place heavy pressure on the finger.
CLASS III: If the pressure is minimal or no pressure is
exerted.
CLASS II: Any position of the tissue between these two
extremes
Overextension in the retromylohyoid areas results
in loss of border seal, displacement of denture or
soreness that readily radiates to the floor of the mouth,
throat and neck


TORI
CLASS I: Tori are absent or minimal in size and do not
interfere with existing denture.
CLASS II: Clinical examination shows several tori of
moderate size, often mild difficulties in denture
construction and use of surgery not required.
CLASS III: Large tori are present. These tori
compromise the function of dentures. These tori
require surgical removal.


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


Diagnosis
The word diagnosis is derived from Greek word dia
(thorough) and gnosis (knowledge) and is defined as “to
know apart or to distinguish”.
For our purposes diagnosis is defined as
1) The act or process of deciding the nature of a
diseased condition by examination
2) A careful investigation of the facts to determine the
nature of things or
3) The determination of the nature, location and causes
of the disease - by Charles Heartwell.
According to glossary of prosthodontics – diagnosis
is defined as determination of the nature of disease.

The ability to make diagnosis is predicted on
several different factors. The knowledge of how to
conduct a careful and thorough investigation of a
problem is important, but still more important is the
knowledge of the system and the problems that might
affect it.
A correct diagnosis is the basis for the
appropriate and adequate treatment of the patient with
the problem. The prosthodontist will know the natural
history of the problem and the most effective form of
therapy. This information in turn then provides the
basis for a prognosis.


DIAGNOSTIC AIDS
1. Pre-extraction records
Old diagnostics casts are invaluable aids in determining tooth
size, position and arrangement.
Old radiographs are also helpful in determining tooth size and
bony changes.
Photographs showing natural teeth can also relay much
information regarding tooth size, position etc; and be helpful in
achieving proper esthetics and patient’s satisfaction.
2. Radiographic Examination Of Edentulous Patients
Radiograph examination of edentulous patients is advisable prior
to the construction of dentures.
Use of the orthopantomograph for routine examination of
prosthetic patients. Such an examination will often reveal the
presence of residual roots, unerupted teeth or other abnormalities in
patients who are otherwise free from signs or symptoms that might
suggest existence of a pathologic condition.

3. Diagnostics Casts
On occasion, ridge relationships, inter-ridge distance or ridge
shape and forces cannot be adequately determined by clinical
examination alone. It may be necessary to make preliminary impressions
and a maxillo mandibular relation record to mount the casts on the
articulator. The centric relation and occlusal vertical dimensions records
must be viewed around the entire arch. Sufficient space may not be
available for both denture bases between the tuberosities of the maxillae
and retromolar pad of mandible.


Conclusion
As it is rightly said in a Latin proverb
“The first step towards cure is to know what the disease
is”
The acquisition of knowledge is one of man’s greatest
accomplishments. Putting that knowledge to use is the
fuel that turns the wheel of progress. Research works
may develop mathematical models, devise predictive
procedures and test them satisfactorily, but the practicing
prosthodontic treating the patient at a time will prove the
ultimate worth of any suggestive method.
So equipped with the knowledge and understanding of
examination and diagnosis, we can become skilled hands
to intervene during treatment planning.

References
1. The Dental Clinics of North America – Complete
dentures
2. Charles M. Heartwell – Syllabus of complete
dentures.
3. Boucher’s – Prosthodontic treatment for edentulous
patients. Pg: 51.
4. Sheldon Winkler – Essentials of complete denture
prosthodontics. Pg: 39.
5. Internet : http//:completedentures/XH229/diagnosis


Thank you
Leader in continuing dental education


Examination and diagnosis of complete denture patients

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