- The document outlines the process for conducting a thorough dental examination, including chief complaints, medical and dental history, extraoral and intraoral examination, diagnostic casts, diagnosis, and treatment planning. - The examination involves assessing the chief complaint, medical history including medications, dental history, temporomandibular joint examination, palpation of muscles and lymph nodes, and intraoral soft tissue and dental evaluation. - Diagnostic casts are useful for diagnosing problems, assessing edentulous spaces, abutment teeth, and developing a treatment plan. A comprehensive treatment plan is developed through a process of data collection, diagnosis, and integrating information to create a logical plan of care.

2. Chief Complaint:
It should be recorded in patients own
words. The accuracy and significance
of patient’s primary reason /reasons
should be analyzed first. This will
reveal problems and conditions of
which the patient is often unaware.

3. Medical History:
An accurate and current general medical
history should include any medication the patient
is taking as well as all relevant medical conditions.
a) Any disorders that necessitate the use of
antibiotic premedication, any use of steroids or
anticoagulants and any previous allergic
responses to medication or dental materials
should be recorded.
b) Any conditions affecting the treatment plan
e.g.: various radiation therapy, haemorrahgic
disorders etc. should be recorded

4. Dental History:
Periodontal, restorative and endodontic history
are first noted.
Orthodontic history should be an integral part of the
assessment of a prosthodontic dentition. Occlusal
adjustment may be needed to promote long term
positional stability of the teeth and reduce or eliminate
parafunctional activity. Restorative treatment can
often be simplified by minor tooth movement. When a
patient is contemplating orthodontic treatment, much
time can often be saved if minor tooth movement for
restorative reasons is incorporated from the start.

5. TMJ dysfunction history
A history of pain or clicking in the
temporomandibular joints or
neuromuscular symptoms, such as
tenderness to palpation, may be due
to TMJ dysfunction which should be
treated before fixed prosthodontic
treatment begins.

6. EXTRAORAL EXAMINATION
Cervical lymph nodes, TMJ and muscles of
mastication are palpated.
Temporomandibular joints:
The TMJ is palpated bilaterally just anterior to the
auricular tragic while having the patient open and
close his lower jaw.
Tenderness, clicking or pain on movement is
noted. Maximum jaw opening less than 40mm
indicates jaw restriction, because the average
opening is greater than 50mm. Any deviation from
the midline is also recorded. Maximum lateral
movement can be measured (normal is about
12mm).

7. Muscles of mastication
A brief palpation of masseter, temporalis,
medial pterygoid, lateral pteregoid, trapezius and
sternocleido mastoid muscles may reveal
tenderness. The patient may demonstrate limited
opening due to spasm of the masseter or
temporalis, muscle.
Lips:
Next, the patient is observed for tooth exposure
during normal and exaggerated smiling. This may
be critical in treatment planning and particularly for
margin placement of metal-ceramic crowns.

8. INTRAORAL EXAMINATION
- First the patient’s general oral hygiene is
observed.
- The presence or absence of inflammation
should be noted along with gingival architecture
and stippling. The existence of pockets should be
entered in the record and their location and depth
chartered.
- The presence and amount of tooth mobility
should be recorded with special attention paid to
any relationship with occlusal prematurities and to
potential abutment teeth.

9. - Check for a band of attached gingiva around all the
teeth, particularly around teeth to be restored with
crowns. Mandibular 3rd molars frequently do not have
attached gingiva around the distal segment (30% to
60% of cases).
- The presence and location of caries is noted. The
amount and location of caries, coupled with an
evaluation of plaque retention, can offer some
prognosis for new restorations that will be placed. It
will also help the preparation designs to be used.
- Finally an evaluation should be made of the
occlusion. The amount of slide between the retruded
position and the position of maximum intercuspation
should be noted. Non-working interferences if present,
should be evaluated. The presence or absence of
simultaneous contact on both sides of the mouth
should be observed.

10. Advantages of diagnostic casts:
1) For diagnosing problems and arriving at a
treatment plan.
2) Allow an unobstructed view of the edentulous
spaces and an accurate assessment of the span
length, as well as occlusogingival dimension.
3) Curvature of the arch in the edentulous region
can be determined so that it will be possible to predict
whether the pontic/pontics will act as a lever arm on
the abutment teeth.
4) Length of the abutment teeth can be accurately
gauged to determine which preparation designs will
provide adequate retention and resistance.
5) The true inclination of the abutment teeth will
also became evident, so that the problems in a
common path of insertion can be anticipated.

11. Diagnosis and treatment
planning
Why bother?
The process of diagnosis and treatment
planning helps us attain a comprehensive
and complete guide to care for any given
patient and their particular situation. It allows
for the care rendered to be logical both in
plan and action

12. Before a diagnosis is made,through data
collection is necessary.
Radiographs
Articulated diagnostic casts
Medical,social and dental histories
Clinical examination
Periodontal charting
Endodontic vitality tests
Patient expectations of treatment.

13. Treatment planning is the intergration of
data collection and diagnosis to form an
omniscient and ordered guide of
treatment.
It can be a very complex and confusing
process if the patient’s needs are great.
So ,having a well-thought-out plan prior
to beginning any treatment is a key to
success.

14. Order of treatment plans:
1)Disease control phase
2)Perodontal phase
3)Restorative phase
4)Maintenance and prophylaxis
phase

15. FDP treatment plan:
1)Abutment evaluation
.Tooth vitality
.Periodontial status
.Crown to root ratio
2)Biochemical considerations
.Management of destructive forces
.Length of span
.pier abutments
.Cantilevered bridges

16. THANK YOU