1. Diagnosis & Treatment Planning
Diagnosis
The determination of the nature of a disease (GPT-8)
Diagnosis in complete prosthodontics is important because it enables the dentist to
estimate the degree of success to be expected from the treatment.(DeVan 1942).
Treatment planning
The Sequence of procedures planned for the treatment of a patient after
diagnosis (GPT-8)
Treatment planning means developing a course of action that encompass the
ramification and sequelae of treatment to serve the patient’s need.
Treating the patient for a complete denture health is an extremely complex and
challenging procedure that must be altered to meet the biological, anatomical,
psychological, technical and instructional needs of the individual.
The complex nature of complete denture treatment demands thorough systematic
and unhurried approach to diagnosis.
Interview
Personal background, experiences, expectations
Medical history
Dental history
Examination - Diagnosis - Prognosis
Treatment Plan
Dental Procedures

2. Name:
Name should be asked to enter it in the record. Addressing patient with name
brings him some confidence and psychological security. It also give an idea about the
patient`s family and community.
Age:
Younger patients usually have better health, neuromuscular control and
adaptive capacity, and therefore have a more favorable prognosis.
Older people remain alert and continue to have sound judgement; however, a
modest decrease in mental agility occurs. After the age of 70 there is slight impairment
of the abilities to learn and to memorise. With increasing age there is a progressive loss
of neurones and synapses in the cerebral cortex. As a result there is a slowing of the
central processing facility with a consequential lengthening of reaction times and
response to sensory stimuli.
Within the sensory system, age brings about a deterioration of the senses of smell
and taste, the former being more affected. Hearing is impaired in approximately 25% of
people over the age of 65 and in 80% of those in the age range 75–79 years.
With respect to the motor system, there tends to be impairment of balance and
some postural tremor, indicating deterioration of cerebellar function and of the
extrapyramidal system. The elderly are less precise in controlling the contraction of
muscles, such as the masseter muscles. It takes more time and effort before new
dentures can be controlled automatically. Of course, an elderly patient has a great deal
of experience to fall back on and if a new task is given which utilises previously
acquired skills, so that difficulties will be minimised. However, problems are more
likely to arise if the new task is more demanding than declining abilities are able to
cope with. For example, previous denture experience can be of the greatest assistance
when having to cope with new dentures, providing that major changes to the design of
the dentures have not been introduced.
Research has shown that the masseter and medial pterygoid muscles suffer a
decrease in cross-sectional area and in muscle density as a consequence of advancing
age; the decrease is more apparent in edentulous people. Such changes might, in
individual cases, be responsible for complaints of difficulty in eating and of eating more

3. slowly than the rest of the family. Of course, such a conclusion can be drawn only after
denture design causes have been eliminated.
Age brings about some deterioration of the denture-bearing tissues. The
epithelium becomes thinner, the connective tissue is less resilient and the ability of the
mucosa to heal is impaired.
Osteoporosis is a common problem in old age, particularly affecting
postmenopausal women, occurring in about one-third of women over 60. Not only is
the skeleton affected, but the lower jaw will show a decrease in bone density. The
severity of osteoporosis is related not only to hormonal changes but also to long-term
calcium deficiency and to loss of normal function. Regarding the latter point, it would
be reasonable to suggest that the edentulous state adversely affects normal function of
the mandible. There is no evidence to suggest that the rate of salivary secretion
decreases with age, but normal salivation can be adversely affected by drug therapy.
Gender:
Men are usually better patients as they are occupied with their work and have
less time to fret about their dentures. Women tend to scrutinize their dentures and are
more particular about esthetics. Nearly always, the most difficult patients are the pre-
menopausal and post-menopausal women as they often have psychological problems
and symptoms such as dry mouth, burning sensations, loquacious, vague pains, etc.
Occupation:
Gives an idea of value that the patient has in his /her oral health, esthetics and
other qualities desired in a denture. Stressful employment often complicates the
adjustment to wearing dentures (example- bruxing).

4. PERSONALITY ASSESSMENT
House’s psychological classifications:
Philosophical: patient willingly accepts the dentist’s judgement without question. They
pay attention and follow instructions. Ideal attitude for successful treatment provided
the biomechanical factors are reasonable They have the best prognosis (80-85%).
Exacting: Patient is methodical, precise and demanding. They ask a lot of detailed
questions and like each step explained in detail. They have an excellent prognosis if
intelligent and understanding. Often dissatisfied with past treatment, doubt the ability
of the practitioner to satisfy him or her , and wants written guarantees or remark on no
additional charge. Once satisfied the exacting patient become practitioners great
support.
Hysterical: Patients who are emotionally unstable and unfit to wear dentures. They
blame the world for their present condition. They’re never satisfied and always
complaining. Theyusually have bad results with previous treatments.Often in poor
health, severely resorbed ridges and other unfavorable conditions. Submit to treatment
as a last resort and has negative attitude. Have unrealistic expectation and think world
is against them. Poor prognosis.
Indifferent: Patient has a low motivation and desire for dental care. They show little
appreciation for the dentist’s efforts and will give up easily if problems are
encountered. Patient not concerned with appearance , often go without denture for
years or Wear poor or worn out denture far beyond serviceability. Such patient have
no desire to wear denture and do not value the effort or skills of the dentist.

5. Winkler described four traits that characterize the ideal patient's response:
Realizes the need for the prosthetic treatment.
Wants the prosthesis.
Accepts the prosthesis.
Attempts to use the prosthesis. This patient corresponds to House's philosophical
mind patient.
Other classification
Cooperative
they may or may not recognize the need for denture but they are open minded and
amenable to suggestions
Apprehensive
Even thought the patient realize the need for dentures they have some irrational
problems , which cant be overcome by ordinary explanation.
Uncooperative
These patient present themselves usually upon urged by relatives or friends .
General attitude is negative
An extreme difficult group of denture bearers
COSMETIC INDEX
CLASS I High cosmetic index
 They are more concerned about the treatment and wonder if the expectation are
fulfilled.

6. CLASS II Moderate cosmetic index
 They are patient with nominal expectation.
CLASS III Low cosmetic index
 Patient are nor bothered about treatment and aesthetics.
 Indifferent , uncooperative and little value of prosthodontist efforts.
CHIEF COMPLAINT
It should be recorded in patient`s own words. It give idea about patient`s psychology.
Patient should be questioned regarding chief complaint because to asses whether
patients expectation are realistic or attainable . It also provide information about
patient`s mental attitude.
HISTORY OF PRESENT ILLNESS.
A person may visit the dental office for the first time for a denture to be made or may
have been wearing a denture.