TRIVENI INSTITUTE OF DENTAL SCIENCES, HOSPITAL AND RESEACH CENTRE

(P.G SECTION)

DEPARTMENT OF PROSTHODONTICS, CROWN & BRIDGE AND ORAL

IMPLANTOLOGY

DIAGNOSTIC CHART FOR EDENTULOUS PATIENTS

CASE NO: OPERATOR :

Name of the patient: Age : Sex:

Address : Occupation :

Contact no : OPD no : Date:

CHIEF COMPLAINT:

PATIENT’S PRIMARY EXPECTATION :- Mastication / Esthetics/ Phonetics / Others :

HISTORY OF PRESENT ILLNESS :

PHASE 1 : PATIENT EVALUATION

1. GAIT :– Normal / Altered

2.COMPLEXION AN PERSONALITY :-

3. COSMETIC INDEX :- High /Moderate/Low

4. MOTOR SKILLS :- Normal/ Altered

5. PATIENT’S MENTAL ATTITUDE:- Philosophical / Exacting / Hysterical / Indifferent.

CLINICAL HISTORY TAKING

MEDICAL HISTORY : Do the patient suffer /suffered from any of the following disease/diseases?

CVS RS BLOOD NEURO RHEUMATOID BONE VIRAL/ IMMUNE/ ALLERGIC

DYSCRASIAS DISORDER ARTHRITIS DISORDER BACTERIAL AUTO REACTION
INFECTION IMMUNE
DISORDER

OTHER : DURATION :

PREVIOUS AND PRESENT MEDICAL HISTORY :

MEDICATION/DRUG HISTORY : DURATION:

NUTRITIONAL STATUS :

HABITS (if any): Pan chewing / tobacco chewing/ smoking / alcohol consumption / other

DENTAL HISTORY : Does patient has undergone any dental treatment prior ?

A. REASON FOR THE LOSS OF TEETH

MAXILLARY : Caries /Periodontal / Congenital / Other …………………..

MANDIBULAR : Caries /Periodontal / Congenital / Other …………………..

B. SEQUENCE OF THE LOSS OF THE TEETH /DURATION FOR WHICH TEETH HAVE BEEN LOST

MAXILLARY : Anterior MANDIBULAR : Anterior

Posterior Posterior

C. DURATION OF EDENTULOUSNESS :
D. PREVIOUS DENTURE WEARER: Yes / No

EVALUATION OF PREVIOUS DENTURES

i. No. of Previous Dentures :-

Maxillary Number Type

Mandibular Number Type

ii. Reason to fabricate the new denture :

iii. Patient’s comments on present denture:

Comfort : Chewing efficiency Esthetics

Speech Soreness Other

iv. Evaluation of the existing denture:

Vertical Dimension : Retention: Stability:

Occlusion : Articulation: Esthetics:

Denture Hygiene maintainence: Parafunctional Habits:

Teeth shade: Plane of orientation :

Denture wear : minimal / moderate / severe

PHASE II - CLINICAL EXAMINATION

GENERAL EXAMINATION :

Vital signs : Built: Gait:

EXTRA-ORAL EXAMINATION

Facial symmetry : Yes/ No

Facial form : Square / Tapering / Ovoid .

Facial profile : Straight/ Prognathic / Retrognathic

 EXAMINATION OF LIP :
Length : Long Medium Short

Volume : Thin Thick Medium

Tonicity : Hypertonic Hypotonic Normal

Lip contact : Class I Class II Class III

Naso-labial fold : Deep Obliterated Absent

Philtrum : Concave Convex Obliterated

EXAMINATION OF TEMPOROMANDIBULAR JOINT

Tenderness / Discomfort / Crepitus

MANDIBULAR MOVEMENT

Opening - normal / restricted / deviation to right / deviation to left .

Closing - normal / restricted / pain during movements .

INTRA-ORAL EXAMINATION

MAXILLARY

MUCOSA :

left right

Buccal

Labial

Palatal
RESIDUAL ALVEOLOAR RIDGE

Arch size: Class I Class II ClassIII

Arch form : Class I (square) Class II (tapered) ClassIII (ovoid)

Ridge contour: High ridge Flat Knife edge

Ridge relation : Normal Retrognathic Prognathic

Ridge parallelism: Class I Class II ClassIII

Interarch distance : Normal Excessive Insufficient

Ridge defect (if any ):

Hard palate : U- Shaped V- shaped Flat

Soft palate : Class I Class II ClassIII

Palatal throat form : Class I Class II ClassIII

Lateral throat form: Class I(deep) Class II (moderate) ClassIII (shallow)

Gag reflex and : Class I(normal) Class II(hyposensitive) ClassIII(hypersensitive

palatal sensitivity

FRENAL ATTACHMENT

Labial :-

Buccal :- Left Right

Saliva : Class I (normal) Class II (excessive) Class III(xerostomia)

MANDIBULAR

MUCOSA : left right

Buccal

Labial

Lingual
RESIDUAL ALVEOLOAR RIDGE

Arch size: Class I Class II ClassIII

Arch form : Class I (square) Class II (tapered) ClassIII (ovoid)

Ridge contour: High ridge Flat Knife edge

Ridge relation : Normal Retrognathic Prognathic

TONGUE

Tongue size: Class I Class II ClassIII

Tongue position: Class I Class II ClassIII

Genial tubercle :

FRENAL ATTACHMENT

Labial :-

Lingual:-

Buccal :- Left Right

PHASE IV- RADIOGRAPHIC EXAMINATION

Bone resorption : Mild Moderate Severe

Bone quality : Good Moderate Poor

Bone quantity : Good Moderate Poor

Abnormalities (if any ):

INVESTIGATIONS :

DIAGNOSIS:

PROGNOSIS:

PROGNOSIS FOR MAXILLARY DENTURE :-

PROGNOSIS FOR MANDIBULAR DENTURE :-

PROGNOSIS FOR COMPLETE DENTURE:-

TREATMENT PLAN :

PHASE I - Adjunctive care:-

 Elimination of infection -

 Elimination of pathosis

 Preprosthetic surgery

 Tissue conditioning

PHASE II- Prosthodontic care

 Treatment outline-

Preliminary impression Material Date Rationale

Diagnostic cast mounting :

Fabrication of special tray :

Spacer design:
 Secondary impression Material Date Rationale

Border moulding

Wash impression

Recording of posterior
palatal seal area and
technique

Final cast :

Fabrication of denture baseplate :

Jaw relation:

Vertical VDO MM VDR MM

2. Vertical articulator name zeroing the articulator

Setting - CG IG Others.

Orientation with face bow and split cast technique –

Horizontal with tentative centric:-

Tracer attachment:-
Tracing and centric and eccentric records :-

Programming the articulator:-

Articulator settings

HORIZONTAL CG BENNET ANGLE FOR SOME ARTICULATOR

BENNET FISCHER
MOVEMENT ANGLE

Selection of teeth :

Anterior Based on:

Posterior Based on:

Characterisation : Based on:

Type of teeth:-

Arrangement of teeth :

Occlusal scheme :

LABORATORY PROCEDURES

Denture base material: Processing by:

Selective grinding:

Finishing protocol:
PATIENT INSTRUCTIONS AFTER DENTURE INSERTION :

PATIENT RECALL SCHEDULE:

Remark by the faculty Guided by :

Signature of faculty .