2. Diagnosis and Treatment Planning

Question 1

Indications for PRDP
 Length of ____ contradicts use of FDP
 No abutment tooth ____ to edentulous space
(Kennedy Class I and II)
 Reduced ____ support of remaining teeth
 Need for ____-PRDP may act as a periodontal splint
 Excessive ____ loss of residual ridge
 Patient desire
 ____ considerations
 After recent extractions-interim until site heals
 Esthetics in ____ region

Answer 1

edentulous span
posterior
periodontal
cross-arch stabilization
bone
economic
anterior

Question 2

Advantages of PRDP
 Not \_\_\_\_
 \_\_\_\_ tooth structure removed 
 No \_\_\_\_
 Can always go to fixed

Answer 2

irreversible
limited
pulpal necrosis

Question 3

The first appointment is the standard appointment where you gather the ____ (radiographs, photographs….and reads rest of list).

You can hand articulate or you can articulate the case definitively, then you can get the study cast articulated.

Then you can get a plan and then you can go to the ____ appointment, assuming all the ____ treatment has been done, and begin getting ready to prepare the teeth.

In the second appointment, you are gonna do mouth ____ and obtain ____ (again, this is assuming all Phase 1 treatment and all period has been done).
The ideal case is someone successfully wearing a removable partial and nothing has changed, they just need a new set and you can more easily move into the second appointment.

If patient is missing enough teeth then you need rims. If you need rims to mount the case, even diagnostically, you need rims made from the ____ cast, bring them back and get the record, and then you can mount the case. So this delayed moving into the second appointment.

Answer 3

information
second
Phase I
preparation
impressions
diagnostic

Question 4

In the second appointment you prepare the ____, you obtain the ____, write a ____ to have a framework made up, and then you go onto appointment 3.

Answer 4

mouth
impression
laboratory authorization

Question 5

Diagnostic casts

 During the treatment-planning, diagnostic casts are ____
 Proposed designs are drawn directly on the ____ cast.
 Individual casts then serve as blueprints for the placement of restorations, the recontouring of teeth, and the preparation of rest seats
 These casts also may be helpful during treatment-planning presentations
 Patients are more likely to approve a treatment plan if they can visualize existing problems than they are if they must rely upon a verbal description

Answer 5

surveyed

diagnostic

Question 6

On the third appointment you are gonna get the framework back from the lab and you are gonna ____ the framework in their mouth to make sure it sits or it doesn’t affect the occlusion. And then you are going to use that to get the record. Remember the framework was made on a ____ cast, which you have not mounted yet. So you are gonna either use the framework by using registration material or adding wax. You are gonna do a ____ and you are also gonna pick the teeth.

If you are gonna do there alternative impression, the altered cast impression, then you are gonna take the impression with the ____. Then this gets sent to the lab for a ____ pour. Now you have a master cast that is cut-out and the edentulous area is the new impression. It is very accurate but not always necessary. This alternative impression gives you a good impression of the ____ areas.

Then you are gonna mount teeth on these frameworks.

Answer 6

fit
master
facebow

framework
second
edentulous

Question 7

Either you do it or the lab but teeth are set in wax and you are gonna bring that back to the patient and do a try in.

This is a difference between a complete denture where you are going from the record base to the trial denture, we have that ____ step where we are getting the framework back, fitting the framework, and then having the teeth put on the framework. So that is this visit, which is similar to the denture try-in visit, so we are looking at how the teeth are placed, aesthetics, and occlusion.

You can make changes chairside, and if things are really off then you are gonna send it back to the lab.

Answer 7

intermediate

Question 8

And then we ____ them, so there is a whole process for inserting them. Each time you are giving some patient education, kinda gearing them up to the concept of what they are gonna be getting. Then you are gonna have them bring them back in ____ hours and if you see sore spots then you adjust it.

Answer 8

insert

24

Question 9

Tell them to leave them out at night if they haven’t worn them before. So take out the prosthesis at night and let the tissues rest and then you are looking for additional adjustments appointments to get them comfortable: adjusting ____, checking for sore spots, checking____

Answer 9

occlusion

sore spots

Question 10

If you see ____ spots then bring bring them back again but if things are going well and they are having any problems tell them to call.

Answer 10

sore

Question 11

First appointment
 Give health \_\_\_\_
 \_\_\_\_ patient
 Establish \_\_\_\_ with patient
 Dr Boucher said :“The first five minutes spent with a patient represent the most important period of dentist- patient interaction. Patients should feel that the dentist is genuinely interested in them and in helping to solve their dental problems.”

Answer 11

questionnaire
interview
rapport

Question 12

First appointment
 Gain insight into a patient's psychological makeup
 House classification 
 \_\_\_\_
 \_\_\_\_
 \_\_\_\_ 
 \_\_\_\_
 Evaluate the effects of patient’s \_\_\_\_ problems on dental treatment (diabetes, arthritis, etc)

Answer 12

philosophical
exacting
hysterical
indifferent

Question 13

Patient treatment (or Management) includes four processes
 Ascertaining a patients dental ____
 Relating the patient’s ____ or wants to needs
 ____ a treatment plan to address the needs
 ____ the treatment plan

Answer 13

needs
desires
developing
executing

Question 14

Importance of the Diagnostic Phase of Treatment

 The formulation of an appropriate treatment plan requires careful evaluation of all pertinent ____
 Information must be obtained from patient ____, radiographic evaluation, oral examination, diagnostic mounting of casts, preliminary survey and design procedures, and appropriate consultations with medical and dental specialists

Answer 14

diagnostic data

interviews

Question 15

Examination of the Partially Dentate Patient
Previous Denture Experience

Question the patient about experience with past removable partial dentures. Has there been an inability to adjust to ____ an PRDP? Why?

Have previous PRDP ____ due to caries or periodontal disease?

What ____ of PRDP has the patient worn in the past?

Speech problems?

Answer 15

wearing
failed
kind

Question 16

Examination of the Partially Dentate Patient

Evaluation of Current Prostheses

Determine if patient report problems with existing PRDP and/or criticisms of present PRDP are justified. This judgment may help you decide if you can help the patient.

Pay special attention to:

1. Complaints concerning ____
2. Complaints concerning specific ____ aspects such as the type of major connector
3. Any evidence of ____ such as excessively worn natural or prosthetic teeth

Answer 16

esthetics
design
parafunction

Question 17

Examination of the Partially Dentate Patient
Radiographic Examination
1. \_\_\_\_ Ratio 
2. \_\_\_\_ Teeth
3. Remaining \_\_\_\_ 
4. \_\_\_\_ Teeth
5. Teeth with prior \_\_\_\_ treatment 
6. \_\_\_\_

Answer 17

crown/root
impacted
bone
extruded
endodontic
caries

Question 18

Examination of the Partially Dentate Patient
Diagnostic casts
1. Diagnostic casts
a. Permit analysis of ____ tissues
b. Permit analysis of tooth ____
c. Permit analysis of ____ space
d. Permit analysis of the ____ (tooth contacts)
e. Valuable aids in patient ____ and presentation of ____ to the patient.

Answer 18

hard & soft
contours
inter-arch
occlusion
education
treatment options

Question 19

Occluded Diagnostic Casts
Adequate \_\_\_\_ space?
Evaluate \_\_\_\_
Adequate inter-occlusal space for \_\_\_\_?
Check for things you did not note when performing \_\_\_\_ examination

Answer 19

inter-ridge
occlusal plane
rest seats
intra-oral

Question 20

Examination of the Partially Dentate Patient

Intra-oral Examination

1. Arch size - If maxillary and mandibular arches differ significantly in size problems may occur with:
   a. ____
   b. Arrangement of ____ Teeth
   c. Alveolar atrophy due to:
2. ) Excessive force delivered to small ____ by prosthesis supported by a large ridge
3. ) Excessive force delivered by teeth in the ____.

Answer 20

esthetics
posterior
edentulous ridge
opposing ridge

Question 21

Examination of the Partially Dentate Patient

Intra-oral Examination

2. Cross Sectional Contour of Ridge
   a. Bulbous Ridge or Any Ridge with Large Undercuts
   1.) Problem with placement and removal of PRDP due to precise path of ____ or
   removal.
   2.) Excessive relief can cause an unaesthetic ____ and problems with food collection.
   3). ____ correction may be advisable.

Answer 21

placement
lip contour
surgical

Question 22

Examination of the Partially Dentate Patient

Intra-oral Examination

3. Torus Palatinus
   a. May create problems with placement of the ____ connector
4. ) Surgical removal is sometimes done.
5. ) Often an ____ major connector may be used

Answer 22

maxillary major

anterior-posterior palatal

Question 23

Examination of the Partially Dentate Patient
Intra-oral Examination

3. Torus Palatinus
   3). A torus palatinus which extends to the ____ can cause special problems.
   4.) Incorporating a ____ major connector in a maxillary distal extension PRDP is a poor choice due to lack of ____ stabilization of
   the distal extension segment.

Answer 23

vibrating line
U shaped
cross arch

Question 24

U Shaped Major Connector

Not a good choice unless the major connector is ____

Answer 24

broad

Question 25

Examination of the Partially Dentate Patient ``` Intra-oral Examination 4. Torus Mandibularis a. Creates ____. b. Covered by ____ tissue 1.) Often results in ____ a.) impingement of major connector b.) impingement of denture base 2.) ____ removal is preferred 3.) ____ is to modify ____ a.) Keep inferior border above torus b.) Place extra relief under connector to allow for settling ```

Answer 25

``` undercut thin soreness surgical option major connector ```

Question 26

Examination of the Partially Dentate Patient Intra-oral Examination 5. Appearance of mucosa a. Dentate areas 1.) Appearance may indicate level of ____ and periodontal health status 2.) ____ of gingiva could affect clasp design and placement

Answer 26

periodontal health status | recession

Question 27

``` Examination of the Partially Dentate Patient Intra-oral Examination 5. Appearance of mucosa b. Inflamed edentulous areas 1.) Indication of ____ of mucosa to previous PRDP 2.) Can also indicate ____ hour wearing of the PRDP ```

Answer 27

reaction | 24

Question 28

Examination of the Partially Dentate Patient Intra-oral Examination 6. Depth of vestibule a. Mandibular anterior lingual area 1.) Space available determines choice of ____ design - lingual plate or lingual bar 2.) Choice is critical because adjustment of major connector is ____ due to material (metal) and limited dimensions a.) ____ of PRDP may be affected adversely by adjustment of major connector

Answer 28

major connector difficult strength and rigidity

Question 29

Examination of the Partially Dentate Patient Intra-oral Examination 6. Depth of vestibule a. Mandibular anterior lingual area 3.) Evaluation procedure a.) Position mouth mirror between tongue and vestibular region b.) Ask patient to elevate ____ to determine functional level of vestibule and lingual frenum c.) Periodontal probe may be used to measure distance from gingival margin to depth of vestibule to transfer to diagnostic cast Also instruct patient to rest tip of tongue on ____ during mandibular diagnostic impression

Answer 29

tongue | lower lip

Question 30

Examination of the Partially Dentate Patient Intra-oral Examination 6. Depth of vestibule b. Mandibular anterior labial area 1.) In situations with advanced alveolar atrophy ____ vestibule may be ____ enough to contraindicate bar clasp designs.

Answer 30

labial | shallow

Question 31

Examination of the Partially Dentate Patient Intra-oral Examination 6. Depth of vestibule 2. ) Shallow vestibule depth in the area may limit ____ of the labial bar of a ____ type of PRDP

Answer 31

placement | swing-lock

Question 32

Examination of the Partially Dentate Patient Intra-oral Examination 6. Depth of vestibule c. Maxillary and mandibular posterior areas 1.) Limited depth may limit clasp design a.) contraindicate ____

Answer 32

bar clasps

Question 33

Examination of the Partially Dentate Patient Intra-oral Examination 7. Inter-arch space - factors to evaluate a. Low tuberosity 1.) Methods to evaluate space in tuberosity area a.) Remove dentures, stand at arms length and ____ the cheeks b.) Have patient allow mandible assume a ____ position, gently separate the lips and observe space in tuberosity region c.) Observe that present PRDP is ____ extended in the posterior region d.) Mounted ____ casts

Answer 33

retract rest under diagnostic

Question 34

Examination of the Partially Dentate Patient Intra-oral Examination 2.) Correction of low tuberosity a.) Usually corrected ____ b.) Evaluate radiographs for position of the ____ c.) Soft tissue enlargement easy to correct by removing a ____. d.) Bony enlargement harder to ____ and slower healing.

Answer 34

surgically sinus wedge remove

Question 35

Examination of the Partially Dentate Patient Intra-oral Examination 7. Inter-arch space - factors to evaluate b. Extruded teeth 1.) ____ 2.) ____ and/or restore a.) May require ____

Answer 35

extract recontour endodontics

Question 36

Examination of the Partially Dentate Patient Intra-oral Examination 7. Inter-arch space - factors to evaluate c. Overclosure 1.) May occur due to lack of a ____ 2.) Evaluate ____ with facial measurements and speech to evaluate rest space and closest speaking space.

Answer 36

vertical stop | OVD

Question 37

Examination of the Partially Dentate Patient Intra-oral Examination 7. Inter-arch space - factors to evaluate Deep ____ Overlap Patients that have a deep vertical overlap are difficult because we don't have a lot of ____.

Answer 37

vertical | room

Question 38

Examination of the Partially Dentate Patient 8. Maxillo-mandibular Relation - antero-posterior relation of the mandible to the maxillae in centric relation. a. Retrognathic 1.) Occlusal balance difficult to achieve due to a deep anterior ____ overlap a.) Need anterior-posterior ____ curve (curve of Spee) to achieve protrusive balance 2.) Patient may function ____ to centric relation or in an area between centric relation and an anterior position

Answer 38

vertical compensating anterior

Question 39

Maxillomandibular Relationships Prognathic Retrognathic In the rethrognathic cases, we have a large amount of ____. In the prognathic cases, the arches tend to be ____ in the maxillary.

Answer 39

overjet | narrow

Question 40

Examination of the Partially Dentate Patient Intra-oral Examination 8. Maxillo-mandibular Relation - ____ relation of the mandible to the maxillae in centric relation. b. Prognathic 1.) Usually results in ____ 2.) Stability of PRDP/ may be poor if maxillary anterior teeth are positioned ____ of the ridge.

Answer 40

antero-posterior posterior crossbite forward

Question 41

Examination of the Partially Dentate Patient 8. Maxillo-mandibular Relation - antero-posterior relation of the mandible to the maxillae in centric relation. c. Normal 1. ) Patient will usually function at or near ____

Answer 41

centric relation

Question 42

``` Tongue Position  Wright • Class I – ____ (favorable) • Class II - ____ (less favorable) • Class III - ____ (unfavorable) ```

Answer 42

neutral slightly retruded fully retruded

Question 43

Examination of the Partially Dentate Patient Intra-oral Examination 10. Evaluation of abutment teeth a. Routine examination of the teeth including caries status, ____, condition of existing restorations, periodontal condition, wear and presence and severity of abfraction lesions is performed. It is usually contraindicated to clasp a tooth with more than a ____+ mobility

Answer 43

tooth mobility | 1

Question 44

Examination of the Partially Dentate Patient Intra-oral Examination 10. Evaluation of abutment teeth b. Evaluation of abutment teeth from radiographs 1. ) ____ ratio 2. ) Root ____ 3. ) ____ 4. ) Existing ____

Answer 44

crown-root root mobility restorations

Question 45

Examination of the Partially Dentate Patient Intra-oral Examination 11. Relation of teeth to desirable occlusal plane a. ____ b. ____

Answer 45

lateral | antero-posterior

Question 46

Getting the centric relation and centric occlusion depends on the case. If it is dentate enough you can just ____ the case. It depends on how many teeth are missing and the occlusion relationships.

Answer 46

hand articulate

Question 47

Examination of the Partially Dentate Patient Intra-oral Examination 13. Contraindications to an PRDP If these teeth are ____ involved, the teeth are extracted and heal and then you make the denture. But maybe they have a couple of teeth that are still ok, maybe they still some canines that don't have bone loss, maybe they just need periodontal treatment but you can work with the teeth, so don't drill(?) the teeth until you have seen all possibilities.

Answer 47

periodontal

Question 48

Examination of the Partially Dentate Patient 14. Instructions to patient So you can try these resources with your patient. The ADA has a Healthy Mouth section with reading materials and good information. They now have videos too. Tells a story about a patient not going to him with bad dentures and he re-did the dentures for the person. Make sure you tell patients that dentures are not gonna ____ their teeth, because their teeth are ____. So they are replacing no teeth. The point is that the patient was misinformed.

Answer 48

replace | gone

Question 49

Examination of the Partially Dentate Patient Intra-oral Examination 15. Prognosis a. Realistic prognosis must be determined and presented to the patient. b. Some factors in prognosis 1.) Past dental ____ 2.) Patient ____ 3.) Oral ____ c. Prognosis must be discussed with patient ____ to beginning treatment.

Answer 49

history expectations hygiene