The Treatment Sequence|
The sequence of bidding Goodbye to Dentures...
1. Clinical Examination
thorough clinical examination is essential to analyze the oral health
status of the patient. It is important to evaluate the health status of
the teeth present in the mouth as well as the supporting gingiva, the
tongue as well as palate. Assessment of mouth opening as well as that of
the jaw joint movements are essential prior to treatment planning. Assessment of occlusion (bite) and the chewing patterns are essential. Restriction in mouth opening, clicking jaw joints, existence of conditions such as neuropathies, bruxism etc. will alter the course
of treatment in a major way.
2. Medical assessment
thorough medical history is made and basic relevant investigations are
carried out. A physician's assessment may be needed in case of patients
with preexisting health conditions such as diabetes, cardiac disease
etc. If patients are already under medications, the drug regimen may
have to be modified prior to initiation of the treatment procedures.
of the jaws to assess condition of the jaw bones and status of existing
teeth, if any, in addition to assessing the position of the vital
structures such as sinuses and nerves. The imaging techniques employed
are usually one or more of the following: OPG Xray, CT Scan, CBCT, Intra
oral peri apical xray, Lateral Cephalogram etc.
4. Diagnostic Casts
of the upper and lower jaw are made to help make plaster moulds (called
diagnostic casts) which will serve as study models during the course of
- procedure photographs are made which will provide guidelines during
the course of treatment. Old photographs of the patient are also studied
in detail to assess the changes in the smile and the facial shape and
contours over years.
6. Treatment planning
of the plan is to ensure that the patient gets a good set of upper and
lower teeth which will help him both functionally as well as
cosmetically for several years to come. The plan is discussed with the
patient in detail.
7. Preparative Treatment
procedures are entirely different for patients who are completely
edentulous (without any teeth in the mouth) and partially edentulous
(who have a few teeth retained). In the case of the former, the teeth
which are to be extracted, based on the treatment plan, are extracted.
Those teeth which are retained are evaluated properly and treated as
needed with procedures such as scaling, fillings, root canals and
8. Replacement of missing teeth: This is accomplished adopting one of the following methods:
a) Crown & Bridge work
- This can be done only when patient has healthy teeth situated at a
reasonable distance from each other, with the missing teeth in between.
The crowns of the existing teeth are reduced in size to attain a certain
form... impressions are made and the casts are sent to the laboratory
for fabrication of the bridgework. The bridgework is cemented with a
particular type of cement.
b) Dental Implants
conventional dental implant is an artificial tooth root that is placed
into your jaw to hold a replacement tooth or bridge. Implants are placed
following certain surgical techniques using special equipments and
instruments. Bone buildup (augmentation) etc. and related procedures
such as guided tissue regeneration, laser bio-stimulation etc. are
carried out as required in addition to the implantation procedures.
c) Combinations of Dental Implant supported as well as teeth supported fixed bridgework
9. Final prosthesis delivery
complex treatment situations such as is the case of full mouth
rehabilitation etc., very often an interim fixed bridge work is
delivered in the first phase which is repeatedly modified over a few
weeks to ensure good fit and function. This bridgework will give the
clinician an idea of how the final bridgework should be designed. The
interim bridgework is often made of vitallium. The final bridgework can
be made as PFM / Zirconia / Noble metal ... which are the most practical
and best options available today. The final bridgework is generally
cemented after a period of 3 - 6 months after the placement of the
implants, after the gum and the bone contours have settled down after
the implant surgery.
10. Followup and regular maintenance visits once in 6 months
This is essential to ensure that there are no untoward developments with respect to the implants and prostheses. Regular visits will help the doctor to assess the oral hygiene measures being adopted by the patient. Corrective measures / modifications in the oral hygiene practices may be undertaken to ensure that the implants and the prostheses perform well over a long term period.
The maintenance instructions given will vary from patient to patient, based on the nature of the implants and prostheses provided to each patient.
The golden rules are:
- Prevention is better than cure… -
- Fire-fighting is better than fire prevention… -