CLINICAL EXAMINATION AND TREATMENT PLAN FOR JOINT PROSTHESIS
1) INTRODUCTION:
The clinical examination in joint prosthesis, including the anamnesis, must be conducted in a complete, meticulous and methodical manner where each is a case. At the end of the first contact the patient must be convinced that the practitioner will do the maximum for his patient so he will be psychologically ready to undergo a complete examination during the following sessions. Thus the indication of a joint or fixed prosthesis can be posed. Whatever the cause of the patient’s visit, the clinical examination should in no case be limited to a restricted territory incriminated by the patient but rather to the entire stomatognathic apparatus.
2) CLINICAL EXAMINATION OF THE PATIENT
21) anamnesis:
- patient’s first and last name
- age (civil and apparent)
- address
- occupation
- Purpose of the consultation: to let the patient speak and listen carefully
When, why and how
- Personality: intellectual, cooperative, demanding
- question about the patient’s general condition
- question about the causes of tooth loss: is it an accident, functional imbalance?
22) clinical examination:
221) oral exo examination:
2211) inspection:
- physical appearance of the patient (idea about the state of health)
- speech: possible swallowing disorder
- mouth opening examination
-amplitude
– DETOUR
- facial examination:
- morphological type: face and profile
- musculature
- facial symmetry/asymmetry
- appearance of the integuments
2212) palpation:
- examination of the temporomandibular joints
- joint noises (cracking, popping, crepitating)
- joint jerks
- pain when opening mouth
- DETOUR
- mouth opening amplitude
- examination of the muscles: labial, jugal, etc.
222) intraoral examination:
2221) inspection:
22211) general appearance of the oral condition
- existence or not of pathological process
- degree of oral hygiene (cavities, tartar)
- lingual volume
- appearance of the gums
- presence or absence of caries
- existence or not of prosthetic restorations
- intrinsic value of residual teeth:
-pulped or on
-presence of caries, dysplasia, abrasions, fillings and prosthetic elements
-volumes and shapes of teeth
-misaligned teeth
– presence of diastemas
- general appearance of the dental arches on the occlusal plane
- occlusion conditions
- importance and topographical situation of edentation
the condition of the supporting tissues:
- Marginal gingiva.
- Papillary areas.
- Attached gingiva: periodontium thin and scalloped, or flat and thick.
- Absence or presence of inflammation.
- Bone morphology (fenestration).
the condition of the teeth:
- Shape and integrity of the arches.
- Intra-arcade and inter-arcade harmony.
- Plaque.
- Tooth shape: square, oval, triangular.
- Pathology of dental organs, caries, dysplasia, etc.
- Facets of wear, cracks.
- Restorations.
2222) palpation:
- Digital palpation or palpation using instruments reveals:
-a- at the periodontal level:
- Sulcular depth.
- Possible anomalies: bleeding, pockets, furcations.
- Dental mobility.
- Morphological relationships: bones-roots.
- Iatrogenic restorations.
-b- at the teeth level:
- Cavities, fractures, cracks, worn veneers, defective restorations, sensitivities.
- Intra and inter arch anomalies.
- The ANGLE class.
- Intermaxillary and intercuspation relationships.
23) additional examinations
231) X-ray examination: panoramic, retro-alveolar images to highlight
- Pulp volume
- Degree of alveolysis
- Root anatomy
- Root length
- ATM appearance
232) examination of plaster study models: This examination allows us to study the occlusion ratios in static and dynamic states
- By direct vision on plaster model
- Models mounted on semi-adaptable articulator
3) THERAPEUTIC DECISIONS AND TREATMENT PLAN:
Depending on the data collected during the clinical examination, 03 therapeutic possibilities are possible
- joint prosthesis
- removable prosthesis
- mixed prosthesis
31) joint or fixed prosthesis : it depends on
- determining the number of supporting teeth according to their location on the arch (Roy’s theory), their intrinsic and extrinsic value, occlusion conditions, muscle power
- anchoring on pulped or pulpless teeth
- determination of the type of anchors according to:
-the coronal-radicular state of the tooth
– the retention required to keep the bridge in place
-aesthetic requirements.
- Determination of the type of bridge location elements based on the edentulous area or crest shape, aesthetics.
32) treatment plan:
321) pre-prosthetic treatment : the older the edentulism, the more a pre-prosthetic treatment is indicated and will consequently be multidisciplinary.
Please note:
- Periodontal therapy: scaling, curettage, surgery, grafts, temporary retention of mobile teeth, etc.
- Surgical therapy: extractions, ridge regularization, etc.
- Operative dentistry: endodontics, apical resection
- Conservative dentistry: cavity fillings
- Prosthetic therapy: provisional, transitional, balancing prosthesis
Occlusal (regularization of the occlusal plane, removal of disruptive prosthetic elements, selective grinding
- Medical therapy if the patient has a general illness
- Orthodontic therapy: repositioning of teeth that have undergone pathological migration, functional rehabilitation
322) prosthetic treatment :
This involves implementing the classic protocol chosen and adapted to the case considered, namely:
- Preliminary impression otherwise study models kept as archive
- Decortication of teeth used as anchorage
- Work footprint
- Temporary prosthesis
- Permanent prosthesis
4) CONCLUSION:
Joint prosthesis treatment is not a standard, one-size-fits-all therapy, but rather a thoughtful act resulting from a careful clinical examination followed by a treatment plan specific to each clinical situation.
Deep cavities may require root canal treatment.
Interdental brushes effectively clean between teeth.
Misaligned teeth can cause chewing problems.
Untreated dental infections can spread to other parts of the body.
Whitening trays are used for gradual results.
Cracked teeth can be repaired with composite resins.
Proper hydration helps maintain a healthy mouth.