Patient Assessment and TreatmentPlanningTreating the edentulous patient is both a complexand rewarding clinical challenge that demandsskill and knowledge.The homeostasis characterizing the healthymasticatory system depends on the dynamicrelationship between dental occlusion, masticatorymusculature, and the temporomandibular joints.In the edentulous patient, this balance can onlybe reestablished when the patient’s anatomy,muscular capabilities, esthetics, and expectationsare in harmony.As with any dental treatment, the medical/health history provides information vital toplanning appropriate treatment and completingsuccessful therapy. Knowledge of disease states,medication, and previous dental therapies willprovide insights indispensable for optimizingthe course and enhancing the likelihood forsuccessful treatment.By tailoring his/her interpersonal approachaccording to each patient’s characteristics, thesuccessful dentist can address each patient’sneeds appropriately. The focus of completedenture therapy may be more directed towardesthetic considerations for one patient and moreon function for another. Some patients arenot interested in knowing the exact techniquesto be used, while others want to follow everydetail of each procedure. The patient interviewis essential for identifying the expectations,misconceptions, personality traits, andsocioeconomic circumstances that will uniquelypredict each patient’s reaction to care.The phrase, “Never treat a stranger,” embodiesan important concept in dental treatment,particularly for complete denture prosthodontics.Comprehensive patient care for the completedenture patient includes an assessment of thepsychologic and physical conditions identifiedin the patient history as well as the oral andorofacial considerations on which the treatmentefforts will be focused. Testing for functionaldisturbances is necessary to identify thosepatients likely to experience special needs.The patient should be instructed to perform thefollowing movements:• Extend the tongue• Move the tongue from side to side whileextended• Lick the lips• Swallow• Open wide• Protrude the mandible• Move the mandible from side to side

Hesitation or incorrect action in following any ofthese directions can signal potential challengesin treatment and treatment outcomes. Often aninability to perform these normal oral functionsmay confirm a medical condition highlighted inthe medical/health history (e.g., stroke).

6. Examining the Old ProsthesesAn examination of the old prostheses, both in andout of the patient’s mouth, yields insights into apatient’s biting, chewing, and hygiene habits aswell as information necessary for identifying andincorporating improvements and changes into thenew dentures. Assessment of the following factorsis important for optimal treatment planning:• Age and condition of prosthesis• Denture position relative to facial landmarks• Extensions• Interocclusal distance• Occlusal relationships• Occlusal vertical dimension• Retention• Soft tissue support• Stability• Chewing stability• Esthetics• Evidence of self-adjustment• Hard and soft microbial deposits and stain• Phonation• Patterns of tooth wear

1. Adaptasi yang baik antara gigi tiruan dengan mukosa mulut. Ketepatan kontak antara basis gigi tiruan denganmukosa mulut, tergantung dari efektivitas gaya-gaya fisik dari adhesi dan kohesi, yang bersama-sama dikenalsebagai adhesi selektif. pd kasus saliva sdikitSelain adanya saliva, retensi dan stabilitas gigi tiruan juga dipengaruhi oleh kondisi anatomi landmark rongga mulut yang bersifat baik mendukung dan ada yang mempersulit. Pada gigi tiruan lengkap rahang bawah, batas posterior bagian sayap lingual dapat diperluas kea rah posteroinferior ke ruang retromylohyoid sehingga menghasilkan retensi dan stabilisasi gigi tiruan. Apabila kedalaman ruang ini lebih dari setengah kaca mulut nomer 3, menunujukkan bahwa daerah tersebut dalam dan dapat memberikan retensi yang efektif. Akan tetapi apabila daerah tersebut dangkal, akan mempersulit retensi yang efektif.Kondisi GTL yang longgar dapat dikarenakan oleh :1.      Adanya perubahan dimensi (thermal dan stress) gigi tiruan yang dipakai2.      Adanya factor intra oral, contoh resorbsi tulang alveolar3.      Adanya factor psikologis pasien, contoh usia pasien lanjut4.      Adanya factor patologis, contoh osteoporosis

7.Intraoral Exam - Examine one arch at a time – look, then write1. General tissue health- Attached mucosa / non attached- Colour- Character- Displaceability2. Specific Anatomical considerations- Examine systematically, e.g. posterior 1st quadrant to post. 2nd quadrant, then palate- Note the significance that a finding has to the therapy you are providing- Visual and tactile exam.MAXILLARYThe form of the maxillary arch affects retention – advise the patient if retention will becompromisedA. Posterior border of denture:1. Hamular notches - posterior denture border – palpate position, visuallydeceiving- Over extension - extreme pain- Under extension - non-retentive- Must be captured2. Vibrating line - identified when the patient says "ah"- At junction of the movable and non-movable portions of the soft palate- Don’t want denture on movable soft palate - it may be displaced- Fovea - rough guide to the position of the vibrating line- Throat form can affect breadth of vibrating line3. Pterygomandibular raphe- Behind hamular notches - significant rarely- Have patient open wide as possible- Can displace denture – requires relief in extreme casesB. Tuberosity- Displaceability- If undercut - use elastomeric impression material – palpate for undercutsC. Ridge form- Advise patient if poor, since it will affect retention and stabilityD. Labial/Buccal vestibule - 2-4 mm thick- Buccal vestibule - zygomatic process - can be prominent- When flat ridge - use care in accurately registering the vestibule to maximizeretentionE. Frena - check prominence:- Buccal frenum - usually broader- Thin labial frenumF. Bony areas, tori - mid palatal suture- Don’t want binding or fulcruming on the midline

- Fulcruming will cause discomfort, loss of retention & possible denture fractureMANDIBULARForm of the mandibular arch is even more critical than in the maxilla, since there is lesssurface area for retention, and the moveable structures of the tongue and floor of themouth can cause denture displacement if the denture is overextended- inform patients ofany potential retentive problems.A. Retromolar pad- Terminal border of the denture base- Compressible soft tissue – affects comfort and denture peripheral seal- Must be captured in impressionB. Buccal shelf- Check width - alginate will almost always overextend - painful- Custom tray, border molded - not felt extraorally- External oblique ridge sometimes prominent - do not cover - painfulC. Labial/Buccal vestibule- Easy to overextend- Check with minimal manipulation of lips- Masseter - affects distobuccal border- if more prominent - concave border of dentureD. Frena- Labial and buccal frena - narrow and wide respectively- Lingual frenum - must allow for movement - or displaces easilyE. Retromylohyoid fossa- Need to capture - especially when there is a severely resorbed ridge- Mylohyoid muscle - raises floor of mouth during activity – in some cases theremay be large differences between level at rest and level when active- Affects length of flange.- Mylohyoid ridge - palpate - if prominent, it will probably require reliefF. Tori- Rarely need surgery unless large- May require relief once dentures are delivered - advise patientG. Genial tubercles- Bony insertion for the genioglossus muscle- May be projecting above the residual ridge if there has been severe resorption

Limiting the amount of vasoconstrictor in a patientwho takes a nonselective beta blocker• Administering nitrous oxide/oxygen to an anxious

patient with poorly controlled hypertension