Department Of Prosthodontics and Maxillofacial Prosthetics

People’s Dental College and Hospital,

Nayabazar, Kathmandu

REMOVABLE PARTAL DENTURE CASE HISTORY

SHEET

PERSONAL INFORMATION:

Reg. No: 4808 Case No: 2

Patient’s Name: Dhawa Buti

Sex:/ Age:57/f

Address: RASHUWA Telephone:

Mobile No:9741025654

Email address:

History

I) Chief complaint: replacement of missing upper front teeth

II) History of present illness:

III) Evaluation of systemic status/ general health

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IV) Medical history:

V) Past dental history: Surgical Restorative/ Endodontic history

Periodontal history:

Prosthodontic history:

Orthodontic history:

Others:

VI) Denture historya. No. and types of previous denture:

i. Duration of wear:b. Previous denture experience:

i. Removable partial:

Maxillary: ……………………… Mandibular: …………………….

ii. Single Complete denture:

Maxillary: ……………………… Mandibular: …………………….

c. Reasons for requesting a new denture:

VII) Diet and personal history:a. Diet:b. Oral hygiene habits:c. Other habits:

VIII) Socio-psychological status:a. Marital status: b. Occupation: c. Family status:

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d. Education status:

Clinical examination:

Extra-oral Examination:1. Examination of face:

a) Form: Ovoid/ Tapering/ Square/……

b) Profile: Normognathic / Prognathic /Retrognathic

c) Symmetry: Symmetrical/ asymmetrical

d) Facial height: Decreased/Normal/Increased

e) Complexion:

I. Face: Dark/ Fair/ Medium

II. Eye: Black/Brown/Gray/Blue

III. Hair:

f) Lip:

I. Type: Thick/Average/Thin

II. Contour: Adequately supported/ Unsupported

III. Length: Short/ Average/ Long

IV. Mobility: Normal/ Reduced/Paralyzed/Hyperactive

1. Unilaterally/Bilaterally

2. Upper/Lower

g) Nasolabial fold:

h) Mentolabial sulcus:

2. Neuromuscular evaluation:a) Muscle of mastication/facial expression:b) Speech: Normal/Affected:

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c) Facial muscle tone:d) Co-ordination: Good/ Fair/ Poor

3. T.M.J. Examination: a) Normal:b) Pain:c) Clicking: d) Movement: Normal/Deviated/ Restricted

4. Lymph node examinationa) Areab) Palpable/ Nonpalpablec) Tender/ Nontenderd) Movable/Fixed

Intra Oral Examination:

A. Number & distribution:

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B. Evaluation of remaining teeth:

a. Caries status:

b. Existing restorations and its status:

c. Occlusal evaluation

d. Periodontal evaluation:i. Mobility ii. Bleeding on probing

iii. Furcationsiv. Oral hygiene

e. Oral hygiene status: C. Evaluation of the pulp:

D. Evaluation of sensitivity to percussion:

E. Occlusal analysis:Jaw relation:

Anterior posterior relation: R: Class I/ Class II/ Class III L: Class I/ Class II/ Class III

Vertical: Overjet: _____mm/ Overbite: _______mm

Transverse: Crossbite: in respect to: ________

Occlusal plane: Straight/ Curved/ Reversed

Type of occlusion:

Centric tooth contact:

Eccentric tooth contact:Latrotrusive Contacts:Protrusive Contacts:

F. Hard tissue evaluation:

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Torus palatinus

Torus mandibularis

Exostoses

Bony undercut

G. Others

The evaluation of the edentulous area/load bearing structures:

A. The form of the edentulous ridge:a. Mucosa:

I. Thickness: II. Resiliency:

B. Maxillary tuberosities:

C. Mylohyoid ridge:

D. Sivert’s classification:a. Class I: b. Class II: c. Class III:

E. Edentulous space evaluation :

b. Cervico –occlusal:c. Mesio- distal :

F. Tissue reaction to wearing a previous prosthesis: a. Palatal papillary hyperplasia: b. Epulis fissuratum: c. Denture stomatitis :

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Soft tissue evaluation:

A. Buccal mucosa:

B. Lip and cheek mucosa:

C. Floor of mouth:

D. Tongue:

E. Soft palate:

F. Frenal attachment: a. Maxillary: Normal/ Close to crest/ Broadb. Mandibular: Normal/ Close to crest/ Broad

Evaluation of the quantity & quality of saliva:

Quantity: Serous/ Mucous/ Mixed

Quality: Normal/ Scanty/ Abundant

Evaluation of existing denture:

Occlusion

Vertical dimention

Extention

Teeth

Denture base:

Major connector:

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Minor connector:

Rest seat:

Direct retainer:

Indirect retainer

Denture Hygiene

Evaluation of prospective abutment teeth:

Endodontic evaluation:

Restorative evaluation:

Periodontal evaluation:

Occlusal evaluation:

General radiographic evaluation (if appreciable):

Provisional diagnosis:

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Provisional treatment plan:

A. Surgical procedures:

B. Occlusal adjustment:

C. Periodontal therapy:

D. Restorative procedures:

E. Endodontic Therapy:

F. Cast crowns:

Radiographic evaluation of prospective abutment:

A. Abnormalities/PathologyB. Pulpal considerationsC. Root length, size & form:D. Crown/ root ratio:E. Tooth alignmentF. Root proximityG. Lamina dura:H. PDL space

Evaluation of study casts:

On the articulator

a. Inter ridge space: adequate/ inadequate

b. Occlusion plane retrievable? Yes/ Doubtful

c. Is there adequate interocclusal space for contempleted rest seats and rests

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where they will be needed??

On the surveyor

a. Most suitable abutment:

b. Tooth alteration is required:

c. Adequate retentive undercuts in a favourable location on abutment tooth:

d. present/ not present

Definite Diagnosis:

Treatment planning:

Preprosthetic:

Prosthetic:

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