The procedure for examining a patient and filling out a case history with orthopedic treatment
Complaints at the moment: violation of chewing, esthetics, tooth mobility, tooth sensitivity, pain in the TMJ, pain under the base of a removable denture, poor fixation, pain in the tooth under the crown, bleeding gums, halitosis, suppuration, swelling of soft tissues , taste disturbances, etc. Complaints about the parafunction of the masticatory muscles (is there a habit of biting your lips or clenching your teeth while watching a movie, reading books or work, is there a habit of gnashing your teeth, complaints from the masticatory muscles (pain, fatigue)).
Anamnesis of the disease: when one or another complaint appeared, what it relates to (caries, periodontitis, periodontal disease, trauma, surgery, etc.), was treatment or prosthetics performed before (how long?).
General condition: the presence or absence of bad habits (smoking, drinking alcohol), concomitant diseases (chronic diseases; hepatitis, tuberculosis, syphilis, HIV), allergic history, whether anesthesia was previously performed during treatment, tooth extraction, its effectiveness.
External examination: skin color, presence of defects, symmetry and type of face (conical, reverse conical, square, round), height of the lower third of the face, protrusion of the chin, nature of the closing of the lips, the severity of the nasolabial and chin folds.
TMJ studies: opening the mouth (intermittent, free, the nature of the movement of the lower jaw smooth or jerky, the displacement of the lower jaw to the side), the presence of crunching, clicking, noise in the TMJ with the movement of the lower jaw.
The state of tonus of the masticatory muscles and their tenderness on palpation, the state of the submandibular lymph nodes, their tenderness and size on palpation. Examination of the osteoarthritis: the color and moisture of the osteoarthritis, the color and shape of the gingival papillae.
Examination of teeth and dentition:
condition of intact teeth (size, anomalies of position, shape, color of hard tissues, mobility, exposure of necks or tooth abrasion (degree), sensitivity (appearance: hot, cold, sour, sweet, etc.), size of periodontal pockets);
the condition of teeth with defects in hard tissues (size and topography of the defect, condition of fillings is satisfactory or not, IROPS, mobility, exposure of necks or tooth abrasion (degree), sensitivity (percussion, probing, temperature reaction) size of periodontal pockets);
the condition of the tabs, veneers, pin designs (size, topography, condition, compliance with the bite, mobility of the abutment or prosthesis, exposure of the necks (degree), sensitivity), crowns, bridges (size, topography, condition, compliance with the bite, mobility of the supporting teeth, exposure of the necks of the supporting teeth, sensitivity, abrasion of the chewing or other surface of the prosthesis), the size of the periodontal pockets of the supporting teeth;
condition of removable dentures (type, integrity of the basis and systems of fixation of the prosthesis, life, fixation of the prosthesis in the oral cavity, balance, compliance with the boundaries).
Type of bite: fixed, not fixed; orthognathic, direct, bipognathic, prognathic, progenic, cross, deep, open.
Condition of dentition: shape, size and topography (classification) of defects, secondary deformations and movements of teeth.
The state of the edentulous jaws: classification of the upper jaw (Doinikov, Kurlyansky, Oksman, Schroeder), the lower jaw (Doinikov, Keller, Kurlyansky, Oksman); Supplement mucosa compliance; attachment of the frenum of the upper and lower lips, buccal-gingival cords.
Language: size (norm, microglossia, macroglossia), shape (round, oval, V-shaped), attachment of the frenum of the tongue.
Additional examination methods: a description of the X-ray examination (intraoral radiography, panoramic radiography, orthopantomography, targeted radiography of the teeth), a description of diagnostic models, a study of the loss of masticatory effectiveness according to I.M. Oxman
The diagnosis is a logical conclusion, a synthesis of the received subjective and objective research data. The diagnosis in orthopedic dentistry should reflect the size and topography of defects in the hard tissues of the teeth, dentition, the condition of the oral mucosa, as well as concomitant diseases of the dentition and complications.
a defect in the hard tissues of the tooth (which one is necessary?), carious, non-carious, or traumatic origin (non-carious diseases include enamel hypoplasia, wedge-shaped defects, fluorosis, acid necrosis and pathological abrasion; trauma – acute and chronic), the degree of destruction of the crown of the tooth must be indicated .
partial adentia (what jaw?) according to Kennedy: bilateral end (I class), unilateral end (P class), included in the region of the posterior teeth (W class)