Condition of Natural Teeth
- Medical and Dental histories.
- Parameters of clinical diagnosis.
- Restorations and edentulous spaces.
The initial examination of a patient requires thorough history taking, both dental and medical. Any question pertaining to systemic health or medications that may interfere with the dental procedures, especially wound healing or the osseointegration process must be addressed with the patients physician.
Once the history is completed the next step is a complete oral examination. The examination begins with an extra-oral exam first. The temporo-mandidublar joints, should be carefully examined and demonstrate a full range of motion, limited to no joint sounds, no evidence of clicking or “popping” and no deviation upon opening. The next step in the examination involves the intra-oral soft tissues. The oral mucous should be intact without any evidence of pathology.
The age of the patient will be mirrored in the dentition (primary, mixed, early adult, adult, aging adult). Understanding the normal characteristics of each is essential in developing a potential treatment plan.
The periodontium is examined next to determine if any evidence or disease is present and to also determine if the patient is performing appropriate oral hygiene. Mobility patterns of the teeth are recorded. The bio type of the periodontium (the phenotypic expression of the genotype) is a critical assessment especially in the anterior zone as it will many times dictate the choice of the restorative material required to achieve maximum esthetics.
The dentition is then evaluated. The occlusal surfaces of the teeth are evaluated to proper contact, and all the excursive movements are evaluated to assure that mutually protected occlusion is present. The occlusal plane is examined for a cant, or the present of supererrupted teeth especially if there are edentulous spaces. There should be careful attention to any areas of severe wear that may be an indication of bruxing or habits that may affect the longevity of the dentition. Evidence of cervical abfraction lesions are noted as these also may indicate changes in the occlusion that may be indications of pathology in the system. There is a complete examination for any form or occlusal disharmony that may contribute to craniomandibular instability that may contributed to TMD.
The existing restorations (if there are any present) are carefully examined for marginal integrity. This is done both visually and radiographically. The teeth are examined for caries and periodontal status. (If any implant procedure is being contemplated a CBCT scan is recommended.)
If the potential site for an implant is to be evaluated one must verify that sufficient room relative to adjacent structures (teeth or implants) is adequate, the condition of the edentulous ridge is suitable its adequate height and width. For a missing single tooth a key element is the status of the two neighbouring teeth. If grossly affected by caries and/or fillings but keeping a good periodontal and endodontic prognosis it may shift the treatment choice to a fixed partial denture.”