I would need to know the amount of treatment the patient can afford.
Are implants within the patient’s budget?
Is patient happy with aesthetics of upper teeth as well?
What are the patient’s expectations? Is the patient only interested in an increase in function? If so, how much of an increase in function?
Are there any esthetic expectations? Will the patient accept fixed bridges or does he want individual functioning teeth?
Is the patient open to having dental implants?
Is the patient open to having a denture, if it is more securely retained with locator attachments?
Further information is needed about the patient’s involvement history in his dental care or about his current treatment goals.
Does the patient wish to go with a complete fixed option or with an implant-supported set-up?
From patient’s perspective, what was it about the lower denture that was unsatisfactory?
What is the patient’s INR?
How stable is the patient’s BP?
Is the patient a smoker?
Medically speaking, can the patient safely have dental implants placed?
What are the risks associated with discontinuing Coumadin prior to surgery, what is the current patient’s INR, and what is the potential of having the surgery without interrupting Coumadin treatment?
What is the periodontal and dental condition of the remaining mandibular and maxillary teeth?
How old is the upper crowns/bridge?
Does the patient come in for regular maintenance of his teeth/mouth?
Is the maxillary situation healthy and stable? Although photos appear to show that, it is hard to tell if there is burnout on Panorex or caries in the cervical areas.
Is occlusion stable?
Does the patient grind or have any para-functional habits?
What is the proper vertical dimension? Is the patient over-closed?
Could the patient tolerate an opened vertical dimension?
Is there cuspid-guided or group function? Has there been any loss of VDO? Are the current LPD teeth worn down at all from use over time which could decrease VDO. Is there a CR-CO discrepancy?
Are there any interferences or slides?
How old is the existing partial lower denture and whether it is loose?
Are the remaining teeth from 43 to 33 healthy and stable? Does the patient want to retain these?
What is the thickness of the alveolar ridge?
What is the quality of the alveolar ridge and its height?
Is this the first RPD worn by the patient; and if not, is this the first free-end RPD?
Has the patient tolerated the acrylic flanges to date; and if not, how are the flanges a concern?
Is there food entrapped under the RPD?
What was the patient’s chief complaint with the current partial denture?
Were there any restrictions as to what could or could not be eaten?
Are there any speech limitations?
Has the partial denture been relined?
What are the mobilities and periodontal probings around the key teeth i.e. 43/33?
How healthy is the tissue where the free end RPD has been resting?
Is there any rubbing or irritation to the gingiva/mucosa? What is the periodontal status of each tooth in the mouth?
I would like to see a cone beam CT scan, and study models mounted.
A sharper Panorex or a cone beam CT to evaluate the IDNC
CAT scan
Study models, diagnostic wax-up of teeth in the posterior mandible bilaterally to fabricate a radiographic stent, (doped with barium and). A CBCT scan of the mandible to assess bone volume, thickness and height posterior to the cuspids for possible implant-supported fixed bridges bilaterally.
Need a further radiographic investigation to assess the quality and quantity of bone in the edentulous areas.
I was unable to get a clear and prolonged view of radiographs. I would like a set of tomographs with a stent/marker in place bilaterally to explore 3-D bone views.