PRINCIPLES OF PATIENT EVALUATION AND TREATMENT PLANNING
Before any. surgical or prosthetic treatment, a thorough evaluation outlining the problems to be solved and a detailed treatment plan should be developed for each patient. It is imperative that no prepartory surgical’ procedure be undertaken without a clear understanding of the desired design of the final prosthesis. Preprosthetic surgical treatment must begin with a thorough history and physical examination of the patient. A thorough assessment of overall general health is especially important when considering more advanced preprosthetic surgical techniques, because many of the approaches described require general anesthesia, donor-site surgery to harvest autogenous graft material, and multiple surgical procedures. Specific attention should· also be given to possible systemic diseases that may be responsible for the severe degree of bone resorption.
Laboratory tests, such as serum levels of calcium, phosphate, parathyroid hormone, and alkaline phosphatase, may. be useful in pinpointing potential metabolic problems that may affect bone resorption.’ An extremely important aspect of the history is to obtain a clear idea of the patient’s chief complaint and expectations of surgical ana prosthetic treatment. Esthetic and functional goals of the patierit must be assessed carefully and a determination made of whether these expectations can be met. Psychologic’ factors and, the adaptability of patients areimportant
determinants of thir ability to function adequately with full or partial dentures. Information on success or failure with previous prosthetic appliances may belpful in determining the patient’s attitude toward and
adaptability to ‘prosthetic treatment. The history should
include important information such a~ the patient’s risk status for surgery, with particular emphasiv on systemic diseases that may affect bone or son tissue healing. An intraoral and extraoral examination of the patient
should’ include an assessment of the existing tooth relationships if any remain, the amount and contour of remaining bone. the quality of soft tissue overlying the primary denture-bearing area, the vestibular depth, the location of muscle attachments, the jaw relationships, and the presence of soft tissue or bony pathologic conditions.