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COMPLETE DENTURE HISTORY TAKING & EXAMINATION

Patient Data
Name: _______________________________________ Case No: ____________
Age: ________ Sex: __________ Race: __________________ Occupation: _______________________
Address: _____________________________________________ Contact No: ___________________
Cosmetic index: 1 - High cosmetic index/ 2- Mid cosmetic index/ 3- Low Cosmetic index ____________________
Personality: Philosophical/ Exacting /Hysterical/ Indifferent _________________________________________

Medical History
General health:
______________________________________________________________________________________
______________________________________________________________________________________
Pathology: ____________________________________________________________________________
Diet habits: Veg / Non-Veg Diet intake: Carbohydrates: Cereals, Potatoes, Sugar; Proteins: Meat, Egg, Fish,
Pulses; Fats: Oil, Butter; Minerals & Vitamins: Vegetables, Fruits, Milk & Curds _____________________________

Quality & Quantity of diet: Satisfactory/ Unsatisfactory: ___________________________________________


Reason for deficient diet: Taste/ Custom / Economic/ Ignorance/ Unable to chew ________________________
Any Habits: Pan / Tobacco chewing / Smoking / Alcoholic / Bruxism / Other: _____________________________

Dental History
Chief complaint:
_________________________________________________________________________________
Extraction history: Reason (Periodontal / Caries / Other) Year
Maxillary anterior __________________________________________ _____________

Maxillary left posterior __________________________________________ _____________

Maxillary right posterior __________________________________________ _____________

Mandibular anterior __________________________________________ _____________

Mandibular left posterior __________________________________________ _____________

Mandibular right posterior __________________________________________ _____________

What is your problem and why do you seek treatment? Lost all teeth and need dentures / Old dentures are
unsatisfactory or ill-fitting / Old dentures are Worn out / broken / lost ______________________________________

Age of present denture: _______________________


Duration of edentulism: Max: ________ Man: _________
Number and type of previous dentures:
Removable partial denture: Maxillary: ___________________ Mandibular: _____________________
Complete denture: Maxillary: ___________________ Mandibular: _____________________
Earlier denture experience: (Good / Poor) ____________________________________________________
COMPLETE DENTURE HISTORY TAKING & EXAMINATION

Patient evaluation of dentures (subjective):


Comfort: Good / Fair / Poor Chewing efficiency: Good / Fair / Poor Esthetics: Good / Fair / Poor
Articulation: Good / Fair / Poor Soreness: Good / Fair / Poor Food trapping: Good /Fair/ Poor
Dentures worn at night: Y / N
Problem with current dentures: __________________________________________________________________
Expectations: Mastication / Speech / Appearance / Comfort / Professional ______________________________
Understands limitations: __________________________________________________________________
Pre-extraction records: Casts / Measurements / Photographs / Old Dentures ____________________________

Clinical examination
A] EXTRAORAL EXAMINATION
1. Facial form:
Front: Square/ Tapering/ Square-tapering/ Ovoid
Profile: Class 1 – Normal / Class 2 – Retrognathic / Class 3 – Prognathic
Height: Normal / Decreased / Increased
2. Muscle tone: Class 1 – Normal/ Class 2 – Slightly impaired/ Class 3 – Greatly impaired
3. Muscle development: Class 1 – Heavy / Class 2 – Medium / Class 3 – Light
4. Complexion: Skin color: _______ Skin texture: ________ Eye color: ________ Hair color: __________
5. Appearance of Cheeks: Full / Hollow
6. Appearance of Skin: Firm / Loose
7. Lip: Thin / Full / Tense / Active ___________________________________________________________
Vermillion border: Max: _______________________ Man: ____________________________
Lip contour: Adequately supported / unsupported Max:_______________ Man: _______________
Mobility: Class 1 – normal/ Class 2 – reduced mobility/ Class 3 – paralysis __________________________
Length: Long/ normal or medium/ short (ave. Males 22m, Females 20mm) __________________________
8. TMJ: Comfort: _________Crepitus: ___________Clicking: _____________ Smoothness: _____________
Locking: ___________ Deviation: ____________ Protrusive: _____________ Lateral: ______________
9. Neuromuscular evaluation:
10. Coordination: Class 1 – Excellent/ Class 2 – Fair/ Class 3 – Poor
11. Speech: Normal / Affected ___________________________________________________________

B] INTRAORAL EXAMINATION:
1. Arch size: (Class 1 – Large/ Class 2 - Medium/ Class 3 – Small) Max: ___________ Man: _____________
2. Arch form: (Class 1 – Square / Class 2 – Tapering / Class 3 – Ovoid) Max: ___________Man: ____________
3. Ridge form:
Max: Class 1 – Square to gently rounded/ Class 2 - Tapering or “V” shaped/ Class 3 – Flat
Man: Class 1 – medium to tall Inverted “Ü” shaped/ Class 2 - short inverted “U” shaped/ Class 3 – unfavourable :
inverted “W” (or) short inverted “V” (or) tall thin inverted “V”
COMPLETE DENTURE HISTORY TAKING & EXAMINATION

4. Residual alveolar ridge Height:


Maxillary: Anterior: Excessive / Deficient / Normal Posterior left: Excessive / Deficient / Normal
Posterior right: Excessive / Deficient / Normal
Mandibular: Anterior: Excessive / Deficient / Normal Posterior left: Excessive / Deficient / Normal
Posterior right: Excessive / Deficient / Normal
5. Residual alveolar ridge Width:
Maxillary: Anterior: Excessive / Deficient / Normal Posterior left: Excessive / Deficient / Normal
Posterior right: Excessive / Deficient / Normal
Mandibular: Anterior: Excessive / Deficient / Normal Posterior left: Excessive / Deficient / Normal
Posterior right: Excessive / Deficient / Normal
6. Severe undercuts: _________________________________________________________________
7. Sharp bony projections: ___________________________________________________________
8. Hypermobile tissue: _____________________________________________________________
9. Tori: (Class 1 – minimal or absent/ Class 2 – moderate/ Class 3 – Large) Max: _________ Man: __________
10. Genial tubercles: Not seen / Prominent
11. Retained Root piece: ___________________________________
12. Interach space: Class 1 – Ideal / Class 2 – Excessive/ Class 3 – Insufficient

13. Ridge parallelism: Class 1 – both ridges parallel to occlusal plane / Class 2 – Mandibular ridge is divergent
anteriorly from occlusal plane / Class 3 – Maxillary ridge or both ridges are divergent anteriorly from occlusal
plane
14. Ridge relationship: Class 1 – Normal / Class 2 – Retrognathic / Class 3 – Prognathic

15. Posterior: Normal / Crossbite

16. Bone quantity (radiographic; according to Branemark et al) (A/B/C/D/E) Max: ______Man: _________
17. Bone quality (radiographic; according to Branemark et al) (1/2/3/4) Max: ________ Man: __________
18. Floor of the mouth: Sublingual gland area: ________________ Mylohyoid area: _________________
19. Retromylohyoid area / Lateral throat form (according to Neil): Class 1 / Class 2 / Class 3
20. Mylohyoid ridge: Average / Sharp / Undercut

21. Tongue size and function: Class 1 – Normal / Class 2 – Changed form and function / Class 3 – Excessively large
and abnormal
22. Tongue Position: Normal / Class 1 – Retracted / Class 2 – Retracted and pulled backward and upward

23. Gagging: Normal / Exaggerated

24. Palatal throat form (according to House): Class 1 – Large size, ends 5 to 12 mm distal to line / Class 2 –
Medium size, ends 3 to 5 mm distal to line / Class 3 – Small size, abruptly ends 3 to 5mm anterior to line
25. Hard Palate: High vault / Medium vault / Flat / U shaped / V shaped

26. Soft Palate: Class 1 – Horizontal, little movement / Class 2 – Turns downward 45o from hard palate / Class 3 –
Turns downward 70o from hard palate Active / Passive
27. Palatal sensitivity: Class 1 – Normal / Class 2 – Hyposensitive / Class 3 – Hypersensitive

28. Incisive papilla: Normal / Tender / Prominent


COMPLETE DENTURE HISTORY TAKING & EXAMINATION

29. Rugae: Normal / Prominent / Faint

30. Palatal mucosa compressibility: Median area: Rigid / Compressible Lateral area: Rigid / Compressible
31. Mucous gland openings: Sparse / Numerous

32. Fovea: Seen / Not seen

33. Ah line: Sharp / Gradual / Medium

34. Posterior palatal seal area: Width: Wide / Narrow / Average Displaceability: Marked / Average / Slight
35. Alveolar tubercle/ Maxillary tuberosity: Normal / Undeveloped / Bulbous / Pendulous / Undercut

36. Space between coronoid process and tuberosity: Adequate / Restricted / Inadequate

37. Mucosa thickness: Class 1 – Normal / Class 2 – Thin / Class 3 – Excessively thick

38. Mucosa condition: Class 1 – Healthy/ Class 2 – Irritated / Class 3 – Pathologic

39. Oral Mucosa: Normal resiliency/ Hard unyielding/ Displaceable/ Spongy/ Hyperemic/ Hyperplastic__________

40. Border attachments height:


Class 1 – 0.5 inches distance / Class 2 – 0.25 to 0.5 inches distance / Class 3 – less than 0.25 inches distance
41. Frenum attachments height:
Class 1 – High in maxilla or low in mandible / Class 2 – Medium / Class 3 – encroach on ridge crest
42. Saliva: Quantity: Class 1 – Normal / Class 2 – Excessive / Class 3 – Xerostomia __________________________

Quality: Watery / Viscous / Normal ______________________________________________________

I. Existing dentures
Anterior teeth: Shade: ___________ Mold: _______________ Material: _________________
Posterior teeth: Shade: ___________ Mold: _______________ Material: _________________
Esthetics: Good / Fair / Poor Phonetics: Good / Fair / Poor Retention: Good / Fair / Poor
Stability: Good / Fair / Poor Extensions: Good / Fair / Poor Contours: Good / Fair / Poor
CR: Acceptable / Unacceptable VDO: Acceptable / Inadequate / Excessive
Occlusal Plane orientation: _________________________________________________________
Palate: ___________________________ Post Dam: Acceptable / Unacceptable
Adaptation: Acceptable / Unacceptable Midline: Acceptable / Unacceptable
Buccal vestibule: Acceptable / Unacceptable Crossbite: None / Unilateral / Bilateral
Characterization: Characterized / Uncharacterized
Comfort: Acceptable / Unacceptable Hygiene: Good / Fair / Poor Wear: Minimal / Moderate / Severe
Attachments and Hardware: _________________________________________________________________

II. Radiographic examination:


COMPLETE DENTURE HISTORY TAKING & EXAMINATION

III. Treatment plan

a) PREPROSTHETIC PHASE:
Corrective measures for general health:
_____________________________________________________
Corrective measures for oral health:
________________________________________________________
Tissue conditioning:
_____________________________________________________________________
Preprosthetic surgery:
Teeth for extraction: Max: R – 8-7-6-5-4-3-2-1 L- 1-2-3-4-5-6-7-8
Man: R – 8-7-6-5-4-3-2-1 L- 1-2-3-4-5-6-7-8
Roots: __________________________________ Unerupted teeth: ____________________________
Alveoloplasty: _______________________________________________________________________
Exostosis: __________________________________________________________________________
Soft tissue: _________________________________________________________________________
Special considerations: _______________________________________________________________
Special investigations: _______________________________________________________________

b) PROSTHETIC PHASE:
Preliminary impression:
Maxillary Mandibular
Trays selected
Impression material used
Impression technique used
Important observations &
Special Problems

Final impression:
Maxillary Mandibular
Custom tray fabrication
Spacer design
Border moulding material used
Impression material used
Impression technique used
Important observations &
Special Problems
COMPLETE DENTURE HISTORY TAKING & EXAMINATION

Maxiilomandibular relation:
Orientation relation: Technique used:
_______________________________________________________
Vertical Relation: Technique used:
_________________________________________________________
Centric relation: Technique used:
__________________________________________________________
Important observations & Special Problems:
_________________________________________________
Articulator:
____________________________________________________________________________
Teeth selection: Shade: _________________ Mold: __________________ Material: ______________
Occlusal scheme:
________________________________________________________________________
Try in:
_________________________________________________________________________________
Anatomic palate: __________________________ Characterization: __________________________
Denture base: Shade: _______________________ Material: ______________________________
List of items to correct in new denture:
_____________________________________________________
List of items to preserve from existing denture:
_______________________________________________
Recall & Follow up:
______________________________________________________________________

IV. Prognosis:
Retention: Good / Fair Stability: Good / Fair Comfort: Good / Fair
Mastication: Good / Fair Speech: Good / Fair Aesthetics: Good / Fair
Reason:
___________________________________________________________________________________