Full Case Assessment for Diagnostic Planning

The new patient consultation will normally yield sufficient information for me to be able to tell you what is required and make a reasonable estimation of time and fees that will be involved in your treatment.

In more complex cases, for example those involving loss of teeth and associated bone support, disruption of the bite where teeth are not in their ideal positions or where patients have had jaw joint pain or instability, it is necessary to carry out a more involved survey of the mouth, jaws and jaw joints in three dimensions with my laboratory technicians.

This survey is called a Full Case Assessment and involves clinical appointment with me and then possiblyseveral days of planning in the laboratory in your absence.

Clinical appointment – 1 hour appointment in addition to New Patient Primary Consultation (or 2 hours as a New Patient Full Case Assessment)

• Recording of jaw relations. I record how your jaws sit in space, in relation to each other and your jaw joints and how they move in relation to each other. It will allow the laboratory to fix models of your teeth onto an articulator (a device which can duplicate your jaw movements) and allow me to see how your jaws relate to each other in space and their range of movements movements in detail. If you are missing multiple teeth, it is likely that I will have taken impressions of your mouth at your new patient consultation. Prior to a Full Case Assessment my laboratory would construct well fitting bases that seat on to your gums and remaining teeth and allow me to take proper bite records at this stage.

• I will also take further clinical photographs and video of detailed aspects of your current condition.

Laboratory planning

• Preliminary waxup. Initially my laboratory technicians and I will decide whether your existing bite is stable enough for us to work with so that any dental work that is carried out conforms to the bite and movement patterns already established by the existing teeth (the so-called Conformative Approach). If the bite is so disrupted that it needs to be reorganised in a planned fashion (the so-called Reorganised Approach) I will take records so that my laboratory technicians can create an initial three-dimensional plan in wax to demonstrate the desired positions, shapes, anatomy and interrelationship of the teeth based on how your jaws relate to each other. This can take my technician 2 to 3 full days and requires meticulous attention to detail. It provides the template for all of your future work and must be as accurate as possible.

• Waxup duplication and creation of tooth shape indexes and templates. This wax pattern is duplicated in model stone. Indexes and templates can then be made on this model which I will work with when redesigning the shapes of your teeth and your bite. I will use these during your treatment to make future provisional crowns.

• Computerised tomography (CT) stents. Where missing teeth are to be replaced with dental implants, it is necessary to take a three-dimensional x-ray of the jaws called a CT scan.  This gives me a computer image of your jaw bones and how these relates to where the final teeth need to be. A CT stent resembles a clear plastic copy of a denture with strategically placed metal inserts that you wear during your CT scan. It shows me the desired positions of the teeth on the scan and shows whether you have sufficient bone in each region or whether I need to build up additional bone before implants can be placed.