rania saeed l12 case presentation
TRANSCRIPT
ALJOHARA ALFAQEEH 42820042 1
Prepared by:Aljohara Alfaqeeh
ID #:42820042
Level:12
COMPREHENSIVE CASE PRESENTATION
RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY
ALJOHARA ALFAQEEH 42820042 2
RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY
Personal Data:
Age: 33 years old.
Gender: Female.
Nationality: Sudanese.
Occupation: Housewife.
Social Status: Married.
Patient’s Cooperation: Cooperative.
File Number : 42538.
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Chief Complain:
“ Do a general check up because I have a lot of decayed & corroded teeth. ”
في “ متآكلة وحشوات تسوس لوجود نظرا األسنان على عام إجراءكشفاألسنان ”.بعض
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Medical History:
She is medically fit.
She takes OCP pills for birth control.
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Family Medical History:
There is no significant family medical history mentioned.
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Past Dental History:
Multiple root canal treated teeth.
Multiple restored teeth.
Multiple extracted teeth.
1 FPD unit.
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Oral Hygiene Activity:
-Good Oral Hygiene. - Patient uses:
Tooth brush : once & sometimes twice/day. Tooth Brush : soft brush. Brushing technique : horizontal (scrub) technique. Dental floss/ Meswak / Mouth wash : none.
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Recommended:- Tooth brush type: Soft Nylon bristle tooth brush.
- Brushing Frequency: 2-3 times per day.
- Brushing Methods: modified bass technique.
- Interdental Aids: Dental floss.
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Clinical Examination
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I. Extra Oral Examination:
Skin TMJ Lymph nodes (Cervical, Submandibular) Neck
All within normallimits.
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II. Intra Oral Examination (soft tissue):
Lips.Vestibules.Soft palate .Tongue .Floor of the mouth.
Hard Palate Patient has torus palatinus.
All within normallimits.
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II. Intra Oral Examination (dentition):
Maxillary arch
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II. Intra Oral Examination (dentition):
Mandibular arch
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Pretreatment Photographs
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Periodontal Chart
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Gingival Index By: “Silness and Loe,1967”
Total = 1.1 Moderate gingival inflammation of the gingiva
11
11
11
12
11
11
11
11 2
11
1
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Plaque Index: By: “Silness and Loe,1967”
Total = 0.75 Mild plaque accumolation
22
12
11
12
00
10
01
11
11 0
0
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Calculus Score:Initial generalized calculus deposits.
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3
3
333
13
PSR (Periodontal Screening & Recording):
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Bleeding
M-CEJ
323 323 212 224 212 212 212 123 332 532 113 M-PD
CAL
28 27 26 25 24 23 22 21 11 12 13 14 15 16 17 18
28 27 26 25 24 23 22 21 11 12 13 14 15 16 17 18M-CEJ
121 322 221 212 222 212 212 223 222 545 344 M-PD
CAL
Bleeding
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Bleeding
M-CEJ
422 324 433 323 112 211 212 212 211 311 312 212 222 345 M-PD
CAL
38 37 36 35 34 33 32 31 41 42 43 44 45 46 47 48
38 37 36 35 34 33 32 31 41 42 43 44 45 46 47 48M-CEJ
315 314 215 114 313 113 114 212 313 213 212 322 222 433 M-PD
CAL
Bleeding
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Mobility assessment
0 No detectable mobility other than physiologic.
No Furcation involvement.
Local factors:
Plaque.
Calculus.
Iatrogenic factors : defective bridge and restorations.
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Diagnosis:
Generalized mild Chronic Periodontitis.
Overall Prognosis:
Good.
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Diet analysis:
- 3 meals/day.- Snacks between meals.- High sugar amount added to tea.- A lot of coffee and dates.
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Recommendations:
- Reduction of Carbohydrates intake.- Reduce the amount of coffee and tea.- Include fruits and vegetables in her diet.
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CRT (Caries Risk Test):
Saliva buffer capacity High Saliva viscosity Viscous
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CRT (Caries Risk Test):
Mutans Streptococci : High RiskLactobacilli : High Risk
According to the “ Standard chart”
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Salivary Flow Rate:
STIMULATED SALIVARY FLOW RATE :
1.2ml / min
NORMAL VALUES:
STIMULATED 0.7-1.5 ml/min.
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Diagnostic tools:
Radiographs.
Mounted Cast.
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Right Bitewings
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Left Bitewings
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Right Side Periapicals
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Left Side Periapicals
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Upper & Lower Anteriors Periapicals
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• Mounted Diagnostic Cast
-Midline: Upper midline is normalLower midline deviated to the Right side by 2 mm. Mild Diastima frenectomy.-Vertical Overbite: 60% -Horizontal Over jet: 3 - 4mm
Anterior Cross bite.Lingual Cross bite.
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• Mounted Diagnostic Cast
Canine Relationship:Class I.
Molar Relationship:Non applicable.
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• Mounted Diagnostic Cast
Canine Relationship:Class I.
Molar Relationship:Non applicable.
Over eruption of the canine due the Lingual Cross bite.
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• Mounted Diagnostic Cast
No crowding.
Mild spacing.
Upper molars are rotated ( #18, #17, #27, #28).
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Vitality & Percussion Test
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Tooth # Cold test V. Percussion test
H. Percussion test
Pulp Diagnosis
Periapical Diagnosis
#17 +ve -ve -ve Normal Normal
Application of Endo Frost (-50° C) on suspected teeth.
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Tooth # Cold test V. Percussion test
H. Percussion test
Pulp Diagnosis
Periapical Diagnosis
#14 -ve +ve -ve Previously Treated
SymptomaticApical Periodontitis
Application of Endo Frost (-50° C) on suspected teeth.
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Tooth # Cold test V. Percussion test
H. Percussion test
Pulp Diagnosis
Periapical Diagnosis
#12 -ve -ve -ve Previously Treated
Normal
Application of Endo Frost (-50° C) on suspected teeth.
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Tooth # Cold test V. Percussion test
H. Percussion test
Pulp Diagnosis
Periapical Diagnosis
#11 -ve -ve -ve Previously Treated
Normal
Application of Endo Frost (-50° C) on suspected teeth.
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Tooth # Cold test V. Percussion test
H. Percussion test
Pulp Diagnosis
Periapical Diagnosis
#21 -ve -ve -ve Previously Treated
Normal
Application of Endo Frost (-50° C) on suspected teeth.
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Tooth # Cold test V. Percussion test
H. Percussion test
Pulp Diagnosis
Periapical Diagnosis
#27 +ve -ve -ve Normal Normal
Application of Endo Frost (-50° C) on suspected teeth.
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Tooth # Cold test V. Percussion test
H. Percussion test
Pulp Diagnosis
Periapical Diagnosis
#36 +ve -ve -ve Normal Normal
Application of Endo Frost (-50° C) on suspected teeth.
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Tooth # Cold test V. Percussion test
H. Percussion test
Pulp Diagnosis
Periapical Diagnosis
#45 +++ve -ve -ve Irriversable Pulpitis (symptomatic)
Normal
Application of Endo Frost (-50° C) on suspected teeth.
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Tooth # Cold test V. Percussion test
H. Percussion test
Pulp Diagnosis
Periapical Diagnosis
#46 -ve +ve -ve PreviouslyTreated
AsymptomaticApical Periodontitis
Application of Endo Frost (-50° C) on suspected teeth.
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TREATMENT OBJECTIVES:
- CONTROL ACTIVE DISEASES.- EXTRACT NON RESTORABLE TEETH.- IMPROVE ORAL HYGIENE.- CARIES CONTROL.- RESTORE FUNCTION AND ESTHETICS.- MAINTAIN THE RESULTS.
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Treatment Plan
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Treatment Phases:Phase I : Emergency/ Preventive Treatment. Phase II : Operative Treatment.Phase III : Endodontic Treatment.Phase IV : Pre-Prosthetic / Surgical Treatment. Phase V : Prosthodontic Treatment.Phase VI : Recall & Maintenance.
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Problem Proposed treatment
Generalized mild Chronic Periodontitis. Extraction of Hopeless teeth. OHI instructions & plaque control. Supragingival scaling & polishing. Correction of iatrogenic factor. Re-evaluation after 4 – 6 weeks. Maintenance every 3 months.
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Tooth Proposed treatment
#18 Occlusal Caires Class I Composite restoration.
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Tooth Proposed treatment
#17 Under prepared abutment.
Prepare the tooth for surveyed crown.
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Tooth Proposed treatment
#16, #15 Missing. Implant.RPD.
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Tooth Proposed treatment
#14 Extensive Caries. Extraction.
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Tooth Proposed treatment
#12 Substandard RCT. + Root Resorption because of the trauma from occlusion (cross bite).
Remove Gp block the wall with MTA and wait till the internal wall of the tooth regenerate. After that RCT + post & core + Crown.
Or Extract the tooth and replace it
by :Implant PFM RPD
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Tooth Proposed treatment
#11 Broken incisors + malformed restoration + Substandard RCT + Root Resorption.
Remove screw post + Redo RCT + post & core + porcelain crown.
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Tooth Proposed treatment
#21 Broken incisors + malformed restoration.
Remove pin + Redo RCT + post & core + porcelain crown.
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Tooth Proposed treatment
#22 Recurrent caries. Redo Class III composite restoration.
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Tooth Proposed treatment
#23 Distal Caries Class III composite restoration.
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Tooth Proposed treatment
#24 #25 #26 Missing. Implant.RPD.
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Tooth Proposed treatment
#27 Faulty Restoration. Redo Restoration.
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Tooth Proposed treatment
#28 Occlusal Caries. Class I Composite restoration.
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Tooth Proposed treatment
#37 Faulty Restoration + recurrent caries.
Redo Restoration.
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Tooth Proposed treatment
#36 Over hanged amalgam restoration.
Redo Restoration.
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Tooth Proposed treatment
#42 #43 Over Eruption. Shave the teeth to create more space for the upper #12 & to relief the trauma from occlusion.
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Tooth Proposed treatment
#34 Distal pit Caries. PRR.
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Tooth Proposed treatment
#44 Pit Caries. PRR.
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Tooth Proposed treatment
#45 Extensive Caries. Endo + Post and core & Crown ( tooth will need crown lengthening ).
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Tooth Proposed treatment
#46 Extensive Caries. Extraction.
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Tooth Proposed treatment
#47 Missing. Implant.RPD.
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Tooth Proposed treatment
#48 Occlusal Caries. Class I Composite restoration.
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Torus Palatinus:Treatment: Surgically remove the torus palatinus because if it will interfere with the placement of the denture and replace it with skin graft.
But in our case we wont remove it because our major connector is horse shoe.
Pre- Prosthetic/ Surgical Phase IV:
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Prosthetic Phase V:
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Wax Up
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Prosthodontic Treatment:
RPD Design for Upper Arch
Major Connector
Direct Retainers
Indirect Retainers
Class III modification I
Horse Shoe #17 Surveyed Crown#17 #27 Aker Clasp#13, #23 T bar.
#13, #23 Cingulum Rest#17, #27 Mesial Rest
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Prosthodontic Treatment:
RPD Design for Lower Arch
Major Connector
Direct Retainers
Indirect Retainers
Class III Lingual Bar #45 Surveyed Crown#45, #48 Aker Clasp#37, #36 Double Aker Clasp
#45, #36 Distal Rest.#48, #37 Mesial Rest.#33, #43 Cingulum Rest.
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Recall & Maintenance Phase VI:
Recall Patient every 3 months :
For periodontal maintenance .
Recall Patient every 6 months :
To take full mouth radiographs and to check the restorations , prosthesis and RCT .
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Treatment Phases:Phase I : Emergency/ Preventive Treatment. Phase II : Operative Treatment.Phase III : Endodontic Treatment.Phase IV : Pre-Prosthetic / Surgical Treatment. Phase V : Prosthodontic Treatment.Phase VI : Recall & Maintenance.
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THANK YOU