Case presentation for comprehensive clinical dentistry

Case presentation for comprehensive clinical dentistry

Case 1

1. Biographic Data:

. Name : M.A.A

. Age : 53 years old

. Gender : Male

. Nationality : Saudi

. Occupation : Employee in Al-Madinah

Regional Municipality

. Marital status : Married

History of chief complaint

2. Chief Complaint

Clinical and Radiographic Examination

Introduction and History

“I have pain on the left side of my lower jaw”

Preapical

35

Patient smile

13

Mock up

46

1. Extraoral Examination

Cast wax up

Intraoral Photograph:upper side

OPG

Onset : 3 weeks ago

Stimulation : Hot coffee and hot tea .

Radiation of pain : Lower jaw

Duration : 1 minute

Mode of onset : Periodic

Type of pain : Sharp pain

Before

Intraoral Photograph: Lateral view – Right side.

Before

After

Periodontal reevaluation

Before

After

Before

Mean probing depth: 2.5 mm

Mean attachment level: -3.7 mm

Plaque: 100%

Bleeding on probing: 35%

Reevaluation of lower jaw

Before

After

Mean probing depth: 2.3 mm

Mean attachment level: -3.5 mm

Plaque: 31%

Bleeding on probing: 15%

Phase III

After

Post and core : #13

Removable prosthodontics treatment:

Treatment Summary

Teeth chart

Fixed prosthodontics treatment: Metal ceramic crown: #13, #14 and Metal ceramic fixed-fixed bridge of 3 units :#(12-11-21)

Before

Reevaluation of upper jaw

• Facial profile: convex.

• Skin: No abnormality detected (NAD).

• Neck: NAD.

• Lymph node: NAD.

• TMJ: NAD

After

Before

2. Intraoral Examination (#17-14)

Content

Reevaluation of risk assessment

After

Before

Intraoral Photograph: Lateral view – Left side.

1- Smooth surface cervical carious lesion : #14

2-Pit and fissure carious lesion: #17

3-Missed teeth and bone resorption due to extraction : #15, #16

After

Phase IV

Thank you

Intraoral Photograph:lower side

Maintenance and periodic rechecking of plaque, gingival condition, restoration and the prosthesis .

Before

After

Intraoral Photograph: Frontal view.

Before

After

Phase III

Post and core : #35

Pulse rate: 70 beats per minute

BP: 120 systolic / 79 diastolic mmHg

Fixed prosthodontics treatment: Metal ceramic crowns : #35, 36

Post and core : #23

#24 (Two posts) Because the placement of one post not enough for caring a core for this bicuspid tooth

Before

After

Phase III

Restorative Treatment:

Restoration for teeth#22 (Class III), 26 (Complexe mesial-occlusal-distal) , 27 (Class I)

Resin composite restoration for all the carious teeth for the following reasons :

* Esthetic .

* Strengthening of the remaining tooth structure

* Conservative cavity which dose not full fill the resistant and convenient features for amalgam restoration .

Color shade ( A2 ).

Phase II:

3. Patient Consideration

Non-surgical endodontic treatment of tooth #46

Procedure information

Phase II:

1- Completion of previously initiated treatment of tooth #35

Mesio-buccal=19

Mesio-lingual=19

Disto-Buccal=19

Disto-lingual=21

Working length

•The patient didn’t mind any treatment plan.

•He consider mainly about the pain in the lower jaw.

Mesio-buccal cusp

Disto-buccal cusp

Reference point

8

1. Objectives of Treatment Plan

Initial file

Fixed prosthodontics treatment: Metal ceramic crown: #22, #23

Procedure information

* Motivate, Improve ,maintain oral hygiene and educate the patient with oral hygiene instructions.

* Restore all defected teeth.

* Restore the oral function and esthetic to the patient.

Pre-operative

Working length

2. Intraoral Examination

23

Mesio-buccal=30

Mesio-lingual=30

Disto-Buccal=30

Disto-lingual=40

Master file

Working length

3. Radiographic Examination

2. Intraoral Examination

Treatment Plan Options

2. Treatment Plan: (Option 1 )

Mesial cusp

Preliminary phase :

Emergency treatment for tooth #35

Reference point

Working length

2. Treatment Plan: (Option 1 )

Pre-operative

1. OPG

Phase II:

Endodontic treatment

Non-surgical endodontic treatment of tooth #46

Non-surgical endodontic treatment of tooth #13

2- Completion of previously initiated treatment of tooth #35

Implant for teeth

#11

#15, #16 : (The mesio distal width =18mm)

#25 : (The mesio distal width =8mm)

8

Mesio-buccal=30

Mesio-lingual=30

Disto-Buccal=30

Disto-lingual=40

Master cone

Initial file

Periodontal Assessment: Uppar arch

#35 #46

2. Treatment Plan: (Option 1 )

2. Treatment Plan

Option 1

Option 2

Option 1

Option 2

40

Phase III :

Final restoration :

Restoration for teeth : #12, #13, #14, #22 #23 , #17 , #14 , #26 , #27 , #37 , #47

Implant crown :

For teeth number:

#11 Type of (crown detect after bridge removal)

#15, #16 Cemented or screw crown (The intra arch space =6mm)

#25 Cemented or screw crown (The intra arch space =7mm)

Fixed prosthodontics treatment:

Crowns (After endodontic treatment):#13, #35 , #46

Crowns (For teeth) : #23 , #24, #12, #21

Phase I:

Periodontics: OHI, scaling and root planning (two visit) .

Restorative : Caries removal of teeth #12, #13, #14, #17, #22, #23 , #26 , #27 , #37 , #47

Fixed prosthodontics :

1- Temporary crown for tooth #24

2- Temporary bridge (#12-21)

Removable prosthodontics:interim partial denture

Assessments of previous treatment

Preliminary phase :

Emergency treatment for tooth #35

Phase II:

Endodontic treatment

Non-surgical endodontic treatment of teeth #46, #13

3- Completion of previously initiated treatment of tooth #35

2. Diagnosis:

2. Treatment Plan

Phase II:

Endodontic treatment

Non-surgical endodontic treatment of teeth #46, #13

3- Completion of previously initiated treatment of tooth #35

Implant for teeth

#11, #15, #16, #25

Master file

Option 1

Option 2

Risk Assessment:

- Periodontal chart finding:

Mean Probing Depth= 2.5 mm

Mean Attachment Level= -3.7 mm

Plaque= 100%

BOP= 35%

Phase III :

Final Restoration :

Restoration for teeth : #12, #13, #14, #22 #23 , #17 , #14 , #26 , #27 , #37 , #47

Implant crown :

For teeth number:

#11 Type of (crown detect after bridge removal)

#15, #16 Cemented or screw crown (The intra arch space =6mm)

#25 Cemented or screw crown (The intra arch space =7mm)

Fixed prosthodontics treatment:

Crowns (After endodontic treatment):#13, #35 , #46

Crowns (For endodontically treated teeth) : #23 , #24

Crowns (For teeth) : #12, #21

Phase III :

Final Restoration :

Restoration for teeth : #12, #13, #14, #22 #23 , #17 , #14 , #26 , #27 , #37 , #47

Fixed prosthodontics treatment:

Crowns (After endodontic treatment):#13, #35 , #46

Crowns (For endodontically treated teeth) : #23 , #24

Bridge : (#12-21)

Removable prosthodontics

Upper partial denture for teeth : #16, #15, #25

Lateral condensation

2. Treatment Plan

Obturation technique

40

Master cone

Master cone

Option 2

Option 1

2. Treatment Plan: (Option 1 )

Phase III

Final obturation

Phase IV:

Maintenance

* Recall every 6 moths

* Reinforce oral hygiene

Phase III

Phase I:

Periodontics : Scaling and root planning (two visit) .

Restorative : Caries removal of teeth #12, #13, #14, #22 #23 , #17 , #14 , #26 , #27 , #37 , #47

Fixed prosthodontics :

1- Temporary crown for tooth #24

2- Temporary bridge (#12-21)

Removable prosthodontics : interim partial denture

Assessments of previous treatment

Design drawing

Lateral condensation

Obturation technique

Restorative Treatment:

Restoration for teeth #37 (Class I) , 47 (Class II) , 45 (Class II)

Restorative :

Caries removal of teeth #12, #13, #14, #17, #22 #23, #26, #27, #37, #47

and temporization with Glass Ionomer Cement

Because

• Holds up well to the forces of biting
• Minimal-to-no shrinkage and resists leakage
• High resistance to further decay

Master cone

Mesh pattern

Aker clasp on tooth #14

Aker clasp on Surveyed crown #24 (Retentive arm in buccal side and reciprocal arm in palatal side)

Aker clasp on tooth #17 (Retentive arm in buccal side and reciprocal arm in palatal side)

Aker clasp on tooth #26 (Retentive arm in buccal side and lingual plate in palatal side)

Distal rest seat on teeth #14, #24

Mesial rest seat on teeth #17, #26

Major connector (palatal strap)

Treatment Plan

Final obturation

Preliminary phase :

Emergency treatment for tooth #35

Caries removal and pulp extirpation

Intra-canal medicament ( Calcium Hydroxide )

* To reduce the number of micro organism and prevent the growth of any new micro organism

*then temporization

Treatment progress

Surveyed cast

4- Prosthodontics

Kennedy classification

Class III modification 1

Fixed prosthodontics :

Temporary bridge (#12-21)

Removable prosthodontics :

interim partial denture

2. Treatment Plan

Phase I:

Periodontics: OHI, scaling and root planning (two visit) .

The chosen treatment option : 2

Because The patient can not afford the cost of the implant

Option 1

Option 2

Phase IV:

Maintenance

* Recall every 6 moths

* Reinforce oral hygiene

37

2. Intraoral Examination

4. Positive and Negative Modifier

Extracted teeth and bone resorbtion

1. Problem List

Previous restoration with secondary caries

Diagnostic Cast

47

Negative

Positive

* Motivated patient .

* Equipment and material shortage .

* Lap production .

2. Intraoral Examination

2. Diagnosis

45

A. Multiple decayed teeth

1- Smooth surface cervical carious lesion : #12, #13, #14, #23

2- Smooth surface proximal carious lesion : #13, #22 ,#47

3- Smooth surface carious lesion on buccal surface : #35

4- Root caries : #26

4- Pit and fissure carious lesion : #17, #26, #27, #37

5- Recreant caries with defective composite restoration : #46

frontal side

Lt lateral side

Rt lateral side

Resin composite restoration for all the carious teeth for the following reasons :

* Strengthening of the remaining tooth structure

* Conservative cavity

2-Endodontic:

According to American Association of Endodontics

#13 Symptomatic Irreversible pulpitis with normal apical tissue (By using endo ice) for teeth #12, #13, #14

#35 Symptomatic Irreversible pulpitis with asymptomatic apical periodontitis(By using endo ice) for teeth #34, #35, #36, #45

#46 Pulp necrosis with symptomatic apical periodontitis (By using endo ice) for teeth #45, #46, #47,#36

Post and core : #46 disto-lingual canal because it is the biggest canal

Phase III

1. Problem List

2. Intraoral Examination

Restorative Treatment:

Restoration for teeth#17 (Complexe mesial-occlusal-distal) , #14 ( Class V)

Phase II:

Intraoral Photograph

Non-surgical endodontic treatment of tooth #13

#13

#46

#35

2. Diagnosis

•Size: Dose not fill the inter dental space .

•Position : Marginal recession with interpapillary enlargement

•Surface texture: Smooth shiny firm surface

•Consistency: Smooth shiny edemutas surface

B. Plaque with marginal recessions and interpapillary enlargements .

C. Periapical radiolucency in tooth #46 .

D. Improper bridge (#12-21) .

E. Missed teeth due to extraction #15, #16, #25

Defective composite restoration : #46

1- Recreant caries : #46

2- Smooth surface proximal carious lesion : #47

3- Smooth surface carious lesion on buccal surface : #35

4-Pit and fissure carious lesion : #37

Amalgam restoration with secondary caries : #36

Marginal resorption on lingual surfaces of the anterior teeth

Procedure information

2. Diagnosis:

28

Working length

Cusp tip

2. Diagnosis

Reference point

Pre-operative

Working length

2. Intraoral Examination

Problem List and Diagnosis

10

Orthodontic

Initial file

3-Restorative:

1- Smooth surface cervical carious lesion #12, #13, #14, #23

2- Smooth surface proximal carious lesion #13, #22 ,#47

3- Smooth surface carious lesion on buccal surface #35

4- Root caries #26

5- Pit and fissure carious lesion

#17, #26, #27, #37

6- Recreant caries with defective composite restoration #46

Periodontal Assessment: Lower arch

50

Master file

Cl. III incisors relationship.

Cl. I canine relationship

Cl. I malocclusal

50

Master cone

Lateral condensation

Obturation technique

Master cone

Resin composite restoration for all the carious teeth for the following reasons :

* Esthetic .

* Conservative cavity which dose not full fill the resistant and convenient features for amalgam restoration .

Color shade ( A2 ).

Final obturation

1-Periodontal:

According to American Dental Association of perodontal disease

Plaque induce gingivitis

Generalized modreate chronic periodontitis.

The clinical attatchment loss ( CAL )

1-2 = 10%

3-4 = 70%

5-6 = 20%

2. Intraoral Examination

3. Radiographic Examination

1. OPG

2. Intraoral Examination

Risk Assessment

Surveyed crown with rest seat where fabricated to receive a cobalt chromium RPD on tooth #24

Endodontically treated teeth

Preapical lesion

2. Intraoral Examination (#33-43)

1- Marginal resorption on lingual surfaces of the anterior teeth

2- Calculus deposition

2. Intraoral Examination (#37-34)

2. Intraoral Examination (#44-47)

1- Smooth surface carious lesion on buccal surface : #35

2-Pit and fissure carious lesion : #37

3-Amalgam restoration with secondary caries : #36

1-Defective composite restoration with recreant caries : #46

2- Smooth surface proximal carious lesion : #47

2. Intraoral Examination (#13-21)

2. Intraoral Examination (#26-27)

2. Intraoral Examination

#13

1- Pit and fissure carious lesion: #26, #27

2- Root caries : #26

1- Smooth surface cervical carious lesion : #12, #13

2- Smooth surface proximal carious lesion : #13

3- Improper bridge (#21-12)

4- Marginal gingival recession with interpapillary enlargement

Periodontal assessment

2. Intraoral Examination (#22-25)

* The gingiva of the patient was edematous and erythematous.

* The teeth surfaces are covered with plaque mainly in interproximal area .

* Calculus is seen on lingual aspect of lower anterior teeth .

1- Smooth surface proximal carious lesion : #22

2- Smooth surface cervical carious lesion : #23

3- Root caries : #24

4- Marginal gingival recession with interpapillary enlargement

5- Missed tooth and bone resorption due to extraction : #25

Fixed prosthodontics treatment: Metal ceramic crown: #46

Prognosis

Self Assessment

2. Intraoral Examination

Teeth chart

Fair prognosis:

It dependent on patient’s ability to maintain good oral hygiene and sustain stable periodontal conditions

* I am proud and satisfied for the work that has been done .

* I learned how to manage and do what ever happened during the treatment phase like complications .

* I increased my ability to deal with patients and I am ready to deal with all patients in my clinic.

* I learned how to think critically and to treat the patient as a whole person with combining different specialty together.

* I improved my quality of work

1. Soft tissue

Cheek, palate, tongue and the floor of the mouth: NAD

Gingival description:

•Color: Pink , pigmented (melanin) with localized erythematous areas .

•Contour: Slight gingival enlargement .

Before

• Introduction and History
• Clinical and Radiographic Examination
• Problem List and Diagnosis
• Treatment Plan Options
• Treatment progress

3. Medical History

4. Dental History

•Patient does not have any significant medical history.

•He does not have any allergic to medications.

•He does not take any medication

•Patient brushes his teeth once a week and does not use dental floss.

•Previous dental treatments include several restorations.

•He did not have anxiety from dental procedures.

•He came to the Dental College one year ago for endodontic treatment.

Mohammed Issa