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Comprehensive Case Presentation

VT Case Presentation

behnam dianat

on 20 May 2013

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Transcript of Comprehensive Case Presentation

Behnam Dianat Comprehensive Case Presentation PRE-TREATMENT ASSESSMENT History Examination Photographs Special Investigations Definitive Diagnoses Personal details KJ, a 39 year old male, presented with multiple carious lesions, periapical periodontitis, tooth surface loss and several unrestorable teeth.

After providing initial symptomatic relief, investigating the aetiology, implementing a comprehensive preventive regime and achieving stabilisation, definitive treatment was completed. This included: restorations using amalgam, composite and glass ionomer cement, root canal treatment, crowns, an onlay and cobalt chrome dentures.
However, the patient failed to attend the last few appointments so the cobalt chrome denture has not yet been provided. It is likely that the patient has moved to Poland and not yet returned.

A maintenance programme was planned on completion of treatment to optimise long-term success. KJ’s presenting complaints would have been addressed and his quality of life significantly improved. CASE SUMMARY Chief complaint Medical history Social and family history - Extra-oral examination Intra-oral examination Consent for photographs Pre-treatment Photographs-

Frontal: Intra-oral views:

Frontal view (Intercuspal position) Right buccal view (ICP) Left buccal view (ICP) Maxillary dentition (occlusal view) Mandibular dentition (occlusal view) Chronic generalized moderate periodontitis

Caries: #17 (OM) , #11 (M) , #21(D)

Supra eruption # 18 Radiographic request Chronic generalized moderate periodontitis

Caries: #17 (OM) , #11 (M) , #21(D)

Supra eruption # 18 TREATMENT PLANNING AND
COMPLETION Ethical issues Phase I: Prevention Phase II: Definitive treatment Written informed consent was taken for several procedures including the overall proposed treatment, photographs, and extractions. Verbal informed consent was used on all other occasions. Plaque and bleeding charts-

21/11/11 10/01/12 6PPC- Information booklet- Splint- Information sheets- Information sheets- Information sheets- Photographs- Class III composite restoration # 11,21 Extraction # 18 POST-TREATMENT
DISCUSSION Outcomes Prognosis Unforeseen incident/emergency
Illegal immigrant
Communication difficulties
Dissatisfied with dental experience Efforts made-

Failure to attend (FTA) letters posted.
Letter, text messages and voicemails sent in Polish.
Called the patient on numerous occasions but no answer.
Contacted translator who said she was no longer in contact with patient. She contacted his landlord who said KJ had moved out. FTA letter: Solutions-

Re-emphasise exact duration required to complete treatment.
Further discuss the likelihood that patient may have to go back to his country mid-treatment.
Gauge willingness to comply and enthusiasm of patient.
Patient may return? Correspondence Quality of life and feedback- Overall predicted success of treatment is fair-good.
Aetiological factor for periodontal disease, caries and TSL were identified, understood by the patient, and controlled; this will contribute to a favourable prognosis.
Moderate-high risk patient in the short term due to the high-level of dental caries and treatment need. Recall interval of 4-6 months.

Current best evidence has been used to estimate the longevity of individual restorative components depend on maintenance of periodontal health and control of other patient-related variables.

The UR7 has a poor RCT. This may become symptomatic in the future and require reconsideration of the treatment options.
Minimally invasive techniques have been used where possible, allowing further restorative options to be considered.
Without the denture(s), the patient there may be uneven loading, leading to a further compromise in occlusion, mastication, aesthetics and longevity of restorations. I have enjoyed treating this case thus far but it is frustrating that the last few stages have not yet been completed. Patient's main concerns have been met.

I have improved and developed both my verbal and non-verbal communication skills. I have realised the importance of foreseeing circumstances which may hinder successful treatment.

Careful planning and division of treatment into specific interdependent stages has treatment to be completed in a logical manner. I implemented an evidence-based approach whilst making treatment decisions and tried to involve the patient at every stage. Any questions? Thank you for listening 1. Friedman S, Mor C. The success of endodontic therapy- healing and functionality. J Californian D Assoc 2004: 32(6): 493-503.
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6. Schiff T et al. Efficacy and safety of a novel stabilised stannous fluoride and sodium hexametaphosphate dentrifice for dental hypersensitivity. J Contemp Dent Pract 2006; 7(2): 1-8.
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8. Davies GM. Delivering better oral health- an evidence-based toolkit for prevention- a review. Dent Update 2008; 35: 460-464.
9. Kidd AM (2005). Essentials of dental caries: the disease and its management. Third edition. Wright. Bristol.
10. Heasman L et al. The effect of smoking on periodontal treatment response: a review of clinical evidence. J Clin Periodontol 2006; 33: 241–253.
11. Zero DT. Etiology of dental erosion- extrinsic factors. Eur J Oral Sci 1996; 104(2): 162-77.
12. Wright EF. Using soft splints in your dental practice. Gen Dent 1999; 47: 50-10. Heasman L et al. The effect of smoking on periodontal treatment response: a review of clinical evidence. J Clin Periodontol 2006; 33: 241-253.
13. McCabe JF, Walls A (2008). Applied dental materials. Ninth edition. Blackwell. London.
14. Petersen E et al (2010). Future use of materials for dental restoration. World Health Organisation. First edition. Geneva.
15. Aquilino SA, Caplan DJ. Relationship between crown placement and the survival of endodontically treated teeth. J Prosthet Dent 2002; 87(3): 256-63.
16. Randow K, Glantz PO. On cantilever loading of vital and non-vital teeth- an experimental clinical study. Acta Odontol Scand 1986: 44(5): 271-7.
17. Beaumont AJ Jr. An overview of esthetics with removable partial dentures. Quintessence Int; 2002: 33(10): 747-55.
18. Ohno Y et al (2010). Mechanial analysis of unilateral distal extension partial denture design. Removable Prosthodontics. First publication. Aichi-Gakuin University.
19. NHS National Institute for Health and Clinical Excellence, NICE (2004). CG19- Dental recall. London.
20. Mjor IA. Repair and replacement of failed restorations. Int Dent J 1993; 43: 466-472.

حبيبي برشلوني يموت ببرشلونه ،، و انا مدريدي لكن ما يحلمش اغير لعيونه Scaling
Root Planning Class II Amalgam restoration # 17 Pain in Upper right Posterior Area HOT drinks
COLD drinks
Air Big No Big No Married but away from his wife 9 month a year TOO BAD Mohammad Yousef Male 46 Yrs Old Initial Consultation : Feb 24, 2013 Final Consultation : Mar 19, 2013 Dental History Last Dental visit 2008
Previous RX Restoration
Scaling Fan of " KARAK TEA" My face My Partner's
Face Dr.Ayyam Face My Patient's Face No signs of pain on palpation or crepitus

No mandibular deviation on opening

Muscles of mastication: NAD Racial pigmentation soft tissue Gingivae Pinkish Red Oral hygiene

Fair Size
Enlarged Bleeding on probing
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