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Comprehensive Case Presentation
Transcript of Comprehensive Case Presentation
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
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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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
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
Enlarged Bleeding on probing