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    Dee presentation level 11 Dee presentation level 11 Presentation Transcript

    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYComprehensive Case Presentation Prepared By: Deena Alshiwirkh ID Number : 42820175 Group: 1 Level 11
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY  Chief Complaint “I feel pain when I drink cold water and when I eat from this tooth” History of Chief Complaint 6 months ago. 1
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY Personal Data :• Age : 35 years old.• Gender : Male.• Nationality : Bengali.• Occupation : Dustman.• Marital & Social Status : Married. 2
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY Medical History :- Medically fit. 3
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACY Family Medical History :• Mother: Healthy.• Father:  Healthy.• Siblings: Healthy. 4
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACY Past Dental History :•Last Dental Visit : 2 years ago- Tooth extraction. 5
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY Habits and Oral Hygiene Activity :•Oral Habit : No oral habits were found.•Oral Hygiene• Brushing: once daily using horizontal technique.• Flossing: none.• Rinses: none.•Patient Attitude : somewhat motivated. 6
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYCLINICAL EXAMINATIONI. Extra – Oral Examination Skin Head Neck WNR Muscles TMJ Lips7
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY II. Intra – Oral Examination Palate Floor of the mouth Gingiva and alveolar WNR mucosa8
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY A white striped lesion cannot be removed with a cotton gauze ! II. Intra – Oral Examination9
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACY After 2 weeks review 10
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYDEFFERNTIAL DIAGNOSIS1. Like lichenoid reaction.2. Lichen Planus.3. Leukoplakia.4. Leukoedema.5. Frictional keratosis.  Take a biopsy to have the definitive diagnosis. 11
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYDiet Analysis : Main meals no: 3. Snacks no: 2. Type of food: Mainly Carbohydrates. 12
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYCARIES RISK TEST(CRT): High buffer capacity 13
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYAcid production by Microorganisms in saliva:L.B < 100,000 CFU Low risk M.S < 100,000 CFU Low risk 14
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACYPRE-TREATMENT PHOTOGRAPHS 15
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACY Front 16
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACY Maxillary occlusal 17
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACYMandibular occlusal 18
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACY Right lateral 19
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACY Left lateral 20
    • 21 RIYADH COLLEGE OF DENTISTRY AND PHARMACYRadiographs: DIAGNOSTIC TOOLSPanoramic OPG
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYI. Radiographs FMX Right side(PA): 22
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYRight side (bitwing): 23
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYUpper ant.(PA) 24
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYLower ant. (PA): 25
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYLeft side (bitwing): 26
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYLeft side (PA): 27
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYII. Mounted Diagnostic Casts • Incisors relationship : Class II div. 2 . • Vertical overlap: 80 %. • Lower Midline shift: Shifted to the left by 2 mm. 28
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYRight lateral. Left lateral. 29
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYMaxillary and Mandibular occlusal mounted castMaxillary Mandibular 30
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY Gingival index: (Silness &Gingival index score  1.2 =~ 1 moderate1964 Loe Index) gingival inflammation. 21 21 24 24 16 16 2 2 1 2 2 2 2 2 1 2 1 1 2 1 1 1 1 1 1 1 2 2 1 1 44 44 41 41 36 36 31
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY P laque index (Silness & Loe Index) 1963 :Plaque score  0.3 mild plaque accumulation. 16 21 21 24 24 16 1 0 1 0 0 0 0 0 0 1 0 1 1 0 2 0 0 0 0 0 0 0 1 1 44 44 41 41 36 36 32
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY Calculus index (Protector & Gamble):Score 3 > moderate calculus accumulation 33
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYPeriodontal Screening and Recording (PSR) 2 1 2 2 2 2 2: pocket depth < 3.5mm, bleeding on probing and calculus is present or rough sub gingival restorations. 34
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYPeriodontal charting 35
    • B + + + + + + + + + + + +M_CEj 222 RIYADH COLLEGE OF 3 222 442PD 321 333 DENTISTRY AND 21 211 322 443 312 211 323 213 112 112 222 211 PHARMACY 2CAL 555 435 764 6Tooth 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28# F F L# Tooth 18 17 16 15 14 13 12 L 11 21 22 23 24 25 26 27 28M_CEjPD 222 221 112 111 221 112 111 222 212 112 244 211 321 221 331CAL DrBander +++ 36
    • +++ +++ +++ +++ +++ +++ +++ +++ B M_CEj RIYADH COLLEGE OF PD 222 212 212 212 321 123 122 233 121 211 112 212 111 CAL DENTISTRY AND PHARMACY#Tooth 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38F L IL# tooth 48 47 46 45 44 43 42 F 41 31 32 33 34 35 36 37 38M_CEjPD 112 212 222 112 212 122 112 221 222 112 222 112 122CALB 37
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY Diagnosis :Generalized moderate – severe Chronic Periodontitis. 38
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYPeriodontal diagnosis, prognosis and treatment planning:  Etiological and risk factors : - Plaque - Calculus - Caries  Over all case prognosis : Fair. 39
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACY Treatment plan :- Extraction of hopeless teeth.- OHI & Plaque control.- Supragingival scaling and polishing.- Re-evaluation: 3-6 weeks.- Maintenance: 3 months.. 40
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY II. Intra – Oral Examination Charting Charting (Maxillary)Carious toothExtruded tooth 41
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY Cont’ II. Intra – Oral Examination Charting Charting (Mandibular)Carious tooth 42
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYVitality test and Percussion : Tooth Cold test Pulpal Vertical Horizontal palpation Periapical . NO diagnosis percussion percussion diagnosis 26 ve+ Vital ve- ve- ve- Normal 25 ve+ Vital ve- ve- ve- Normal 43
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYFinding and Diagnosis :- Generalized moderate – severe Chronic Periodontitis.- Dental caries on teeth #18,17,15,14,26,27,28,38,37,36,35,45,46-- Remaining root # 18 , 37- Rotated tooth # 24- Extruded teeth # 17 , 27 44
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACYTREATMENT PLAN 45
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYTreatment Objectives - Address patient’s chief complaint. - Maintain adequate oral hygiene. - Educate and motivate the patient for the dental treatment. - Eliminate active disease and prevent future oral diseases. - Maintain good gingival and periodontal health. - Restore occlusion, form, function, and aesthetics. 46
    • #18 Problem : .Remaining rootProposed Treatment: Extraction. 47
    • #17 Problem : Occlusal caries.Proposed Treatment: Class I amalgam. 48
    • #16 Problem : Occlusal caries.Proposed treatment: PRR (Preventive resin restoration). 49
    • #15 Problem: Occlusal Caries.Proposed treatment: Preventive ResinRestoration (PRR). 50
    • #14 Problem: Occlusal Caries.Proposed treatment: PRR. 51
    • #13 , 12 , 11Sound teeth. 52
    • #21 , 22 , 23 Sound teeth.53
    • #24 Problem: Malposed tooth due to traumatic occlusion. Proposed treatment: 1.Orthodontic treatment . 2. Leave it.54
    • #25 Sound tooth55
    • #26 Problem: Mesial Proximal caries. Proposed treatment: RCT + post and core + crown.56
    • #27 Problem: Occlusal caries. Proposed treatment: Class I Amalgam.57
    • #28 Problem: Badly decayed tooth. Proposed treatment: Extraction.58
    • #38 Problem: Occlusal caries. Proposed treatment: Class I Amalgam.59 56
    • #37 Problem: Remaining root. Proposed treatment: Extraction.60 57
    • #36 Problem: Occlusal caries. Proposed treatment: Class I Amalgam.61 58
    • #35 Problem: Occlusal caries. Proposed treatment: Class I Amalgam.63 60
    • #34 Sound tooth62 60
    • #33 , 32 , 31 Sound teeth.64
    • # 41 , 42 , 43 Sound teeth 65
    • # 44Sound teeth 66
    • #45 Problem: Occlusal caries.Proposed treatment: PRR. 67
    • # 46 Problem: Occlusal caries.Proposed treatment: Class I Amalgam . 68
    • #47 Problem: Missing tooth.Proposed treatment: 1.Replacement. 2.Leave it.. 69
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYORTHO ASSISMENT 70
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACYTreatment objectives :1.Intrusion of teeth 17 # and 27 #2.Correction of the tilted and rotated tooth 24#3. Up righting tooth 38 # 71
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY Correction of the tilted and rotated tooth 24# 1. Consultation with Periodontist (for the severe bone resorption and recession with no abnormal mobility is found) 2 options : 1. Adjunctive ortho treatment (minimal forces) 2. Leave it (Choice) 72
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYProsthodontic Treatment Plan 73
    • RIYADH COLLEGE OFDENTISTRY AND PHARMACY 74
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY For the upper arch: FPD : # 26 (Post and core +crown)75 68
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACY For the lower arch: 1.Implant : 37 , 47 2. FPD : 36 , 38 (3 unit) 3.RPD : 37 , 4776 69
    • RIYADH COLLEGE OF DENTISTRY AND PHARMACYTreatment PhasesPhase I : Emergency/ Preventive Treatment.Phase II : Operative Treatment.Phase III : Endodontic Treatment.Phase IV : Pre-Prosthodontic / Surgical Treatment.Phase V : Prosthodontic Treatment.Phase VI : Recall & Maintaince. 77