Your SlideShare is downloading. ×
Case Presentation-Internship!
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Case Presentation-Internship!

1,015
views

Published on

This is a case I treated from A-Z which was presented today at the Internship Treatment Plan Seminar, the patient last visited the dental office on the sixth grade!! He was very apprehensive at the …

This is a case I treated from A-Z which was presented today at the Internship Treatment Plan Seminar, the patient last visited the dental office on the sixth grade!! He was very apprehensive at the initial visits, but thankfully we managed to over come that successfully.

Published in: Health & Medicine, Education

0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,015
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
3
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Clinical Case Presentation Majd Hasanin, Bach V, 42620112
  • 2. Patient’s Personal Data• Age: Twenty-One yrs old.• Gender: Male• Nationality: Saudi• Occupation: College Student• Marital Status: Single• Patient’s Attitude: Cooperative (Apprehensive in the initial visits).• Patient’s File number: 25129 2
  • 3. Chief Complaint “‫”حساسية في كل أسناني‬ “Sensitivity all over”History of chief complaint: Started since more than 3 years ago! Dentists scare me and I never bothered to visit a practitioner ever since the sixth grade. 3
  • 4. Medical History Patient stated that he is medically fit. Allergies: None. Hospitalization: Never been hospitalized. Medications he is on: None.Family Medical History Not significant. 4
  • 5. Past Dental History Few extracted teeth (Upper 6’s). Few restored teeth (Lower 6’s). 5
  • 6. Past Dental History Few extracted teethFew restored teeth 6
  • 7. Habits and Oral Hygiene Activities Patient brushes once daily mostly never. Technique of brushing: Horizontal Scrub. Uses a “Medium” brush. Doesn’t change his tooth brush very often. Doesn’t floss. Doesn’t visit the dentist nor the hygienist periodically. 7
  • 8. Pretreatment Photographs 8
  • 9. Extra-oral Photographs Frontal (Non-Smile) Frontal (Smile) 9
  • 10. Extra-oral Photographs Lateral (Non-Smile) Lateral (Smile-45 ْ ) 10
  • 11. Intra-oral Photos “Frontal” 11
  • 12. Intra-oral Photos “Upper Arch” 12
  • 13. Intra-oral Photos “Lower Arch” 13
  • 14. Intra-oral Photos “Right Side” 14
  • 15. Intra-oral Photos “Left Side” 15
  • 16. Diagnostic Aids 16
  • 17. Panoramic Radiograph 17
  • 18. Radiographs-BitewingsRt Lt 18
  • 19. Radiographs-PeriapicalsU Rt U LtL Rt L Lt 19
  • 20. Mounted Diagnostic Casts 20
  • 21. Mounted Diagnostic Casts Rt Lt 21
  • 22. Diagnostic Casts Maxillary Occlusal View Mandibular Occlusal View 22
  • 23. Clinical Examination 23
  • 24. Extra-oral ExaminationTransverse “non-smile”: Symmetrical. Nothing Abnormal Detected. 24
  • 25. Extra-oral Examination• Antro-posterior, Vertical: Concave profile. Class I extra-orally. Incompetent lips. Normal NLA (Nasiolabial Angle “90⁰”). Increased lower facial height. 25
  • 26. Intra-oral ExaminationTongue, floor of the mouth, Palate and Mucosa areall with-in the normal limit (WNL). 26
  • 27. Intra-oral Examination Lower midline is deviated to the left around 3.0mm in comparison to the upper midline. 27
  • 28. Intra-oral Examination Two restored teeth. Multiple carious teeth. Two missing teeth. 28
  • 29. Clinical Examination PSR(Periodontal Screening and Recording) 1 = Pocket Depth < 3.5 mm, bleeding upon probing. 29
  • 30. Clinical Examination  Gingival Index (GI): By: “Leo and Silness,1963” 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28FLF 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 Ramfjord “ 5” = 2 / Moderate Gingival Inflammation 30
  • 31. Clinical Examination  Plaque Index (PI): By: “Silness & Loe”,1964 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28FLF 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 Ramfjord “ 5” = 2 / Moderate Plaque accumulation 31
  • 32. Clinical Examination  Periodontal Chart (FM) Upper: B M- CEJ M-BP 333 333 333 333 333 323 323 322 223 323 333 333 233 333 CALF 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 M- CEJ M-BP 333 333 333 333 333 333 333 333 333 333 333 333 333 333 CALL B 32
  • 33. Clinical Examination  Periodontal Chart (FM) Lower: B M- CEJ M-BP 333 333 333 333 333 333 323 323 322 223 323 333 333 333 233 333 CALL 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 M- CEJ M-BP 333 333 333 333 333 333 333 333 333 333 333 333 333 333 333 333 CALF B 33
  • 34. Clinical Examination Generalized Plaque Accumulation. Calculus Index: 0 “Zero”. 34
  • 35. Clinical Examination Key: Restoration Caries Recurrent PA Leison Dental Charting “Upper Arch”18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 35
  • 36. Clinical Examination Key: Restoration Caries Recurrent PA Leison  Dental Charting “Lower Arch”48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 36
  • 37. Clinical Examination  Pulpal and Periapical Tests for suspected teethTooth # Cold Test Vertical Percussion Horizontal Percussion Palpation Test# 14 -ve -ve -ve -ve# 25 -ve -ve -ve -ve# 36 +ve (normal) -ve -ve -ve# 46 +ve +ve -ve -ve (prolonged) Control Teeth# 15 +ve -ve -ve -ve# 24 +ve -ve -ve -ve# 37 +ve -ve -ve -ve# 47 +ve -ve -ve -ve 37
  • 38. Laboratory Investigations CRT (Caries Risk Test)  Saliva Flow Rate : 12 ml in 5 min = 2.4 ml/min (above standard) Low Caries Risk  Saliva Viscosity : Watery  Saliva Buffer Capacity : Between 4.5-7 PH Low to Medium Caries Risk 38
  • 39. Laboratory Investigations CRT (Caries Risk Test) Measuring the Acid Production by the microorganism in the saliva; According to the “Standard chart”: 1 and 2 = Low Risk 3 and 4 = High Risk S.M L.B 39
  • 40. Laboratory Investigations CRT (Caries Risk Test) Results have revealed the following: •S.M = 2 < 100,000 CFU Low Risk •L.B = 3 > 100,000 CFU  High Risk S.M L.B 40
  • 41. Diagnosis and Treatment Planning 41
  • 42. Treatment Objectives•Chief Complain.•Oral Hygiene Motivation.•To Restore:  Function.  Structure.  Esthetics. 42
  • 43. Preliminary “Emergency” 43
  • 44. Preliminary “Emergency”• Diagnosis  Peri-apical radiolucency.  Irreversible Symptomatic Periodontitis.• Proposed Tx.  Pulp extirpation of the offended tooth, initial instrumentation, placing calcium hydroxide (as an intra-canal medicament) and T.F. 44
  • 45. Phase I, II(Restorative, Endo, Prostho) 45
  • 46. Phase I: (Periodontic Therapy)• Diagnosis for the “Periodontium”:  Chronic Generalized Moderate Gingivitis, resulting from local factors “Plaque”, “poor oral hygiene” of the patient (Multi-factorial).• Prognosis: Diagnostic: Good. Therapeutic: Excellent. 46
  • 47. Phase I: (Periodontic Therapy)• Proposed Tx.  Scaling, by ultrasonic scaling and hand instruments.  Prescribing 0.12% Chlorohexidine mouth wash, incase there was excessive bleeding, during scaling.  Modifying and emphasizing on the Oral Hygiene Instructions.  Re-evaluation in 4-6 weeks.  Maintenance every 6 months. 47
  • 48. Phase I: (Periodontic Therapy)• Oral Hygiene Instructions:  Includes the demonstration of the right technique in brushing and flossing: Brushing “Modified Bass” technique. 48
  • 49. Phase I: (Periodontic Therapy)• Oral Hygiene Instructions:  Flossing: 49
  • 50. Phase I: (Preventive Therapy)•Based upon the CRT the patient will need:  Diet Alteration (less Sweets, CHO Balance , more Protein & Vitamins).  Fissure Sealant (for intact deep fissured sound teeth). S.M L.B 50
  • 51. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 18:  Occlusal Caries.• Proposed Tx.  Modified class I composite or amalgam restoration occlusally. 51
  • 52. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 17:  Occlusal Caries.• Proposed Tx.  Modified class I composite or amalgam restoration occlusally. 52
  • 53. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 15:  Occlusal Caries.• Proposed Tx.  Modified class I composite restoration. 53
  • 54. Phase I, II:• Diagnosis for tooth # 14:  Deep Occluso-distal Caries.  Necrotic Pulp.• Proposed Tx.  Conventional Endodontic Tx.  Fiber Post and Direct Composite Resto. 54
  • 55. Literature Article Supporting Tx Option: Premolars with MOD restorations were stronger if reinforced with fibres. 55
  • 56. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 24:  Occlusal Caries.• Proposed Tx.  Modified class I composite restoration. 56
  • 57. Phase I, II:• Diagnosis for tooth # 25:  Deep Occluso-mesial Caries.  Necrotic Pulp.• Proposed Tx.  Conventional Endodontic Tx.  Fiber Post and Direct Composite Resto. 57
  • 58. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 27:  Occlusal Caries.  Palatal Pit Caries.• Proposed Tx.  Modified class I composite or amalgam restoration occlusally and palatally. 58
  • 59. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 28:  Occlusal Caries.• Proposed Tx.  Modified class I composite or amalgam restoration occlusally. 59
  • 60. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 38:  Occlusal Caries.• Proposed Tx.  Modified class I composite or amalgam restoration occlusally. 60
  • 61. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 37:  Occlusal Caries.• Proposed Tx.  Modified class I composite or amalgam restoration occlusally. 61
  • 62. Phase I:• Diagnosis for tooth # 36:  Defective Restoration.  Deep Occluso-distal Caries.• Proposed Tx.  Temporization with G.I.C. 62
  • 63. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 35:  Occlusal Caries.• Proposed Tx.  Modified class I composite restoration. 63
  • 64. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 34:  Shallow Occlusal Caries.• Proposed Tx.  Modified class I composite restoration. 64
  • 65. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 44:  Occlusal Caries.• Proposed Tx.  Modified class I composite restoration. 65
  • 66. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 45:  Occluso-distal Caries.• Proposed Tx.  Class II composite restoration. 66
  • 67. Phase I, II:• Diagnosis for tooth # 46:  Deep Occluso-distal Caries.  P.A Radiolucency.  Symptomatic Irreversible Periodontitis.• Proposed Tx.  Conventional Endodontic Tx.  Temporization with G.I.C.  Ortho Consultation. 67
  • 68. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 47:  Occlusal Caries.• Proposed Tx.  Modified class I composite or amalgam restoration occlusally. 68
  • 69. Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 48:  Occlusal Caries.• Proposed Tx.  Modified class I composite or amalgam restoration occlusally. 69
  • 70. Tooth # Treatment PlanPeriodontium Supragingival Scaling and Polishing# 18 Class I composite or amalgam# 17 Class I composite or amalgam# 15 Class I composite or amalgam# 14 Conventional Endo + Fiber Post and Composite Core# 24 Class II composite# 25 Conventional Endo + Fiber Post and Composite Core# 27 Class I composite or amalgam# 28 Class I composite or amalgam# 38 Class I composite or amalgam# 37 Class I composite or amalgam# 36 GIC-To be referred to Ortho# 35 Class II composite 70
  • 71. Tooth # Treatment Plan# 34 Class I composite# 44 Class I composite# 45 Class II composite# 46 Conventional Endo + GIC-To be referred to Ortho# 47 Class I composite or amalgam# 48 Class I composite or amalgam 71
  • 72. Phase III (Orthodontic Therapy) 72
  • 73. Orthodontic Consultation 73
  • 74. Orthodontic Consultation An orthodontic consultation is needed to:1. Correct the lower midline shift.2. Gain normal anterior bite.3. Close the inter-proximal spaces.4. Gain a proper occlusal relationship. 74
  • 75. Orthodontic Consultation After the Consultation:1. Lower 6’s (# 36, # 46) will be extracted.2. Treatment will take upto 2 years and a retainer is required to be worn for life.3. Conventional Orthodontic Treatment will be carried out as the patient’s treatment option. (Pt. refused orthognathic surgery as a tx option). 75
  • 76. Post Treatment Progress 76
  • 77. Pre and Post Photographs 77
  • 78. Frontal 78
  • 79. Occlusal-Maxillary 79
  • 80. Occlusal-Mandibular 80
  • 81. Lateral-Rt 81
  • 82. Lateral-Lf 82
  • 83. Pre and Post Radiographs 83
  • 84. Panoramic-Before 84
  • 85. Panoramic-After 85
  • 86. Bitewings-Rt 86
  • 87. Bitewings-Lf 87
  • 88. Periapicals-RCT # 14 88
  • 89. Periapicals-RCT # 25 89
  • 90. Tooth # Treatment DonePeriodontium Supragingival Scaling and Polishing# 18 Class I amalgam# 17 Class I amalgam (Palatal Extension restored with composite)# 15 Class I composite# 14 Conventional Endo + Fiber Post and Direct Composite Build-up# 24 Class II composite# 25 Conventional Endo + Fiber Post and Direct Composite Build-up# 27 Class I composite# 28 Class I composite# 38 Class I composite# 37 Class I composite# 36 GIC-Referred to Ortho# 35 Class II composite 90
  • 91. Tooth # Treatment Done# 34 Class I composite# 44 Class I composite# 45 Class II composite (OD)# 46 Conventional Endo + GIC-Referred to the Orthodontist# 47 Class II composite (OM)# 48 Class I composite 91
  • 92. Phase IV (Maintenance) 92
  • 93. Phase IV (Maintenance)  Recall the patient every 3 months to: • Do periodontal maintenance. • Emphasize on the oral hygiene. • Maintain good relationship with the patient. “Treat the patient as a whole, not a hole…” is very important to always keep in mind.  Recall the patient every 6 months to: • Do full mouth X-Ray, check all restorations. 93
  • 94. Thank you all, for your kind attention Any Questions?

×