• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
CasePresentation-II
 

CasePresentation-II

on

  • 1,521 views

 

Statistics

Views

Total Views
1,521
Views on SlideShare
1,521
Embed Views
0

Actions

Likes
6
Downloads
0
Comments
1

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Adobe PDF

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel

11 of 1 previous next

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    CasePresentation-II CasePresentation-II Presentation Transcript

    • Clinical Case Presentation Majd Hasanin, Level X, 42620112
    • Patient’s Personal Data• Age: Thirty-six Years Old• Gender: Female• Nationality: Sudanese• Occupation: House-keeper• Marital Status: Divorced, with one daughter• Patient’s Attitude: Cooperative• Patient’s File number: 19652 2
    • Chief Complaint‫”سني اللي تحت مكسور، يتجمع فيه األكل ويئلمني لما أشرب‬ “‫موية باردة‬“My lower tooth is broken, it accumulates food there and it is painful when I drink cold water”History of chief complaint:Started around two weeks before her visit to theclinics. 3
    • Chief Complaint 4
    • Medical History Patient stated that she is suffering from “Asthma” since fifteen “15” years ago. Medications she is on:  Butanol Inhaler.  Ventolin Inhaler.Family Medical History Not significant. 5
    • Past Dental History Multiple restored teeth. Different intervals starting from about ten “10” years back till recently. Several extracted teeth. Tattooing of the upper gingiva. Around ten “10” years ago. 6
    • Past Dental History Several extracted teeth Multiple restored teeth 7
    • Habits and Oral Hygiene Activities Patient brushes once daily. Technique of brushing: Horizontal Scrub. Uses a “soft” brush. Doesn’t change her tooth brush very often. Doesn’t floss. Doesn’t visit the dentist nor the hygienist periodically. 8
    • Pretreatment Photographs 9
    • Extra-oral Photographs 10
    • Intra-oral Photos “Frontal” 11
    • Intra-oral Photos “Upper Arch” 12
    • Intra-oral Photos “Lower Arch” 13
    • Intra-oral Photos “Right Side” 14
    • Intra-oral Photos “Left Side” 15
    • Diagnostic Aids 16
    • Panoramic Radiograph 17
    • Radiographs-BitewingsRt Lt 18
    • Radiographs-PeriapicalsU Rt U LtL Rt L Lt 19
    • Mounted Diagnostic Casts 20
    • Mounted Diagnostic Casts Rt Lt 21
    • Diagnostic Casts Maxillary Occlusal View Mandibular Occlusal View 22
    • Clinical Examination 23
    • Extra-oral ExaminationTransverse “non-smile”: Non-symmetrical face. 24
    • Extra-oral Examination• Antro-posterior, Vertical: Convex profile. Class II extra-orally. Competent lips. Normal NLA (Nasiolabial Angle “90⁰”). Slightly increased lower facial height. 25
    • Intra-oral ExaminationTongue, floor of the mouth, Palate and Mucosa areall with-in the normal limit (WNL). 26
    • Intra-oral Examination Tattooing of the upper gingiva. 27
    • Intra-oral Examination Intra-oral Sinus Tract. 28
    • Intra-oral Examination Lower midline is deviated to the right around 5.0mm in comparison to the upper midline. 29
    • Intra-oral Examination Multiple restored teeth. Multiple carious teeth. Several missing teeth. 30
    • Clinical Examination PSR(Periodontal Screening and Recording) 2* = Pocket Depth < 3.5 mm, bleeding upon probing, calculus, with recession 31
    • 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 “ 6” = 2 / Moderate Gingival Inflammation 32
    • 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 “ 6” = 2 / Moderate Plaque accumulation 33
    • Clinical Examination  Periodontal Chart (FM) Upper: B M- CEJ 121 111 111 111 111 112 000 111 111 131 M-BP 222 112 222 212 211 222 111 111 111 111 112 212 CAL 343 112 333 323 322 333 223 111 222 222 112 343F 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 111 111 000 000 000 000 000 000 111 111 M-BP 322 313 323 333 223 222 211 111 112 222 312 312 CAL 433 313 434 333 223 222 211 111 112 333 312 423L B 34
    • Clinical Examination  Periodontal Chart (FM) Lower: Class I Furcation, Λ B M- CEJ 111 111 111 111 111 111 111 111 111 111 111 111 111 M-BP 222 222 322 323 311 111 221 212 223 323 323 233 333 CAL 333 333 433 434 422 222 332 323 334 434 434 344 444L 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 222 222 111 111 111 111 111 111 111 111 111 111 111 M-BP 222 222 323 322 111 111 111 223 313 211 323 223 223 CAL 444 444 434 433 222 222 222 334 424 322 434 334 334F B 35
    • Clinical Examination Generalized Staining. 36
    • Clinical Examination Calculus Index: is: “Moderate, localized, accumulation sub-gingivally” 37
    • Clinical Examination Key: Restoration Caries Root Canal Tx Recurrent Dental Charting “Upper Arch” Pins PA Leison Screw18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 38
    • Clinical Examination Key: Restoration Caries  Dental Charting “Lower Arch” Root Canal Tx Recurrent PA Leison48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 39
    • Clinical Examination  Pulpal and Periapical Tests for suspected teethTooth # Cold Test Vertical Percussion Horizontal Percussion Palpation Test# 11 -ve -ve +ve +ve# 21 -ve -ve -ve -ve# 22 -ve -ve -ve -ve# 24 +ve (late) -ve -ve -ve# 46 +ve (prolonged) -ve -ve -ve Control Teeth# 14 +ve -ve -ve -ve# 25 +ve -ve -ve -ve# 34 +ve -ve -ve -ve# 36 +ve -ve -ve -ve 40
    • 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 41
    • 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 42
    • 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 43
    • Diagnosis and Treatment Planning 44
    • Treatment Objectives• Chief Complain.• Oral Hygiene Motivation.• To Restore:  Function.  Structure.  Esthetics. 45
    • Preliminary “Emergency” 46
    • Preliminary “Emergency”• Diagnosis for tooth # 46  Deep Distal Caries.  Symptomatic Irreversible Pulpitis.• Proposed Tx.  Excavation of caries and  Emergency pulp extirpation, then placement of T.F. 47
    • Preliminary “Emergency”• Diagnosis  Swelling.  Intra-oral Sinus Tract.• For Further Definitive Diagnosis  Tracking of the sinus tract, to know the origin of it.• Proposed Tx.  Pulp extirpation of the offended tooth, initial instrumentation, placing calcium hydroxide (as an intra-canal medicament) and T.F. 48
    • Phase I (Restorative) 49
    • Phase I: (Periodontic Therapy)• Diagnosis for the “Periodontium”:  Chronic Generalized Mild to Moderate Periodontitis, resulting from local factors “Plaque” and “Calculus”, “poor oral hygiene” of the patient and of “aging” as a normal physiological process. (Multi-factorial).• Prognosis: Diagnostic: Poor to Questionable. Therapeutic: Good to Fair. 50
    • Phase I: (Periodontic Therapy)• Proposed Tx.  Scaling and root planning, 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 3 months. 51
    • Phase I: (Periodontic Therapy)• Oral Hygiene Instructions:  Includes the demonstration of the right technique in brushing and flossing: Brushing “Modified Bass” technique 52
    • Phase I: (Periodontic Therapy)• Oral Hygiene Instructions:  Flossing: 53
    • 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 54
    • Phase I: (Extraction of Hopeless Teeth)• Diagnosis for tooth # 18  Hopeless tooth.  Remaining root.• Proposed Tx.  Extraction. 55
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 16:  Shallow Occlusal Caries.  Palatal Pit Caries.• Proposed Tx.  Modified class I composite restoration occlusally and palatally. 56
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 15:  Shallow Occlusal Caries.  Distal Caries.• Proposed Tx.  Modified class II composite restoration. 57
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 14:  Occluso-mesial Caries.• Proposed Tx.  Modified class II composite restoration. 58
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 13:  Well defined radiolucent area at the apex of the root.  Defective Complex Composite Restoration (Mesial, Distal and Palatal), with Pins.• Proposed Tx.  Removal of the composite restoration.  Removal of the pins.  Placement of T.F. 59
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 12:  Defective Composite Restoration (Mesial and Distal), with Pins.  Recurrent Caries.• Proposed Tx.  Removal of the composite restoration.  Removal of the pins.  Excavation of caries.  Placement of T.F. 60
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 11:  Defective Composite Restoration (Mesial and Distal), with a Pin.  Necrotic Pulp.  Well defined radiolucent area at the apex of the root, resulting from recurrent caries beneath the restored upper incisor, leading to a necrotic pulp. It is clinically asymptomatic.• Proposed Tx.  Removal of the composite restoration.  Removal of the pin.  Excavation of caries.  Placement of T.F. 61
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 21:  Defective Composite Restoration (Mesial and Distal).  Necrotic Pulp.• Proposed Tx.  Removal of the composite restoration.  Excavation of caries.  Placement of T.F. 62
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 22:  Defective Composite Restoration (Mesial and Distal).  Recurrent Caries.  Necrotic Pulp.• Proposed Tx.  Removal of the composite restoration.  Excavation of caries.  Placement of T.F. 63
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 23:  Defective Composite Restoration (Mesial and Distal), with a screw.• Proposed Tx.  Removal of the composite restoration.  Removal of the screw.  Placement of T.F. 64
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 24:  Occlusal Caries.  Mesial Caries.  Distal Caries.• Proposed Tx.  Excavation of caries.  Pulp extirpation.  Placement of T.F. 65
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 25:  Occlusal Caries.• Proposed Tx.  Modified class I composite restoration. 66
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 27:  Tarnish of The Old Amalgam Restoration.• Proposed Tx.  Polishing of the amalgam restoration. 67
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 38:  Occlusal Caries.• Proposed Tx.  Class I amalgam restoration. 68
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 37:  Occlusal Caries.• Proposed Tx.  Class I amalgam restoration. 69
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 36:  Occlusal Caries.  Distal Caries.• Proposed Tx.  Class II amalgam or composite restoration. 70
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 35:  Occlusal Caries.• Proposed Tx.  Modified class I composite restoration. 71
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 34:  Occlusal Caries.• Proposed Tx.  Modified class I composite restoration. 72
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 44:  Occlusal Caries.• Proposed Tx.  Modified class I composite restoration. 73
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 45:  Occlusal Caries.• Proposed Tx.  Modified class I composite restoration. 74
    • Phase I: (Excavation of Caries and Restorations)• Diagnosis for tooth # 47:  Occlusal Caries.• Proposed Tx.  Class I amalgam restoration. 75
    • Phase II (Endodontic) 76
    • Phase II: (Endodontic Therapy)• Diagnosis for tooth # 13:  Substandard RCT.• Periapical Diagnosis:  Well defined radiolucent area at the apex of the root. (Most probably caused of the substandard RCT).• Proposed Tx.  Re-treatment.Tooth # Cold Test Vertical Percussion Horizontal Palpation Percussion#13 +ve -ve -ve 77
    • Phase II: (Endodontic Therapy)• Diagnosis for tooth # 12:  Substandard RCT.• Periapical Diagnosis:  Normal.• Proposed Tx.  Re-treatment. 78
    • Phase II: (Endodontic Therapy)• Pulpal Diagnosis for tooth # 11:  Necrotic Pulp.• Periapical Diagnosis:  Chronic Apical Abscess.  Sinus Tract.  Well defined radiolucent area at the apex of the root, resulting from recurrent caries beneath the restored upper incisor , leading to a necrotic pulp. It is clinically asymptomatic.• Proposed Tx.  Conventional RCT. 79
    • Phase II: (Endodontic Therapy)• Pulpal Diagnosis for # 21:  Necrotic Pulp.• Periapical Diagnosis:  Normal.• Proposed Tx.  Conventional RCT. 80
    • Phase II: (Endodontic Therapy)• Pulpal Diagnosis for # 22:  Necrotic Pulp.• Periapical Diagnosis:  Normal.• Proposed Tx.  Conventional RCT. 81
    • Phase II: (Endodontic Therapy)• Diagnosis for tooth # 23:  Substandard RCT.• Periapical Diagnosis:  Normal.• Proposed Tx.  Re-treatment. 82
    • Phase II: (Endodontic Therapy)• Diagnosis for tooth # 24:  Deep Caries.  Partially Necrotic Tooth.• Periapical Diagnosis:  Normal.• Proposed Tx.  Elective RCT. 83
    • Phase II: (Endodontic Therapy)• Diagnosis for tooth # 46:  Deep Distal Caries.  Symptomatic Irreversible Pulpitis.• Periapical Diagnosis:  Symptomatic Apical Periodontitis.• Proposed Tx.  Conventional RCT.Tooth Cold Test Vertical Horizontal Palpation# Percussion Percussion#46 +ve +ve -ve -ve )Prolonged) 84
    • Phase III (Prosthetic Therapy) 85
    • Phase III (Prosthetic Therapy)• Diagnosis :  Missing Tooth: (#17).• Proposed Tx.  Implant (Ideal Tx).  RPD. Alternative Tx  Do Nothing!BL Width = Height = MD Length = 12mm 5mm 10mm 86
    • Phase III (Prosthetic Therapy)• Diagnosis for tooth # 13:  Week Remaining Tooth Structure.  RCT.• Proposed Tx.  Fiber Post and Composite Core.  Veneer or Full Ceramic Crown. 87
    • Phase III (Prosthetic Therapy)• Diagnosis for tooth # 12:  Week Remaining Tooth Structure.  RCT.• Proposed Tx.  Fiber Post and Composite Core.  Veneer or Full Ceramic Crown. 88
    • Phase III (Prosthetic Therapy)• Diagnosis for tooth # 11:  Week Remaining Tooth Structure.  RCT.• Proposed Tx.  Fiber Post and Composite Core.  Veneer or Full Ceramic Crown. 89
    • Phase III (Prosthetic Therapy)• Diagnosis for tooth # 21:  Week Remaining Tooth Structure.  RCT.• Proposed Tx.  Fiber Post.  Direct Composite Core Build-up and Veneer. 90
    • Phase III (Prosthetic Therapy)• Diagnosis for tooth # 22:  Week Remaining Tooth Structure.  RCT.• Proposed Tx.  Fiber Post and Composite Core.  Veneer or Full Ceramic Crown. 91
    • Phase III (Prosthetic Therapy)• Diagnosis for tooth # 23:  Week Remaining Tooth Structure.  RCT.• Proposed Tx.  Fiber Post and Composite Core.  Veneer or Full Ceramic Crown. 92
    • Phase II: (Endodontic Therapy)• Diagnosis for tooth # 24:  Week Remaining Tooth Structure.  RCT.• Proposed Tx.  Direct Restoration or Cast Post and Core.  Ceramo-metal Crown. 93
    • Phase III (Prosthetic Therapy)• Diagnosis :  Missing Tooth (# 26).• Proposed Tx.  Implant (Ideal Tx).  Fixed Bridge (3 unit).  RPD. Alternative Tx  Do Nothing!BL Width = Height = MD Length = 10mm 6mm 6mm 94
    • Phase III (Prosthetic Therapy)• Diagnosis :  Missing Tooth (# 42 and #43).• Proposed Tx.  Implant (Ideal Tx).  Fixed Bridge (3 unit).  RPD. Alternative Tx  Do Nothing! BL Width = Height = MD Length = 8mm 6mm 6mm 95
    • Phase III (Prosthetic Therapy)• Diagnosis for tooth # 46  Week Remaining Tooth Structure.  RCT.• Proposed Tx.  Direct Restoration or Cast Post and Core.  Ceramo-metal Crown. 96
    • Phase III (Orthodontic Therapy) 97
    • Orthodontic Consultation An orthodontic consultation is needed to:1. Correct the lower midline shift.2. Correct the Bilateral Posterior Cross bite.3. Gain a proper occlusal relationship. 98
    • Phase IV (Maintenance) 99
    • 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 and crowns. 100
    • Thank you all, for your kind attention Any Questions?