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Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
Clinical case presentation
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Clinical case presentation

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This presentation is about a clinical case. All photos are not property of the author of the presentation.

This presentation is about a clinical case. All photos are not property of the author of the presentation.

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  • 1. Problem Based Learning: Clinical caseL E B A N E S E U N I V E R S I T Y- S C H O O L O F D E N T I S T R Y DUB1-DRE S T E P H A N I E M O U AWA D 0 9 - 0 3 - 2 0 11
  • 2. Case presentation Localized hypersensitivity Mr. I. Cervical lesions Age: 75 Chronic periodontal diseaseSex: Male Occlusal overload Diastemas
  • 3. 1- Defining the problemsLocalized hypersensitivityPossible causes: Pulp exposure and potential pulpal pathology Exposed root Enamel loss with exposed dentin #14
  • 4. Cervical lesions on premolars and molars Tensile stresses causing abfraction, Associated with other local chemical and biomechanical factors, causing erosion and abrasion Increased stress (tooth # 14: opposing crown)
  • 5. Severe chronic periodontal disease with gingival recession  Poor oral and dental RECESSION hygiene  Occlusion problems and bad parafunctional habits SEVERE BONE LOSS
  • 6. Occlusal overloadMalocclusionParafunctional habits (bruxism) Incisal WEAR
  • 7. Important upper and lower anterior Diastemas •Periodontal disease •Occlusal overload •Inter-arch tooth size discrepancies
  • 8. 2- Elaboration of a treatment planning A- Medical History The patient is asked to declare any medical condition (present and past)
  • 9. B- Sequencing of treatment1- Chief complaint2- Preventive measures (motivation to oral care)3- Interdisciplinary discussion (periodontist/ orthodontist)4- Discussion of treatment options with patient (take consent to proceed)5- Treatment procedure
  • 10. 1- CHIEF COMPLAINT: Tooth # 14Indirect pulp RCT capping
  • 11. 2- Preventive measures
  • 12. 3-Interdisciplinary discussion Occlusion adjustment Root scaling
  • 13. Orthodontic treatment (?)
  • 14. 4- Discussing the options with the patient Option 1 Direct composite Veneers
  • 15. Post. teeth Tooth #14 Tooth #44 Crown replacementClV composite Cl V comp/ Endo+ Crown
  • 16. Option 2 Orthodontic
  • 17. 13 11 23 14 Cl V compositeCl V composite/ crown Cl I Incisal 16 15 45 44 41 31 46 Cl V composite Crown replacement Cl IV composite
  • 18. PSIf Orthodontic movement creates large posterior space, then consider RPD with dento-mucosal support
  • 19. Option 3
  • 20. Option 4 13 11 23 14Cl V composite/ crown Cl V composite Cl I Incisal 16 15 45 44 41 31 46Cl V composite Crown replacement Cl IV composite
  • 21. splinting Stabilization of loose teeth and occlusion Types:- Fixed: Wire & composite splints, Ribbond- Removable appliances: Hawley, Clear tray
  • 22. Wire & composite technique
  • 23. Ribbond unfilled bonding adhesivefilled composite
  • 24. flowable composite
  • 25. ? Removable appliances+ night guard??
  • 26. ReviewTreatment Aesthetics Preservation Resistance Cost Time*Direct ok shortVeneers(C) + - - (large gaps* ClV post = large*Crown 44 teeth)And orCrown 14*Splinting
  • 27. Treatment Aesthetics Preservation Resistance Cost Time*Orthodontic High Long*ClV, ClIV, +++ +++ +++ClI(C)*Crown 44And or Crown14*Splintingand retention
  • 28. Treatment Aesthetics Preservation Resistance Cost Time*Full mouth High Okrestorations + -- ++with crowns (long*Splinting crowns)
  • 29. Treatment Aesthetics Preservation Resistance Cost Time*Keep the - Low shortdiastemas +++ +++*ClV, ClIV,ClI(C)*Crown 44And orCrown 14*Splinting
  • 30. + Age + Motivation +Patient Preferences
  • 31. 5- Proceeding with the treatmentOption # 4 Keep the diastemas, treat all other lesionsOption # 1 Direct composite Veneers
  • 32. Maintenance and recall Check the state of the splints/effect of night guard Check for gum health and bone supportcheckups every 6 months for overall treatment control
  • 33. Thank you

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