Clinical case presentation

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Clinical case presentation

  1. 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. 2. Case presentation Localized hypersensitivity Mr. I. Cervical lesions Age: 75 Chronic periodontal diseaseSex: Male Occlusal overload Diastemas
  3. 3. 1- Defining the problemsLocalized hypersensitivityPossible causes: Pulp exposure and potential pulpal pathology Exposed root Enamel loss with exposed dentin #14
  4. 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. 5. Severe chronic periodontal disease with gingival recession  Poor oral and dental RECESSION hygiene  Occlusion problems and bad parafunctional habits SEVERE BONE LOSS
  6. 6. Occlusal overloadMalocclusionParafunctional habits (bruxism) Incisal WEAR
  7. 7. Important upper and lower anterior Diastemas •Periodontal disease •Occlusal overload •Inter-arch tooth size discrepancies
  8. 8. 2- Elaboration of a treatment planning A- Medical History The patient is asked to declare any medical condition (present and past)
  9. 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. 10. 1- CHIEF COMPLAINT: Tooth # 14Indirect pulp RCT capping
  11. 11. 2- Preventive measures
  12. 12. 3-Interdisciplinary discussion Occlusion adjustment Root scaling
  13. 13. Orthodontic treatment (?)
  14. 14. 4- Discussing the options with the patient Option 1 Direct composite Veneers
  15. 15. Post. teeth Tooth #14 Tooth #44 Crown replacementClV composite Cl V comp/ Endo+ Crown
  16. 16. Option 2 Orthodontic
  17. 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. 18. PSIf Orthodontic movement creates large posterior space, then consider RPD with dento-mucosal support
  19. 19. Option 3
  20. 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. 21. splinting Stabilization of loose teeth and occlusion Types:- Fixed: Wire & composite splints, Ribbond- Removable appliances: Hawley, Clear tray
  22. 22. Wire & composite technique
  23. 23. Ribbond unfilled bonding adhesivefilled composite
  24. 24. flowable composite
  25. 25. ? Removable appliances+ night guard??
  26. 26. ReviewTreatment Aesthetics Preservation Resistance Cost Time*Direct ok shortVeneers(C) + - - (large gaps* ClV post = large*Crown 44 teeth)And orCrown 14*Splinting
  27. 27. Treatment Aesthetics Preservation Resistance Cost Time*Orthodontic High Long*ClV, ClIV, +++ +++ +++ClI(C)*Crown 44And or Crown14*Splintingand retention
  28. 28. Treatment Aesthetics Preservation Resistance Cost Time*Full mouth High Okrestorations + -- ++with crowns (long*Splinting crowns)
  29. 29. Treatment Aesthetics Preservation Resistance Cost Time*Keep the - Low shortdiastemas +++ +++*ClV, ClIV,ClI(C)*Crown 44And orCrown 14*Splinting
  30. 30. + Age + Motivation +Patient Preferences
  31. 31. 5- Proceeding with the treatmentOption # 4 Keep the diastemas, treat all other lesionsOption # 1 Direct composite Veneers
  32. 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. 33. Thank you

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