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Recurrent Procedures                      PROCEDURE                                             RATIONALE                 ...
Systemic/Diagnostic Phase    PROCEDURE                                               DESCRIPTION/RATIONALE                ...
PROCEDURE                                                DESCRIPTION/RATIONALE                                     To info...
PROCEDURE                                                DESCRIPTION/RATIONALERe-evaluation of initial non surgical   Re-e...
PROCEDURE                                                DESCRIPTION/RATIONALE                                        Orth...
PROCEDURE                                            DESCRIPTION/RATIONALE                                     PFM reducti...
Maintenance Phase               PROCEDURE                                              DESCRIPTION/RATIONALE              ...
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Dental Treatment Table - Patient SM


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Dental Treatment Table - Patient SM

  1. 1. Recurrent Procedures PROCEDURE RATIONALE -Easy to use, quick and is of low cost -Adequate accuracy for diagnostic value if Alginate - Irreversible they are poured within fifteen minutes of Diagnostic impressions impression taking hydrocolloid -Should be stored in a humid environment if there is a delay before pouring stone -Accurate, tasteless, odorless, dimensionally stable impression material -Allows for accurate multiple pours Final impressions of fixed -Triad custom tray fabricated from prosthodontic treatment diagnostic casts used to produce a uniform Vinyl Polysiloxane utilizing a (crowns/fixed dental thickness of VPS material and increasing custom tray prostheses) material conservation -VPS adhesive applied to the tray aids in material retention an decreases distortion of the material The Hanau Wide Vue ARCON Articulator is a semi-adjustable articulator -Arbitrary 110mm distance between the Hanau Wide Vue ARCON vertical components of the lower member Articulation of casts Articulator -Vertical members represent the patient’s (AR-ticulating CON-dyle) ascending ramus -ARCON articulator because the upper member houses the condylar guidance -The Spring Bow transfer system records the relationship of the patient’s maxilla to the anatomic terminal hinge axis Facebow Transfer Record Hanau Spring-Bow Facebow -Used to relate the maxillary cast to the upper member of the Hanau articulator and indirectly relate the mandibular cast to the articulator’s terminal hinge axis. -Topical ester anesthetic 20% Benzocaine Topical -Applied to dry gingival tissue for 1 minute Anesthetic -Decreases initial pain from anesthetic injection Local Anesthesia -Amide anesthetic with low allergenicity -Epinephrine is used in conjunction with the 2% Lidocaine with 1:100,000 anesthetic, primarily to increase the Epinephrine duration of analgesia -Up to 1.5hrs pulpal analgesia and 3.25 hrs soft tissue analgesia a
  2. 2. Systemic/Diagnostic Phase PROCEDURE DESCRIPTION/RATIONALE A planned, methodical and systematic approach including patient questioning and objective clinical tests to evaluate the overall health of the patientComprehensive Intra/Extra oral i. Chief Complaint - relates patient needs, desires and expectations Exam ii. Medical/Dental history - establishes current overall health of the patient Hard/Soft Tissue Exam iii. Oral Cancer Screening - allows visualization/palpation of the entire oral cavity to include floor of mouth Radiographs (Full mouth series, Bitewings, Panoramic and Cephalometric) Enables identification of: - Hard tissue pathology - Alveolar bone levels - Root configuration Radiographs - Peri-radicular lesions - Root to crown ratios - Interproximal carious lesions - Potential sites for endosseous implant placement Intra/Extra oral photographs Photos for study and presentation purposes Comprehensive Endodontic Percussion/palpation - to determine areas of peri-radicular inflammation Exam Thermal cold testing - to establish pulp vitality Assess the health of the patient’s periodontium and aid in developing a periodontal diagnosis and treatment plan. Examination to include: -Probing depths Comprehensive Periodontal -Clinical attachment level Exam -Function involvement -Tooth mobility -Bleeding on probing -Presence of calculus/plaque (PASS) Medical Consult for HTN Medical consult regarding the patient’s Stage 1 Hypertension Alginate impressions for the fabrication of diagnostic casts See Recurrent Procedures Description Utilize a Facebow transfer record to mount casts on a Hanau ARCON articulator A 3D guide to assist in treatment planning Diagnostic Waxup Aids in developing an occlusal scheme, final restoration contours and esthetics Used to fabricate a stent for tooth reduction, provisional fabrication and implant radiographic and surgical guide 2
  3. 3. PROCEDURE DESCRIPTION/RATIONALE To inform the patient of the planned treatment and discuss any alternative treatment plans Explain goals, advantages, disadvantages, and complications for each proposed plan Discusses the rationale and sequencing of each treatment, and the proposed time required to complete treatmentPresent treatment plan to patient Allows the patient the opportunity to participate with an informed decision on his treatment outcome Emphasis has been and will continue to be made on the patient improving and maintaining an acceptable level of oral hygiene throughout the treatment and maintenance phase Monitor vital signs before each To obtain baseline signs and identify any changes during treatment to ensure vital signs are procedure and continuously within acceptable limits during any surgery Any deviation from normal will receive an appropriate referralPreparatory Phase PROCEDURE DESCRIPTION/RATIONALE Control the etiology of caries and periodontal disease Improve prognosis for comprehensive treatment Oral Hygiene Instruction Evaluate compliance and reinforce effective OH Goal: 85% plaque free surfaces (PASS) Educate the patient on the effects of frequent sugar intake Diet Counseling Explain how sugar indirectly affect the pH in the mouth and, when combined with poor OH, can increase the risk of new and recurrent caries a. Removal of caries and defective restorations and restore with a Glass Ionomer restorative material b. Sealant placement Initiation of the c. CHX Rinse/Fluoride Varnish Anderson Medical Model d. Xylitol Gum e. At home fluoride rinse (ACT 0.05% NaF) f. Re-eval/bacteriologic testing Periodontal Diagnosis: Generalized Slight Chronic Periodontitis Initial non surgical periodontal therapy removes basic etiological factors i. Pre-rinse with 0.12% CHX for 30 seconds Initial Non Surgical Periodontal ii. Generalized scaling removes calculus, plaque, and stains Treatment iii. Site specific root planing of sites ≥ 3.0mm with local anesthesia if required (see Recurrent Procedures Description) Oral hygiene reinforcement - reinforce hygiene technique and standards 3
  4. 4. PROCEDURE DESCRIPTION/RATIONALERe-evaluation of initial non surgical Re-evaluation is the diagnostic appointment to evaluate the effects of non surgicalperiodontal therapy: periodontal therapyA. Periodontal charting Plaque disclosure will show the patient areas of poor plaque control and reinforce areas ofB. Decide to perform open flap success debridement to areas which do Goal: 85% plaque free surfaces (PASS) not respond to initial therapy Decision PointBy bettering his home care and diet compliance, I anticipate Patient S will display acceptable bacteriologic testing levels and attain aPASS score of 85% plaque free surfaces and <100,000 CFU of S. Mutans. Arresting Patient S’s caries process and periodontal diseasewill enable us to continue with the Preparatory Phase of treatment. Immediately following a successful re-evaluation, I will replaceall posterior GI provisional restorations with definitive amalgam restorations. Subsequently, orthodontic treatment will continue for12-18 months. The patient will be placed on 3 month periodontal recalls to ensure compliance with oral hygiene. However, if thepatient does not attain a PASS score of 85% plaque free surfaces and <100,000 CFU S. Mutans, I will replace all provisional GlassIonomer restorations with definitive restorations, and fabricate Mx and Md treatment partial dentures. Definitive Amalgam restorations will be placed in teeth #’s 3,4,5,14,21,28,31 Replace posterior provisional GI -high compressive strength restorations with definitive amalgam restorations -long history of clinical success -will act as cores for crowns Previously endodontically treated tooth #9 -Asymptomatic Endodontic Retreatment -Previously large mesial carious lesion on tooth Tooth #9 -Apical radiolucent lesion 2 appointment endodontic retreatment -Increase the probability of a successful endodontic outcome Initial fabrication of a Md treatment partial to assist in closing Md diastemas (particularly mesialization of tooth #21) Fixed Ortho Appliances Goals: Maxillary and Mandibular Arches i.Correct OB/OJ 12-18 months ii.Correct Midlines iii.Dev functional occlusion iv.Close diastemas Patient S will be on 3 month periodontal recalls to reinforce his oral hygiene 1 Stage Implant Placement Implant (opposing tooth #14) to serve as: i. Orthodontic anchorage (if required) 1 x Nobel Biocare Replace Select ii. Locator abutment for distal extension RDP Wide Platform 4
  5. 5. PROCEDURE DESCRIPTION/RATIONALE Orthodontic treatment will be considered complete when the following goals are achieved: 1. 1mm OJ Removal of Orthodontic fixed 2. 10% OB appliances 3. Intrusion of tooth #14 (≥3mm) 4. Md diastemas closed Alginate impressions for the Fabrication of Essix retainer(s) fabrication of diagnostic casts Diagnostic Waxup Diagnostic Waxup -Enables visualization of proposed treatment Diagnostic restorative waxup -Establishes proper occlusal plane and tooth forms -Aids in CCL evaluation 1. Functional crown lengthening: Teeth #’s 14,21,28 -Prevent violation of the biologic width (2.04mm) Clinical Crown Lengthening -Provide adequate exposure of tooth structure for crown placement Ant Mx Teeth 2. Esthetic crown lengthening: Teeth #’s 6-11 FDP Tooth #14 -Will reestablish the gingival margin at the desired level for an optimal esthetic result RDP abutment teeth #‘s 21 & 28 -Provide adequate exposure of tooth structure for crown placement Preparation of the teeth for PFM crowns/FDP will proceed 6 weeks following CCL if uncomplicated healing occurs Re-evaluation of the CCL procedure (s) will occur 1 week, 4 weeks and 6 weeks post op Re-evaluation of Preparation of the teeth for PFM crowns/FDP can proceed 6 weeks following CCL if Clinical Crown Lengthening uncomplicated healing occursCorrective Phase PROCEDURE DESCRIPTION/RATIONALE Type III gold casts accurately and is readily finished before and after cementation Tooth #9 cast post/core restoration using Type III gold Zinc phosphate has reduced expansion, good retention, and high compressive and tensile strength Luted with zinc phosphate cement The cast post will serve to retain the crown core PFM reduction criteria: -Labial: 1.3mm shoulder margin Prepare teeth #‘s 3,6,7,8,9 & 10 for -Incisal: 2mm reduction PFM crowns and temporize with -Palatal: 1mm reduction with 0.5mm chamfer MMA temporary material using a VPS putty stent MMA provisional material: -excellent esthetics -easy to manipulate (easy addition to voids/marginal discrepancies) 5
  6. 6. PROCEDURE DESCRIPTION/RATIONALE PFM reduction criteria: -Labial: 1.3mm shoulder margin Prepare teeth #’s 11,14 for PFM -Occlusal: crowns as FDP abutments Functional cusps: 1.5mm reduction (metal) Non-functional cusps: 1.5mm (porcelain) -Lingual: 0.5mm chamfer Survey of diagnostic waxup of RDP abutment crowns to develop: -Sufficient height of contour for retentive elements Prepare teeth #‘s 21, 28, 31 as surveyed PFM crowns to act as -Guide planes abutment teeth for Md RDP -Rest seat preparation Survey of wax up directs lab to proper contouring of PFM crowns as RDP abutments PFM crowns: -High esthetics -High wear and fracture resistance -High marginal integrityDeliver PFM crowns/FDPs and lutewith Resin-modified glass ionomer Resin Modified Glass Ionomer Luting agent cement. -Good marginal integrity -Low film thickness -Good retentive adhesive properties -Fl release Primary Impression for RDP Primary impression for fabrication of a custom tray fabrication Border molding and secondary Please see Recurrent Procedures Description for VPS impressionimpression of Md arch using VPS. -Border molding accurately captures the buccal vestibule and edentulous ridge in order toUse Locator impression coping for ensure optimal seal and distribution of forces of the denture impression -2 impressions allow for fabrication of master cast and subsequent RDP fabrication RDP intaglio surface adjusted using Pressure Indicating Paste -Occlusal evaluation and adjustment -Male locator placement utilizing chair side “pick-up” methodMd RDP denture processing, chair -Male locator attached to female attachment and captured in seated Md RDP with cold cure side male Locator attachment acrylic placement and RDP delivery -Eliminates necessity of lab-work involved in indirect method of male attachment placement -Allows for quick eval of attachment retentive properties - Denture will be polished and post insertion care and instructions reviewed 24 hr and 1 week denture re-call Occlusal and “sore-spot” adjustment and locator retention evaluation appts. Re-appoint as necessary 6
  7. 7. Maintenance Phase PROCEDURE DESCRIPTION/RATIONALE Three month periodontal recall to eval periodontal stability and reinforce Periodontal Re-eval oral hygiene. -After one year of successful recalls, SPC will be placed on 6 month recall Prosthodontic/restorative recalls at three months, Verification of stability and retention of RDP and Locator attachments nine months, then yearly Check integrity of restoration Endodontic Re-eval Yearly clinical and radiographic evaluation of endodontically treated teeth Treatment Prognosis Statement With adequate restoration of carious and defection teeth, the long term prognosis for this patient isgood. Patient S is highly motivated and very receptive to treatment options. He will be in the Army at FortHood for at least two years and should be able complete treatment. In order for the prognosis to improve, thepatient must maintain excellent oral hygiene and diet compliance, and report for recall appointments. Alternate Treatment PlanIf Patient S were to deploy within 30 days, his treatment would consist of the following:Urgent - NoneSystemic - Med referral for Stage 1 HTNPreparatoryA. Initial periodontal therapy (SRP) and OHIB. Application of a Modified Anderson Medical Model to include: i. Removal of carious lesions in teeth #’s 4,6,7,8,9,10 & 31 and placement of an RMGI provisional restorative material ii. Defective restorations in teeth #‘s 3,5,14,21 & 28 would be removed and replaced with new amalgam restorations iii. CHX 0.12%, Fl Varnish, Xylitol gum, Fl rinse (home)Decision Point i. >85% plaque free surfaces and <100,000 CFU S. Mutans ii. Sufficient time prior to deploymentCorrectiveC. Provisional restorations would be replaced with definitive restorationsD. Fabrication of maxillary and mandibular treatment partialsE. Fabrication of a bruxism splint 7