Rania saeed l12 case presentation

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Rania saeed l12 case presentation

  1. 1. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY COMPREHENSIVE CASE PRESENTATION Prepared by: Aljohara Alfaqeeh ID #: 42820042 Level: 12ALJOHARA ALFAQEEH 42820042 1
  2. 2. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYPersonal Data: Age: 33 years old. Gender: Female. Nationality: Sudanese. Occupation: Housewife. Social Status: Married. Patient’s Cooperation: Cooperative. File Number : 42538.ALJOHARA ALFAQEEH 42820042 2
  3. 3. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYChief Complain:“ Do a general check up because I have a lot of decayed & corroded teeth. ”ALJOHARA ALFAQEEH 42820042 3
  4. 4. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYMedical History:She is medically fit.She takes OCP pills for birth control.ALJOHARA ALFAQEEH 42820042 4
  5. 5. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYFamily Medical History:There is no significant family medical history mentioned.ALJOHARA ALFAQEEH 42820042 5
  6. 6. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYPast Dental History:Multiple root canal treated teeth.Multiple restored teeth.Multiple extracted teeth.1 FPD unit.ALJOHARA ALFAQEEH 42820042 6
  7. 7. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYOral Hygiene Activity: -Good Oral Hygiene. - Patient uses:Tooth brush : once & sometimes twice/day.Tooth Brush : soft brush.Brushing technique : horizontal (scrub) technique.Dental floss/ Meswak / Mouth wash : none.ALJOHARA ALFAQEEH 42820042 7
  8. 8. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYRecommended:- Tooth brush type: Soft Nylon bristle tooth brush.- Brushing Frequency: 2-3 times per day.- Brushing Methods: modified bass technique.- Interdental Aids: Dental floss.ALJOHARA ALFAQEEH 42820042 8
  9. 9. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Clinical ExaminationALJOHARA ALFAQEEH 42820042 9
  10. 10. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYI. Extra Oral Examination:SkinTMJLymph nodes All within normal(Cervical, Submandibular) limits.NeckALJOHARA ALFAQEEH 42820042 10
  11. 11. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYII. Intra Oral Examination (soft tissue):Lips.Vestibules.Soft palate . All within normalTongue . limits.Floor of the mouth.Hard Palate  Patient has torus palatinus.ALJOHARA ALFAQEEH 42820042 11
  12. 12. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYII. Intra Oral Examination (dentition):Maxillary archALJOHARA ALFAQEEH 42820042 12
  13. 13. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYII. Intra Oral Examination (dentition):Mandibular archALJOHARA ALFAQEEH 42820042 13
  14. 14. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Pretreatment PhotographsALJOHARA ALFAQEEH 42820042 14
  15. 15. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYALJOHARA ALFAQEEH 42820042 15
  16. 16. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYALJOHARA ALFAQEEH 42820042 16
  17. 17. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYALJOHARA ALFAQEEH 42820042 17
  18. 18. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYALJOHARA ALFAQEEH 42820042 18
  19. 19. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYALJOHARA ALFAQEEH 42820042 19
  20. 20. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYALJOHARA ALFAQEEH 42820042 20
  21. 21. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYALJOHARA ALFAQEEH 42820042 21
  22. 22. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Periodontal ChartALJOHARA ALFAQEEH 42820042 22
  23. 23. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYGingival Index By: “Silness and Loe,1967” 1 1 1 1 1 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1Total = 1.1  Moderate gingivalinflammation of the gingiva ALJOHARA ALFAQEEH 42820042 23
  24. 24. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYPlaque Index: By: “Silness and Loe,1967” 2 0 2 2 0 0 1 1 1 1 1 1 2 1 0 1 1 1 0 0Total = 0.75  Mild plaque accumolation ALJOHARA ALFAQEEH 42820042 24
  25. 25. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYCalculus Score:Initial generalized calculus deposits.ALJOHARA ALFAQEEH 42820042 25
  26. 26. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY PSR (Periodontal Screening & Recording): 3 3 1 3 3 3 3ALJOHARA ALFAQEEH 42820042 26
  27. 27. Bleeding M-CEJ M-PD 113 532 332 123 212 212 212 224 212 323 323 CAL 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-PD 344 545 222 223 212 212 222 212 221 322 121 CALBleeding ALFAQEEH 42820042 ALJOHARA 27
  28. 28. Bleeding M-CEJ M-PD 345 222 212 312 311 211 212 212 211 112 323 433 324 422 CAL 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-PD 433 222 322 212 213 313 212 114 113 313 114 215 314 315 CALBleeding ALFAQEEH 42820042 ALJOHARA 28
  29. 29. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Mobility assessment0  No detectable mobility other than physiologic. No Furcation involvement. Local factors:Plaque.Calculus.Iatrogenic factors : defective bridge and restorations.ALJOHARA ALFAQEEH 42820042 29
  30. 30. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYDiagnosis:Generalized mild Chronic Periodontitis.Overall Prognosis:Good.ALJOHARA ALFAQEEH 42820042 30
  31. 31. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYDiet analysis:- 3 meals/day.- Snacks between meals.- High sugar amount added to tea.- A lot of coffee and dates.ALJOHARA ALFAQEEH 42820042 31
  32. 32. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYRecommendations:- Reduction of Carbohydrates intake.- Reduce the amount of coffee and tea.- Include fruits and vegetables in her diet.ALJOHARA ALFAQEEH 42820042 32
  33. 33. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYCRT (Caries Risk Test): Saliva buffer capacity High Saliva viscosity ViscousALJOHARA ALFAQEEH 42820042 33
  34. 34. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY CRT (Caries Risk Test):Mutans Streptococci : High RiskLactobacilli : High Risk According to the “ Standard chart” ALJOHARA ALFAQEEH 42820042 34
  35. 35. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Salivary Flow Rate: STIMULATED SALIVARY FLOW RATE : 1.2ml / min NORMAL VALUES: STIMULATED 0.7-1.5 ml/min.ALJOHARA ALFAQEEH 42820042 35
  36. 36. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYDiagnostic tools:Radiographs.Mounted Cast.ALJOHARA ALFAQEEH 42820042 36
  37. 37. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYALJOHARA ALFAQEEH 42820042 37
  38. 38. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Right BitewingsALJOHARA ALFAQEEH 42820042 38
  39. 39. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Left BitewingsALJOHARA ALFAQEEH 42820042 39
  40. 40. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Right Side PeriapicalsALJOHARA ALFAQEEH 42820042 40
  41. 41. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Left Side PeriapicalsALJOHARA ALFAQEEH 42820042 41
  42. 42. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYUpper & LowerAnteriors Periapicals ALJOHARA ALFAQEEH 42820042 42
  43. 43. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY• Mounted Diagnostic Cast-Midline:Upper midline is normalLower midline deviated to the Right side by2 mm.Mild Diastima  frenectomy.-Vertical Overbite: 60%-Horizontal Over jet: 3 - 4mmAnterior Cross bite.Lingual Cross bite.ALJOHARA ALFAQEEH 42820042 43
  44. 44. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY• Mounted Diagnostic Cast Canine Relationship: Class I. Molar Relationship: Non applicable.ALJOHARA ALFAQEEH 42820042 44
  45. 45. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY• Mounted Diagnostic CastCanine Relationship:Class I.Molar Relationship:Non applicable. Over eruption of the canine due the Lingual Cross bite.ALJOHARA ALFAQEEH 42820042 45
  46. 46. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY• Mounted Diagnostic Cast No crowding. Mild spacing. Upper molars are rotated ( #18, #17, #27, #28).ALJOHARA ALFAQEEH 42820042 46
  47. 47. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Vitality & Percussion TestALJOHARA ALFAQEEH 42820042 47
  48. 48. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYApplication of Endo Frost (-50° C) on suspected teeth.Tooth # Cold test V. Percussion H. Percussion Pulp Periapical test test Diagnosis Diagnosis#17 +ve -ve -ve Normal Normal ALJOHARA ALFAQEEH 42820042 48
  49. 49. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYApplication of Endo Frost (-50° C) on suspected teeth.Tooth # Cold test V. Percussion H. Percussion Pulp Periapical test test Diagnosis Diagnosis#14 -ve +ve -ve Previously Symptomatic Treated Apical Periodontitis ALJOHARA ALFAQEEH 42820042 49
  50. 50. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYApplication of Endo Frost (-50° C) on suspected teeth.Tooth # Cold test V. Percussion H. Percussion Pulp Periapical test test Diagnosis Diagnosis#12 -ve -ve -ve Previously Normal Treated ALJOHARA ALFAQEEH 42820042 50
  51. 51. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYApplication of Endo Frost (-50° C) on suspected teeth.Tooth # Cold test V. Percussion H. Percussion Pulp Periapical test test Diagnosis Diagnosis#11 -ve -ve -ve Previously Normal Treated ALJOHARA ALFAQEEH 42820042 51
  52. 52. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYApplication of Endo Frost (-50° C) on suspected teeth.Tooth # Cold test V. Percussion H. Percussion Pulp Periapical test test Diagnosis Diagnosis#21 -ve -ve -ve Previously Normal Treated ALJOHARA ALFAQEEH 42820042 52
  53. 53. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYApplication of Endo Frost (-50° C) on suspected teeth.Tooth # Cold test V. Percussion H. Percussion Pulp Periapical test test Diagnosis Diagnosis#27 +ve -ve -ve Normal Normal ALJOHARA ALFAQEEH 42820042 53
  54. 54. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYApplication of Endo Frost (-50° C) on suspected teeth.Tooth # Cold test V. Percussion H. Percussion Pulp Periapical test test Diagnosis Diagnosis#36 +ve -ve -ve Normal Normal ALJOHARA ALFAQEEH 42820042 54
  55. 55. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYApplication of Endo Frost (-50° C) on suspected teeth.Tooth # Cold test V. Percussion H. Percussion Pulp Periapical test test Diagnosis Diagnosis#45 +++ve -ve -ve Irriversable Normal Pulpitis (symptomatic) ALJOHARA ALFAQEEH 42820042 55
  56. 56. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYApplication of Endo Frost (-50° C) on suspected teeth.Tooth # Cold test V. Percussion H. Percussion Pulp Periapical test test Diagnosis Diagnosis#46 -ve +ve -ve Previously Asymptomatic Treated Apical Periodontitis ALJOHARA ALFAQEEH 42820042 56
  57. 57. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYTREATMENT OBJECTIVES:- CONTROL ACTIVE DISEASES.- EXTRACT NON RESTORABLE TEETH.- IMPROVE ORAL HYGIENE.- CARIES CONTROL.- RESTORE FUNCTION AND ESTHETICS.- MAINTAIN THE RESULTS.ALJOHARA ALFAQEEH 42820042 57
  58. 58. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Treatment PlanALJOHARA ALFAQEEH 42820042 58
  59. 59. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYTreatment Phases:Phase I : Emergency/ Preventive Treatment.Phase II : Operative Treatment.Phase III : Endodontic Treatment.Phase IV : Pre-Prosthetic / Surgical Treatment.Phase V : Prosthodontic Treatment.Phase VI : Recall & Maintenance.ALJOHARA ALFAQEEH 42820042 59
  60. 60. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Problem Proposed treatment Generalized mild Chronic Periodontitis.  Extraction of Hopeless teeth.  OHI instructions & plaque control.  Supragingival scaling & polishing.  Correction of iatrogenic factor.  Re-evaluation after 4 – 6 weeks.  Maintenance every 3 months.ALJOHARA ALFAQEEH 42820042 60
  61. 61. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #18  Occlusal Caires Class I Composite restoration.ALJOHARA ALFAQEEH 42820042 61
  62. 62. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #17  Under prepared Prepare the tooth for abutment. surveyed crown.ALJOHARA ALFAQEEH 42820042 62
  63. 63. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #16, #15 Missing. Implant. RPD.ALJOHARA ALFAQEEH 42820042 63
  64. 64. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #14  Extensive Caries. Extraction.ALJOHARA ALFAQEEH 42820042 64
  65. 65. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #12  Substandard RCT. + Root  Remove Gp block the wall with MTA Resorption because of the trauma from and wait till the internal wall of the occlusion (cross bite). tooth regenerate. After that RCT + post & core + Crown. Or  Extract the tooth and replace it by :Implant PFM RPDALJOHARA ALFAQEEH 42820042 65
  66. 66. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #11  Broken incisors + Remove screw post + malformed restoration + Redo RCT + post & core + Substandard RCT + Root porcelain crown. Resorption.ALJOHARA ALFAQEEH 42820042 66
  67. 67. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #21  Broken incisors + Remove pin + Redo RCT malformed restoration. + post & core + porcelain crown.ALJOHARA ALFAQEEH 42820042 67
  68. 68. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #22 Recurrent caries. Redo Class III composite restoration.ALJOHARA ALFAQEEH 42820042 68
  69. 69. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #23  Distal Caries Class III composite restoration.ALJOHARA ALFAQEEH 42820042 69
  70. 70. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #24 #25 #26 Missing. Implant. RPD.ALJOHARA ALFAQEEH 42820042 70
  71. 71. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #27 Faulty Restoration. Redo Restoration.ALJOHARA ALFAQEEH 42820042 71
  72. 72. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #28  Occlusal Caries. Class I Composite restoration.ALJOHARA ALFAQEEH 42820042 72
  73. 73. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #37 Faulty Restoration Redo Restoration. + recurrent caries.ALJOHARA ALFAQEEH 42820042 73
  74. 74. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #36 Over hanged Redo Restoration. amalgam restoration.ALJOHARA ALFAQEEH 42820042 74
  75. 75. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #42 #43 Over Eruption. Shave the teeth to create more space for the upper #12 & to relief the trauma from occlusion.ALJOHARA ALFAQEEH 42820042 75
  76. 76. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #34 Distal pit Caries. PRR.ALJOHARA ALFAQEEH 42820042 76
  77. 77. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #44 Pit Caries. PRR.ALJOHARA ALFAQEEH 42820042 77
  78. 78. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #45  Extensive Caries. Endo + Post and core & Crown ( tooth will need crown lengthening ).ALJOHARA ALFAQEEH 42820042 78
  79. 79. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #46  Extensive Caries. Extraction.ALJOHARA ALFAQEEH 42820042 79
  80. 80. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #47 Missing. Implant. RPD.ALJOHARA ALFAQEEH 42820042 80
  81. 81. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Tooth Proposed treatment #48 Occlusal Caries. Class I Composite restoration.ALJOHARA ALFAQEEH 42820042 81
  82. 82. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYPre- Prosthetic/ Surgical Phase IV:Torus Palatinus:Treatment:Surgically remove the torus palatinusbecause if it will interfere with the placementof the denture and replace it with skin graft.But in our case we wont remove it becauseour major connector is horse shoe.ALJOHARA ALFAQEEH 42820042 82
  83. 83. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYProsthetic Phase V: ALJOHARA ALFAQEEH 42820042 83
  84. 84. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY Wax UpALJOHARA ALFAQEEH 42820042 84
  85. 85. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYProsthodontic Treatment: RPD Design Major Direct Indirect for Upper Arch Connector Retainers Retainers Class III Horse Shoe #17  #13, #23  modification I Surveyed Cingulum Rest Crown #17, #27  #17 #27 Mesial Rest Aker Clasp #13, #23 T bar.ALJOHARA ALFAQEEH 42820042 85
  86. 86. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYProsthodontic Treatment: RPD Design Major Direct Indirect for Lower Arch Connector Retainers Retainers Class III Lingual Bar #45 #45, #36  Surveyed Distal Rest. Crown #48, #37  #45, #48  Mesial Rest. Aker Clasp #33, #43  #37, #36  Cingulum Rest. Double Aker ClaspALJOHARA ALFAQEEH 42820042 86
  87. 87. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYRecall & Maintenance Phase VI:Recall Patient every 3 months :For periodontal maintenance .Recall Patient every 6 months :To take full mouth radiographs and to check the restorations , prosthesis and RCT .ALJOHARA ALFAQEEH 42820042 87
  88. 88. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGYTreatment Phases:Phase I : Emergency/ Preventive Treatment.Phase II : Operative Treatment.Phase III : Endodontic Treatment.Phase IV : Pre-Prosthetic / Surgical Treatment.Phase V : Prosthodontic Treatment.Phase VI : Recall & Maintenance.ALJOHARA ALFAQEEH 42820042 88
  89. 89. RIYADH COLLEGES OF DENTISTRY & PHARMACOLOGY THANK YOUALJOHARA ALFAQEEH 42820042 89

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