Decision-making and Treatment planning

1. Case Presentation
Joint Seminar Series
Prosthodontics – Periodontics - Oral Radiology
Oct. 4th, 2010
Babak Shokati

2. Gender Male
Age 58 years old
Occupation Small Business owner
Chart # 067751
General Information

3. Chief Complaint
“I want my lower teeth fixed
possibly with implant ”

4. Social History
Marital Status Married
History of Smoking Quit smoking 1 year ago
Alcohol Consumption Socially
Dental Literacy Average
Financial Status Able to Afford Tx.

5. Medical History
Medication None
Allergy History Negative
Systemic Disease Negative
Overall Health Good

6. Extra/O Examinations
Full Face Frontal:Symmetrical

7. Extra/O Examinations
Right Left

8. Extra/O Examinations
Lips (Rest) Lips (Smile)

9. Intra/O Examinations
Present
Prosthesis
Maxillary IS-Fixed Complete Denture (1995)
No Complication
Periodontal
(Excluding
Mandibular Incisors)
Chronic Periodontitis
Generalized Moderate/Severe
Loss of Attachment (≈ 50%)
Tooth Mobility (M1)
Probing Depth: 2-3 mm, No Bleeding
Furcation Involvement (Degree II)
Missing Teeth Due to Periodontal Disease
Oral Hygiene Currently: Fair

10. Intra/O Examinations
Labial Mucosa – NSF
Buccal Mucosa – NSF
Tongue – NSF
Hard palate – NSF
Soft palate – NSF
Floor of the Mouth – NSF
Saliva – WNL, Viscous

11. Intra/O Examinations
Front View

12. Intra/O Examinations
Mandibular Teeth Front View
Periodontal Splint (43,42,41,31,32,33)

13. Radiographic Findings

14. Radiographic Findings
2009
2008

15. Right
Intra/O Examinations
Maximum Intercuspal
Position (MIP)
Lateral
Excursion

16. Intra/O Examinations
Left
Maximum Intercuspal
Position (MIP)
Lateral
Excursion

17. Remaining Bone support
Less then adequate,
Tooth mobility (grade I)
Controlling etiologic factors Genetic / Maintenance
Furcation involvement Grade II
Systemic/environmental factors
Quitting smoking
no systemic disease
Patient cooperation ???
Risk Factors

18. • Kao RT. Journal of Periodontol ogy. 2008;79:971-7.
Mordohai N, et al., British Dental Journal. 2007; 202:63-72.
- Are Implants more reliable* when compared to teeth with questionable
periodontal prognosis? Under which conditions?
Debate
Treating/maintaining questionable teeth
or
replacing them with dental prostheses
(implant or conventional)
Decision Making:

19. - Does the overall Prosthodontic treatment plan - in part - determine
whether or not questionable teeth are maintained?
Debate
Decision Making:
Clinical Scenario
Is it Justified extracting a tooth with a relatively good prognosis, but
requiring several pre-treatment procedures IF:
the adjacent teeth require restorations (lower risks and costs)

20. Treatment Planning
-- Exo.: 42, 41, 31, 32 and temporary denture
-- Composite Restoration: 43, 44, (possibly 35)
-- Exo.: 36
-- IS-Fixed Bridge (42-x-x-32)
-- IS-Crown 36
-- Alternatives for 46 Either keeping or IS-crown

21. Treatment