Comprehensive case , dental treatment.
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Comprehensive case , dental treatment.
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Comprehensive case , dental treatment.
- 1. Clinical Comprehensive case presentation Prepared by : Ghadah Sidqi Abulqumsan
- 3. Introduction • Patient’s name : Ms. Suha M. Murtaja • Religion : Muslim • Date of birth : 23 December, 1993 • Age : 21 • Occupation : universal student Personal data
- 4. Reason for attendance Chiefcomplaint • I want remove the plaque and & caries , and • I want repair the bad teeth in my mouth before installing the braces Medicalhistory • she’s suffering from Anemia • No allergies nor medication
- 5. • Past dental history the last dental visit before 1 and half years • Previous dental treatment multiple composite restorations of #11, #37, & #46 endodonticaly treated of #37 multiple extractions , #16, & #26 • No allergies or complications nor compilations occurred Dentalhistory • Brush twice daily with vertical and horizontal motion • Doesn't use auxiliary aids • No oral habits Oral hygiene & habits
- 7. Extra Oral Examination • Face :Symmetrical , no swelling • Skin :No abnormalities detected ( NAD ) • Lips :Competent • TMJ :No clicking, no deviation during opening & closing mouth & not tender to palpation • SMLN:not palpable and not tender to palpation
- 8. Intra Oral Examination Lips NAD Labial / Buccal mucosa NAD Hard / soft palate NAD Tongue NAD Saliva NAD Labial / Buccal / lingual vestibule NAD Gingiva NAD Floor of the mouth NAD
- 10. Frontal View
- 11. Maxillary occlusal view Mandibular occlusal view
- 12. Lateral Left ViewLateral Right View
- 13. DIAGNOSTIC TOOLS
- 14. Mounted diagnostic cast • Mounted diagnostic cast : • Molar relationship Rt : indeterminable Lt : indeterminable • Canine relationship Rt: class III Lt : class III
- 15. RADIOGRAPHS
- 16. #16, & #26 localized horizontal bone resorption due to extraction #27 over eruption #36 fly remaining root #37 Mesial tilted & Short RCT with apical third curvature in mesial roots #48 mesial impacted
- 17. Periapical films
- 20. DIAGNOSIS
- 21. Diagnosis Multiple carious teeth RR #36 Destructed crown with short RCT Partially edentulous of upper
- 22. TREATMENT PLANE
- 23. Objectives of treatment • Address the patient chief complaint. • maintain good oral hygiene. ( scaling & root planning) • To replace the missing teeth • To improve the patient comfort and masticatory ability • To maintain the health and integrity of dental arches • educate and motivate the patient. (OHI) • To restore to full function and rehabilitation of entire occlusion
- 24. Treatment options for missing teeth Orthodontic Implants Crowns and bridges RPD
- 25. Treatment phases PhaseI : Emergency treatment + oral hygiene PhaseII : Surgical & Endodontic Treatment PhaseIII : Restorative & Prosthodontic Treatment PhaseIV : Followup & Maintenance
- 26. Treatment plan • Phase I oral hygiene instructions, scalling and root planning, caries excavation of #12, #15, #17, #22, #45 & #47 Remove old restorations #11, #37 & #46 Recalling the patient after 3 weeks • Phase II Extraction RR #36 & Re-treatment root canal treatment of #37 • Phase III Permenent resto ratiomfor #11, #12, #15, #17, #22, #37, #45, #46 & #47 Post & core #37 Fixed crown #37 Refer the pt. to orthodontic to treat the spaces. • Phase IV Follow up & Maintenance
- 28. Control Oral hygiene • Generalized mild gingivitis condition • Scalling of lower lingual, • Polishing of all teeth, • Oral hygiene instructions Treatment
- 29. treatment
- 30. Extraction Condition • Remaining root #36 Treatment • Extraction
- 31. Restorative treatment • Conditions #11 mesial recurrent caries #12 mesial caries #15 tip of cusp caries #17 occlusal caries #22 mesial caries #45 tip of cusp caries #46 recurrent cries #47 occlusal caries with buccal bit caries #37 recurrent caries UR UL LR UL
- 32. Maxilla #11 mesio- incsal recurrent caries Condition • Mesio-incsal recurrent caries Treatment • Remove old resto and filled by composite
- 33. Maxilla #12 mesial caries Condition • Mesial caries Treatment • Remove caries and filled by composite
- 34. Maxilla #22 mesial caries Condition • Mesial caries Treatment • Remove caries and filled by composite
- 36. Maxilla #15 caries of the tip of cusp Condition • Tip of cusp caries Treatment • Remove caries and filled by composite
- 37. Maxilla #17 Mesial Occlusal caries Condition • Occlusal caries Treatment • Remove the caries and filled by composite
- 39. Mandible Condition • Tip of cusp caries Treatment • Remove caries and filled by composite #45 caries of the tip of cusp
- 40. Mandible Condition • Occlusal with buccal fissure caries Treatment • Remove caries and filled by composite #47 occlusal with buccal fissure caries
- 41. Mandible Condition • Recurrent cries Treatment • Remove old resto and build up and crown #46 recurrent cries
- 42. Mandible Condition • Recurrent cries with large old destructed restoration & R crown and short RCT Treatment • Remove old resto • Re-treatment of RCT • Post & core • Fixed crown #37
- 43. During treatment
- 44. After treatment
- 52. CASES TREATED WITH COMPREHENSIVE CASE
- 53. PERIODONTIC CASE
- 54. Radiographic Examination Generalized moderate horizontal bone loss
- 55. Periodontal Charting 212 323333 424 313 313 533 222 544 332 675 342 424 000 313 000 313 000 323 000 533 000 222 000 111 111 000000000 313 313 424 424412312212 212 000 000 312 000 412 122 434 312 221 445 224
- 56. 311 543 232443000 111 111 554 111112 212112 355 243 333 545 232233 112 RR RR RR 232 565 333 RR RR RR 345 344 232 454 222212211 211 000 655 443333 333222 443 221 311 644 213112 322 RR RR RR 332 644 312 RR RR RR 434 546
- 57. DIAGNISIS Generalized Chronic Moderate Severe Periodontitis
- 58. SURGICAL CASE
- 59. Clinical Scenario • A 32 year old female, came to the clinic with complaint of sever pain in #36 during the eating , this pain started after going to the dental clinic to endodontic treatment of the same tooth, but she doesn't go back again to complete the treatment , and still with TF and pain.
- 60. Examination ClinicalExamination Large occlusal cavity with little of TF RadiographicFindings • Access cavity • Perforation in furcation area • Apical lesions Pulpalvitality Test Percussion +ve Palpation -ve Cold test -ve
- 61. Diagnosis • Perforation in furcation area with apical lesion ( non restorable tooth )
- 63. ENDODONTIC CASE
- 64. Clinical scenario • A 36 year old female came to the clinic with complaint of sever spontaneous pain in upper left teeth, can't sleep due to the pain for one (1) week before coming to the clinic, the pain relief by the analgesic ( Brufen 40mg ), and no swelling detected intra& extra oral
- 65. Examination Clinical Examination Large carious cavity (Occluso-Mesial) in #26 RadiographicFindings • Large radiolucency close to the pulp • No apical lesion Pulpalvitality Test Percussion -ve Palpation -ve Cold test -ve
- 67. Root canal treatment #26 Measurement of master file & cone Canal Length Size Mesio-Buccal 19 35 Desto-Buccal 19 40 Palatal 18 45 Treatment
- 68. Radiographs Master Cones Post-operative Master filesPre-operative
- 70. Clinical Scenario • A 24 Y/O female, came to the clinic with no any symptoms, just to replace the missing teeth
- 71. Examination Clinical Examination Missing of #36 & 45 Rotation #35 RadiographicFindings No Abnormality detected Pulpalvitality Test Percussion -ve Palpation -ve Cold test +ve ( normal )
- 72. Diagnosis Partially edentulous of lower arch
Editor's Notes
- #36 fly RR #37 RCT in three canals ( MB, ML, & D ) in carved mesial root there is short RCT treated before 3 years without pain and without any periapical lesion , but should re-treated to can receive post inside treated canals & to be good prognosis with post and core #45 Class VI tip of the cusp ( radiolucent on the cusp ) #46 old large composite restoration not close to the pulp , but there is recurrent caries ( secondary ) on the margins of the restoration #47 Radiolucent on occlusal suface
- She want to installing braces ( ortho-treatment )
- #47 treated by composite build-up without crown , because not indicated, because after removal of old restoration, showing the remaining natural crown structure is strong enough to restore by build-up only
- #37 Not treated to need specialist of endodontic , so she is referred after full mouth treatment to specialist of endodontic and after that to orthodontic to treat the spaces.
- The tooth extracted with the apical lesions The socket is is excavated by periodontal excavator to remove the remaining of soft tissue , and then irrigate by normal saline
- The pre-operative film with elongation error ( show the radiolucency in #26 close to the pulp ) Initial files: MB 19 mm by file no. 15 MD 20 mm by file no. 20 P 19 mm by file no. 25 Master files: MB 19 mm by file no. 35 DB 19 mm by file no. 40 P 18 mm by file no. 45 Master cones : MB 19 mm by cone no. 35 DB 19 mm by cone no. 40 P 18 mm by cone no. 45