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LOGO        RIYADH COLLEGE OF DENTISTRY AND
                      PHARMACY



Comprehensive Case
  Presentation

              Prepared By:
                 p      y
       Sultan Rkeeb al-Shammery
                    al-

                 Level

                  12

                                              1
Age : 25

           Gender : Male

           Nationality : Yamani

       Occupation : receptionist

Marital & Social Status : Single


                       2
In the ‫• ﺗﺼﺒﻐﺎت ﻓﻲ‬
          ‫ﻲ‬      ‫ﺒ‬
patient’s
   i ’      ‫اﻷﺳﻨﺎن‬
  own
 words:
     d      ‫اﻷﻣﺎﻣﻴﺔ‬

•History of Chief Complaint


 Long time ago
    g       g
                              3
Medical History

Within Normal •

Family Medical History
Within Normal •

Past Dental History
Just for check up •
                p
                      4
No habits       He use tooth
                brush twice a
                day




            5
6
I. Extra – Oral Examination



  Swelling


    Skin       NAD


    TMJ




                          7
II. Intra – Oral Examination
II.




                 NAD




                           8
III . Oral Hygiene

   Gingival Index ► 1 mild inflammation

    18   17   16   15   14   13   12   11   21   22   23   24   25   26   27   28


              1                             1              1
                        1              0                              1
    48   47   46   45   44   43   42   41   31   32   33   34   35   36   37   38



    Plaque Index ► 1

    18   17   16   15   14   13   12   11   21   22   23   24   25   26   27   28


              1                             0              1
                        1              0                              1
    48   47   46   45   44   43   42   41   31   32   33   34   35   36   37   38


                                                 9
PRE-TREATMENT PHOTOGRAPHS



             10
Frontal view




               11
Maxillary Occlusal view




                     12
Mandibular Occlusal view




                       13
Right lateral view




                     14
Left lateral view




                    15
16
Panoramic
Pa o amic




            17
Bitwing Radiograph




                     18
Diagnostic Casts




         19
20
1                2              3
generalized
        li d        Carious teeth   Extraction
sever enamel
fluorosis with
stains             16 , 17 , 18 ,    28 , 38
affecting all of   27, 37 , 47 ,
the permanent
teeth              48




                             21
Caries




         22
Caries




         23
Diagnosis




 Periodontium:   Generalized mild gingivitis
                 G     li d ild i i iti




                           24
25
26
Phase I
Ph             Perio treatment



    Condition:
    Generalized mild gingivitis


    Recommendation :
    Polishing , Oral hygiene instructions




                                  27
28
Phase II   Operative t
           Op   ti treatment
                       tm nt




                    Condition:
                    # 18 , O Caries
                           O. C ries


                    Recommendation :
                    Class I composite restoration


                           29
Condition:
# 17 , O Caries
       O. C ries


Recommendation :
Class I composite restoration


       30
Condition:
# 16 , Dist l , Palatal Caries
       Distal P l t l C ries


Recommendation :
P.R.R


        31
Condition:
# 27 , O. Caries


Recommendation :
Class I composite restoration


                           32
Condition:
# 37 , O. Caries


Recommendation :
P.R.R


                   33
Condition:
# 4 , O. Caries
  48


Recommendation :
Class I composite restoration




       34
Condition:
# 4 , O. Caries
  47


Recommendation :
P.R.R




       35
36
Condition:
# 38 , impacted teeth


Recommendation :
Extraction




                        37
Phase III Surgical Treatment
Condition:
# 28 , traumatize and No opposing
after extraction tooth # 38


Recommendation :
Extraction


 After discussing the Surgical
 treatment plan with the patient ,
 The patient said (No need to go
 surgery at this time , Because No
    g y
 any symptoms or pain in this time




                                     38
39
Upper anterior teeth
U       t i t th

Condition:
Sever dental fluorosis of
TFI = 6-9 with yellow/brown
       6 9
discoloration, based on the 1978
dental flourosis classification scheme of
Thylstrup and Fejerskov


Recommendation options :
- Bleaching ??
- Veneer




                                            40
41
preparation ( 0.5 – 0.8 ) mm
midfacially , ( 0 3 – 0 5 )mm along
                0.3 0.5
       the gingival margin




42
p    y    p
Temporary composite restoration

                                  43
After veneer cementation



44
45
Lower anterior teeth
L       t i t th

Condition:
Sever dental fluorosis of
TFI = 6-9 with yellow/brown
       6 9
discoloration, based on the 1978
dental flourosis classification scheme of
Thylstrup and Fejerskov


Recommendation options :
- Bleaching or microabrasion
  ( coast?? Pt need ?? )
- Veneer



                                            46
Microabrasion



                              Conservative treatment
 Bleaching

                Veneer




                         47
Microabrasion
Mi    b i

        ( No any Effect )




                 48
Bleaching ( ZOOM2)
                49
Bleaching ( ZOOM2)
  eac g OO )




    isolation




                     50
Bleaching ( ZOOM2)
  eac g OO )




                          Whitening Gel




                     51
Bleaching ( ZOOM2)
  eac g OO )




                          ZOOM light
                                   g
                          ( 45 – mint )




                     52
After Bleaching


                  53
After 1 month


                54
Veneer


After 1 month , patient come back to evaluate the lower
anterior shade color . The CC In the patient s own words
                                     patient’s
‫ﻟﻮن اﻷﺳﻨﺎن ﻣﺎ ﻋﺠﺒﻨﻲ‬
‫وارﻏﺐ ﻓﻲ ﻋﻤﻞ ﺗﺮآﻴﺒﺎت ﻟﻸﺳﻨﺎن اﻟﺴﻔﻠﻴﺔ‬




                                        55
56
57
Temporary composite restoration
                                  58
Return        After veneer cementation
         59
POST-TREATMENT PHOTOGRAPHS



             60
Frontal view




               61
Maxillary Occlusal view




                     62
Mandibular Occlusal view




                       63
Right lateral view




                     64
Left lateral view




                    65
1   restore esthetic and function



2         improve his OHI
                                         Treatment
                                         T
                                         Objectives
                                           j

3          control caries




                                    66
LOGO




       67
office bleaching with 35% hydrogen
peroxide does not significantly affect the
color and luminosity of fluorotic teeth

                        Konsl 2007 , dental digest journal



   Return

                        68
Conservative treatment options such as tooth whitening
                          p                           g
and microabrasion can dramatically improve severely
discoloured fluorosed teeth. This can provide a
satisfactory interim outcome or minimize the removal of
discoloured enamel and dentine prior to the provision of
veneers
                              Manton DJ , 2007 Australian dental journal




   return


                               69
A chronic endemic form of hypoplasia of the dental
 e a e
 enamel caused by d   drinking water with a high
                             g ate     t      g
 fluorine content during the time of tooth
 formation, and characterized by defective
            ,                     y
 calcification that gives a white chalky
 appearance to the enamel, which g
   pp                         ,      graduallyy
 undergoes brown discoloration.

                      Jablonski's Dictionary of Dentistry, 1992, p286

Return
                             70

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Comprehensive Case Presentation Sultan Alshammery

  • 1. LOGO RIYADH COLLEGE OF DENTISTRY AND PHARMACY Comprehensive Case Presentation Prepared By: p y Sultan Rkeeb al-Shammery al- Level 12 1
  • 2. Age : 25 Gender : Male Nationality : Yamani Occupation : receptionist Marital & Social Status : Single 2
  • 3. In the ‫• ﺗﺼﺒﻐﺎت ﻓﻲ‬ ‫ﻲ‬ ‫ﺒ‬ patient’s i ’ ‫اﻷﺳﻨﺎن‬ own words: d ‫اﻷﻣﺎﻣﻴﺔ‬ •History of Chief Complaint Long time ago g g 3
  • 4. Medical History Within Normal • Family Medical History Within Normal • Past Dental History Just for check up • p 4
  • 5. No habits He use tooth brush twice a day 5
  • 6. 6
  • 7. I. Extra – Oral Examination Swelling Skin NAD TMJ 7
  • 8. II. Intra – Oral Examination II. NAD 8
  • 9. III . Oral Hygiene Gingival Index ► 1 mild inflammation 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 1 1 1 1 0 1 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 Plaque Index ► 1 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28 1 0 1 1 0 1 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 9
  • 16. 16
  • 20. 20
  • 21. 1 2 3 generalized li d Carious teeth Extraction sever enamel fluorosis with stains 16 , 17 , 18 , 28 , 38 affecting all of 27, 37 , 47 , the permanent teeth 48 21
  • 22. Caries 22
  • 23. Caries 23
  • 24. Diagnosis Periodontium: Generalized mild gingivitis G li d ild i i iti 24
  • 25. 25
  • 26. 26
  • 27. Phase I Ph Perio treatment Condition: Generalized mild gingivitis Recommendation : Polishing , Oral hygiene instructions 27
  • 28. 28
  • 29. Phase II Operative t Op ti treatment tm nt Condition: # 18 , O Caries O. C ries Recommendation : Class I composite restoration 29
  • 30. Condition: # 17 , O Caries O. C ries Recommendation : Class I composite restoration 30
  • 31. Condition: # 16 , Dist l , Palatal Caries Distal P l t l C ries Recommendation : P.R.R 31
  • 32. Condition: # 27 , O. Caries Recommendation : Class I composite restoration 32
  • 33. Condition: # 37 , O. Caries Recommendation : P.R.R 33
  • 34. Condition: # 4 , O. Caries 48 Recommendation : Class I composite restoration 34
  • 35. Condition: # 4 , O. Caries 47 Recommendation : P.R.R 35
  • 36. 36
  • 37. Condition: # 38 , impacted teeth Recommendation : Extraction 37
  • 38. Phase III Surgical Treatment Condition: # 28 , traumatize and No opposing after extraction tooth # 38 Recommendation : Extraction After discussing the Surgical treatment plan with the patient , The patient said (No need to go surgery at this time , Because No g y any symptoms or pain in this time 38
  • 39. 39
  • 40. Upper anterior teeth U t i t th Condition: Sever dental fluorosis of TFI = 6-9 with yellow/brown 6 9 discoloration, based on the 1978 dental flourosis classification scheme of Thylstrup and Fejerskov Recommendation options : - Bleaching ?? - Veneer 40
  • 41. 41
  • 42. preparation ( 0.5 – 0.8 ) mm midfacially , ( 0 3 – 0 5 )mm along 0.3 0.5 the gingival margin 42
  • 43. p y p Temporary composite restoration 43
  • 45. 45
  • 46. Lower anterior teeth L t i t th Condition: Sever dental fluorosis of TFI = 6-9 with yellow/brown 6 9 discoloration, based on the 1978 dental flourosis classification scheme of Thylstrup and Fejerskov Recommendation options : - Bleaching or microabrasion ( coast?? Pt need ?? ) - Veneer 46
  • 47. Microabrasion Conservative treatment Bleaching Veneer 47
  • 48. Microabrasion Mi b i ( No any Effect ) 48
  • 50. Bleaching ( ZOOM2) eac g OO ) isolation 50
  • 51. Bleaching ( ZOOM2) eac g OO ) Whitening Gel 51
  • 52. Bleaching ( ZOOM2) eac g OO ) ZOOM light g ( 45 – mint ) 52
  • 55. Veneer After 1 month , patient come back to evaluate the lower anterior shade color . The CC In the patient s own words patient’s ‫ﻟﻮن اﻷﺳﻨﺎن ﻣﺎ ﻋﺠﺒﻨﻲ‬ ‫وارﻏﺐ ﻓﻲ ﻋﻤﻞ ﺗﺮآﻴﺒﺎت ﻟﻸﺳﻨﺎن اﻟﺴﻔﻠﻴﺔ‬ 55
  • 56. 56
  • 57. 57
  • 59. Return After veneer cementation 59
  • 66. 1 restore esthetic and function 2 improve his OHI Treatment T Objectives j 3 control caries 66
  • 67. LOGO 67
  • 68. office bleaching with 35% hydrogen peroxide does not significantly affect the color and luminosity of fluorotic teeth Konsl 2007 , dental digest journal Return 68
  • 69. Conservative treatment options such as tooth whitening p g and microabrasion can dramatically improve severely discoloured fluorosed teeth. This can provide a satisfactory interim outcome or minimize the removal of discoloured enamel and dentine prior to the provision of veneers Manton DJ , 2007 Australian dental journal return 69
  • 70. A chronic endemic form of hypoplasia of the dental e a e enamel caused by d drinking water with a high g ate t g fluorine content during the time of tooth formation, and characterized by defective , y calcification that gives a white chalky appearance to the enamel, which g pp , graduallyy undergoes brown discoloration. Jablonski's Dictionary of Dentistry, 1992, p286 Return 70