Diagnosis and treatment planning.....

2. Diagnosis &Treatment Planning
in Conservative Dentistry
Presented By
Dr.M Arsalan Zubair
M.D.S resident Dow Dental College
Dow University Of Health Sciences

5. Patient Assessment
• Chief Complaint
 Symptoms
• Medical History
 Communicable Disease,
 Allergies or Medications,
 Cardiac abnormalities,
 Physiologic changes associated with aging
• Dental History

6. • Magnification
• Photography in Operative dentistry

8. • Advantages:
 Easy to use
 We can document current esthetic condition of patient
 Notice changes in existing pits and fissures
 Photographs of treatment of deep carious lesion aid in
future diagnosis of tooth
 For digital documentation it is easier and cost effective.

10. • Preparation Of Clinical Examinations
 Clean, dry, Well illuminated mouth that’s why initial scaling, flossing, tooth
brushing is required
 Proper examination instruments
 Cotton rolls should be placed
 Floss is good for determining over hanging, improper contours and open
contacts
 Starting from the upper right quadrant with posterior tooth and then moving
to maxillary and mandibular arches

11. Risk assessment
Risk Indicators

13. • Categorization according to the above factors

15. • Identify early lesion
• Visual changes
• Tactile sensation
• But explorers are discouraged Why???
Clinical Examination of Caries

16. • Good for root surface caries
• Radiographs are also good
• Primary Occlusal grooves and
Fossa are less prone
• Occlusal fissures and pits are
more prone

17. • Chalkiness or softening or cavitations of tooth
structure
• Brown gray discoloration radiating peripherally
from pit and fissure
• Carious pits
Causes
 Developmental defects
 Erosion or Abrasion
Occurrence
 Occlusal two-third of Facial and lingual surface of tooth
 May be on the palatal side of Maxillary tooth

18. ICDAS(International caries Detection
and Assessment system)

19. • Histological depth
1= 90% in outer enamel & 10% into dentin
2=50% inner enamel & 50% into outer one third dentin
3=77% dentin
4=88% dentin
5=100% dentin
6=100% dentin into one third of inner dentin

21. • Proximal surface caries
Diagnosed
 Radio graphically
 Visually by separating contact
 Fiber optic transillumination
• Brown Spots
 Remineralized lesion less prone
to caries rather more resistant to caries.
• Proximal Surface Caries in
anterior teeth
Diagnosed
 Radio graphically
 Visually
 Fiber optic transillumination
 Probing or explorer

22. • Cervical Caries
 White spot early enamel lesion
 Dry and wet is distinguishing test
 Diagnosed tacitly
• Root surface Caries
 Root exposure, dietary changes, Systemic disease, Xerostomia
 Lesion at C.E.J
 Soft and spread laterally around C.E.J
 Active lesion is soft and cavitated
 Best diagnosed by vertical bite wing radiographs
• New Methods For Diagnosing caries
 DIAGNOdent
 Spectra Camera
 Carie ScanPro

23. • DIAGNOdent device
• Major disadvantage is false positive test

24. • Spectra Camera
• High energy violet or blue light on tooth surface
• It stimulate porphyrins metabolites which make
carious lesion red while enamel appear green
• It has scale 0-5

25. • Carie Scan PRO
 Caries detection by alternating current impedance
spectroscopy(ACIST)
 Detects early carious lesion
 Provide color and numerical scale for severity of caries

26. Clinical examination Of Amalgam
Restorations
• Amalgam blues
• Proximal overhangs
• Marginal Ditching
• Voids
• Fracture lines
• Lines indicating the interface b/w abutted restorations
• Improper anatomic contours
• Marginal ridge incompatibility
• Improper proximal contacts
• Recurrent Caries
• Improper occlusal contacts

28. Clinical Examination Of Tooth colored
Restorations
• Proximal Over hangs
• Marginal ditching
• Recurrent caries
• Improper contour
• Marginal Ditching
• Voids

29. Clinical Examination of
Dental implants and Implant Supported
Restorations
• In molars it is difficult to replace
three roots with one implant
• Vertical loss of bone support prior
to implant placement makes
vertical space making crown
implant ratio difficult
• Peri-implantitis
• Occlusion is difficult to maintain
due to lack of cushioning
• Restoration should confined in the
middle with no deflections

30. Clinical examination of Additional
Defects
• Non hereditary hypo calcified areas of enamel
• Chemical erosion
• Idiopathic Erosion
• Abrasion
• Attrition
• Fracture
• Craze line
• Dental anomalies…

31. Radiographic Examination of Teeth
and Restorations
• Indications of Radiographs
• Proximal caries, overhang, poorly
contoured restorations
• Pulpal abnormalities
• Periapical changes in peridontium
• Impacted tooth or congenital
abnormality
• False positive and negative diagnosis

32. Guide lines for Prescribing Dental Radiographs For
Dentate Adults
New Patients

33. • Recall Patient
• Clinically caries present or High risk
• No Clinically Caries or No Risk Factors
• Periodontal disease

34. Adjunctive Aids in diagnosis of teeth
and Restorations
• Percussion
• Palpation
• Vitality Test
 Hot test
 Cold test
 Electric pulp tester
 Test Cavity
• Study Cast

35. Examination Of Occlusion
• Signs of enamel cracks, occlusal trauma
• Potential effect of restoration on occlusion
• Class of occlusion
• Over jet
• Over bite
• Midline shifts
• Position of malposed teeth, super erupted, spacing
• Dynamic occlusion should be evaluated
• Relation should also be assessed in centric relation
• Canine guidance or group function exist
• Presence and amount of anterior guidance
• Non working side contacts
• Abnormal wear should be checked
• Plunger cusp

36. Review Of Peridontium
Clinical Examination
• Gingival color,shape,texture
• Depth of sulcus
• Instrument used for measuring depth
• Six locations
• Normal sulcus depth
• Involvement of furcation
• Gingival recession
• Mobility
• Plaque presence
• Proper contoured restorations

37. Radiographic Examination
• Bitewing are good for assessing bone level
• What is Biologic width?
• Normal value?
• What will happen if restoration encroach
biologic width?
• What method is done to avoid these
condition?

40. Treatment Planning
• General Consideration
• Sequencing
• Interdisciplinary Consideration
 Endodontic
 Periodontics
 Orthodontics
 Oral Surgery
 Fixed and Removable prosthodontics
• Indications for Operative Treatment
• Preventive treatment
• Restoration of incipient lesion

41. • Treatment Of Abrasion, Erosion and Attrition
• Root surface Sensitivity
• Repairing of Restoration
• Replacement of Restorations
• Indication of Amalgam Restoration
• Indication of Direct Composites
• Indication of Indirect tooth Color restoration
• Geriatric Patient

43. Sequencing

44. Inter-disciplinary Consideration in
Operative treatment
• Pulpal or periapical Pathology
• Endodontic ally treated tooth show no evidence
of healing,
• Inadequate fill
• Fill exposed to oral fluids
• Precede operative treatment
• Poor periodontal prognosis=no extensive
restoration
• Good health = Before or after
• Surgical procedure indicated= before permanent
restorations
• Biological width: Crown lengthening ( 6 week after
surgery)

45. • Extrusion
• Realignment
• Impacted, Unerupted
• Grossly carious tooth should be extracted
especially 2nd molars whose has to receive cast
restoration are damaged due to removal of 3rd
molars
• Core buildup can be done from amalgam or
composite
• Preparation for receiving clasp, rests in
removable prosthesis

46. Treatment Of Abrasion, Erosion,
Abfraction and Attrition
Considered for restoration only
• Area is affected by caries
• Defect is sufficiently deep compromise structural
integrity of tooth
• Intolerable sensitivity
• Defect continue to peridontal problem
• Area is to be involved in design of partial denture
• Involving the pulp
• Actively progressing
• Desire for esthetic improvement

47. Treatment of root surface caries
• Arrested lesion not need to be restored until
for aesthetic purposes
• Active lesion can be restored by tooth color
restorations
Treatment of root surface sensitivity
• Fluoride varnishes
• Oxalate solutions
• Resin based adhesives
• Desensitizing tooth paste contain Potassium nitrate
• Restorative treatment

48. Replacement of Existing restoration
Non tooth color restoration
• Marginal void
• Gingival overhang
• Marginal ridge
discrepancy
• Over contouring of facial
and lingual surface
• Poor proximal Contact
• Recurrent Caries
• Ditching deeper than
0.5mm
Tooth color restoration
• Improper contour that
cannot be repaired
• Large voids
• Deep marginal staining
• Recurrent caries
• Unacceptable aesthetics