Nadine Hassan, a 46-year-old Lebanese housewife, presented with pain and a bad smell when chewing on her old bridge. She wanted to fix her teeth and have a beautiful smile. Her medical history included an allergy to penicillin. Her dental history showed multiple extractions due to decay and pain, root canals, and a bridge. Her oral exam found poor hygiene, decay, failed restorations, and mild to moderate periodontitis. Her treatment plan involved emergency extractions, nonsurgical treatments like cleanings and restorations, surgical treatments like extractions and a sinus lift, and restorative treatments like crowns, bridges, and implants.
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Dental Treatment Plan for Biographical Patient
1.
2. BIOGRAPHICAL DATA
Name: Nadine Hassan
Age: 46 years
Gender: Female
Nationality: Lebanese
Occupation: housewife
Marital status: Married
3. “I feel severe pain under old
bridge on mastication with bad
smell, I want to fix my teeth and
make new beautiful smile”
«عمبحسبوجعكتٌرلما
عضعلىالجسرورٌحة
كرٌهة,بديزبطًاسنانو
تصٌرًضحكتحلوة»
4. MEDICAL HISTORY
- No medications intake
- No previous surgery
- She doesn’t suffer from any medical condition
except:
Allergy to Penicillin
5. • Anaphylactic reactions
General hypersensitivity reactions (e.g. rashes) to
penicillin occur in between 1 and 10% of exposed
patients
• True anaphylactic shock occur in less than
0.05% of treated patients.
What’s the True Incidence of ‘Penicillin Allergy’?
6. What to do on spot?
• Call 140 or emergency medical help.
• Use an epinephrine injection immediatly, if available, by pressing it
into the person's thigh.
• Oxygen, antihistamine
• Make sure the person is lying down and elevate his or her legs.
• Check the person's pulse and breathing and, if necessary,
administer CPR or other first-aid measures.
7. PAST DENTAL HISTORY
Multiple tooth extraction due to caries and pain
Endodontic treatments
Restorative restorations (Amalgam & composite)
Prosthodontic treatement ( Bridge)
11. EXTRA-ORAL EXAMINATION
• She has normal weight, fit &
healthy looking
• No obvious facial asymmetry
• No submental, submandibular or
other lymph nodes are palpable
• TMJ appear normal with
• No clicking, tenderness or
deviation in the mouth openning
• No masticatory muscles
tenderness
12. • Lips are competent
• No loss of VDO
5.9 mm (VD at rest) – 6.2 mm (VD at occlusion) = 3 mm
22. Gingival health
Pale pink in color, stippled, firm and exhibit a matte surface
pointed
fill the gingival embrasure right up to the contact area
28. Mandibular posterior area: class II bone loss from
1/3 to 2/3 of original height bone
(wical and swoope classification)
Maxillary Right Quadrant: Severe Bone loss that
need bone graft and sinus lift for future implants
No bone pathology
33. •
Treatment of
emergencies
• Dental or
periapical
• Periodontal
• Extraction of
hopeless teeth
Nonsurgical Phase
(Phase I Therapy)
• Plaque control and
patient education:
• Diet control
• Removal of calculus
and root planing
• Correction of
restorative and
prosthetic irritation
factors
• Excavation of caries
and restoration
• Antimicrobial
therapy
• Minor orthodontic
movement
• Provisional splinting
and prosthesis
Surgical Phase
(Phase II Therapy)
• Periodontal
therapy, including
placement of
implants
• Endodontic
therapy
Restorative Phase
(Phase III Therapy)
• Final restorations
• Fixed and
removable
prosthodontic
appliances
• Evaluation of
response to
restorative
procedures
53. PFM crown + occlusal rest seat
On: #45
Old cast post Temporary Crown
54.
55. 4 UNITS SPLINTED BRIDGE OVER IMPLANTS
Treatment protocol:
External Sinus lift/augmentation (through buccal plate) , bone graft
Two-stage approach :
2 Implants will be placed after a healing period of 4-8 months following sinus grafting
3 Abutments
1 Pontic 3 Connectors 3 retainers