my comprehensive dental treatment and rehabilitation case
DESCRIPTION
This Clinical case presentation shows the sequential Dental diagnosis, treatment plan, and treatment done for my case in the Fifth year dental school at the Libyan International Medical University as a part of the BDS graduation requirements and evaluation. [email protected]TRANSCRIPT
Libyan International Medical UniversityFaculty Of Dentistry
Comprehensive Dental Course
Clinical Case Presentation July 2013
Presented by :
Ziad S. Abdul Majid
NO : 19
Biographical data & chief compliant
51 years old Libyan female.
Married, teacher & lives in Buhdyma/Benghazi. Chief Complaint :
The patient want to replace her missing teeth.
History of present complaint : She did multiple extractions due
to caries & the last extraction done since 4years without complications.
Medical& Dental history
Medical History:
Diabetes Mellitus type II : 7 years ago.
Last Fasting blood sugar was 125 mg/dl.
Last HBA1C was 1 month ago = 7.4 %.
Last physical exam April/2013.
Metformin 500mg
Aspirin 75 mg
Simvastatin 20mg
Medications
Past Dental History
H/O multiple teeth extractions due to caries without any complications.
H/O endodontic treatment & fixed prosthesis, restorations due to caries.
Oral Hygiene Practice :
Tooth brush: Yes
Brushing method : Horizontally
Any other orophysiotheraputic aids :
No
Kind of Dentrifice
used : Crest
Any other No
Smoker No
Others :
Oral Habits : Nail Biting. Diet : 3 meals daily, snacks in between, 2-3 cups
of coffee daily. Patient Attitude: Extremely motivated But she is
not regular dental attender .
Clinical Examination
Extra-oral
Examination Intra-oral
Examination
Extra-Oral :
She is slightly overweight, a fit & healthy looking, with no obvious facial asymmetry, no submental, submandibular or other lymph nodes are palpable.
the tempromandibular joint appears normal with no clicking, crepitus, tenderness or deviation in the mouth opening with no masticatory muscles tenderness.
The Lips are competent.Initial vital signs : BP : 123/82 mmHg BPM : 79 RES : 18
INTRA-ORAL Examination
INTRAL-ORAL :
The soft tissue ( Oral Mucosa ) is healthy & normal. Her OH is fair there is soft deposits , stains ,
calculus & no Halitosis .
Decayed Missing Filled
12,21,34,42,43
14,15,16,17,23,24,25,27,35,36,37,46,
47
13,22,26
DMFT= 21
Intra Oral findings:
No objective or subjective sign of parafunction :
Attrition , Abrasion ,Erosion. There is slight crowding in the lower anterior area. No loss of proximal contact. No TFO, cross bite , open bite, deep bite .
Gingival Status
Maxillary Region :
Max. Left Posteriors
Max. AnteriorsMax. Right Posteriors
red Pale pink - Color
rolled margin Scalloped, rolled margin, blunt IDP
- Contour
Normal Normal - Size
Soft& Edematous Soft& Edematous - Consistency
- Present - Stippling
Apical to CEJ Coronal to CEJ - Position
Present Present - Bleeding on Probing
Absent Absent - Exudation
Mandibular Region :
Man. Left Posterior
Man. AnteriorMan. Right
PosteriorPale pink Pale pink Pale pink Color
Scalloped, rolled margin, blunt IDP
Scalloped, rolled margin, blunt IDP
Scalloped, rolled margin, blunt IDP
Contour
Normal Normal Normal Size
Soft& Edematous Soft& Edematous Soft& Edematous Consistency
Absent Absent Absent Stippling
At CEJ At CEJ At CEJ Position
Present Present Present Bleeding on Probing
Absent Absent Absent Exudation
Periodontal Examination
1 1 1 1 1 0 1 0 1 1 0 1 1 1 1 CAL
3 2 2 2 2 2 2 2 2 1 0 1 2 2 2 PD
5 6 6
2 2 2
2 2 1 1 0 1 1 1 1 1 1 1 1 1 1 CAL
2 2 1 1 0 1 1 1 1 1 1 1 1 1 1 PD
4 4 4
2 1 2
2 2 1 1 1 1 1 2 2 2 3 3 3 3 4 4 4 4 3 2 2 1 1 1 1 1 2 CAL
2 2 1 1 1 1 1 1 1 1 2 1 1 1 2 2 2 2 3 2 2 1 1 1 1 1 2 PD
1 0 0 1 1 0 1 1 2 1 2 1 1 2 1 1 1 1 1 1 1 1 0 1 1 1 1 CAL
1 0 0 1 1 0 1 1 2 1 2 1 1 2 1 1 1 1 1 1 1 1 0 1 1 1 1 PD
Other Periodontal findings:
Mobility
•41,31 ,Grade I
Recession
•42,41,31,32,26
RADIOGRAPHIC EXAMINATION
Extra-oral
panorama
IOPA IO-Bitewing
Bone: •Mild to moderate generalized
bone loss.•Normal trabecular pattern.•No bone pathology.•Normal anatomical structures.
Teeth: •Tooth # 22 rotated .
•RCT, intra-radcular & coronal coverage radiopauqe rest. related to tooth # 13. •Proximal radiolucency related to tooth # 12, 21,42,43. •Tooth # 26 restored by a radiopaque rest. with a radiolucent shadow underneath the prox. Rest.
IOPA
Tooth # 12 ,13
Tooth # 21
Tooth # 42,43
IO- Bitewing
Tooth # 34
Diagnostic casts
Supplementary tests :
Palpation
Percussion
Vitality test ( EC )
Tooth #
Normal Normal Respond 12
Normal Normal Respond 21
Normal Normal Respond 42
Normal Normal Respond 43
Final
Diagnosi
s
Diagnosis :
Severe generalized chronic periodontitis . Reversible pulpitis (class III DC ) related to
tooth #12, 21, 42, 43. Dentinal caries (class II DC ) related to
tooth # 34. Recurrent caries related to tooth # 26.
Treatment plan
Aims & objectives of treatment :
Address patient’s chief complaint. Maintain good oral hygiene. Restore occlusion, form, function, and esthetics. Educate and motivate the patient. Eliminate active disease and prevent future oral
disease. Maintain gingival and periodontal health. Long term maintenance.
Extraction of tooth # 26 :
Justification for extraction :
Heavily restored, recurrent
caries, gingival
recession, severe
attachment & bone loss,
surpra-eruption.
Compromised tooth as long term
abutment
PRELIMANERY PHASE :
PHASE 1 THERAPY: OHI ; patient education,
motivation . Diet counselling . Scaling & root
debridement . Restoration of the caries
teeth. Topical fluoride application.
Diet sheet analysis:
Instructions
given
Condition : # 12 : class III
TTT Proposed : IPC + Composite
restoration
Condition : # 21: class III
TTT Proposed : IPC + Composite
restoration
Condition : # 42 & 43 : class III
TTT Proposed : IPC + Composite
restoration
Condition : # 34: class II
TTT Proposed : Composite
restoration
Perio ttt & polishing
Topical fluoride application
PHASE 2 THERAPY (surgical phase) : Not indicated ; BUT may indicated in the
revaluation of periodontal therapy.
PHASE 3 THERAPY (Restorative
phase) :
Replacement of the missing teeth : Treatment options : 1-implants & implant supported fixed
bridges.2- implant supported overdenture. 3- overdenture. 4- upper & lower chrome cobalt partial
denture with distal extension. 5- upper & lower acrylic partial
denture with distal extension .
CLINICAL PROCEDURES :
Phase 4 therapy : Periodic rechecking for: Plaque and
calculus . Recall and maintenance every 6 month .
Post treatment photographs :
Frontal view
Lateral view
Occlusal view
Prognosis & conclusion :
Chronic periodontitis is characterized by low grade chronic inflammation that may remain silent in diabetics causing damage that is not locally limited but may extend systemically.
Diabetes is associated with an increased risk of developing inflammatory periodontal diseases, and glycemic control is an important determinant in this relationship.
Patient’s commitment to oral hygiene will be a major factor in long term prognosis.
Regular VT required for the restored teeth with IPC to evaluate the outcome and success of ttt.
Thank you