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Comprehensive case presentation

Wejdan AL- Marzooq

42920166L 9 G 2

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Personal data 40 Age

Female Gender

sudanese Nationality

House wife Occupation

Married Marital and social status

Cooperative and willing to attend her appointments regularly.

Patient cooperation

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In the patients own words:(I heat how my upper front tooth

looks like)

Chief complaint

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History of Chief complaint

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She is medically fit and she is not under any medications.

Medical history:

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There is no significant family medical history mentioned.

Family medical history:

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1-Previous Root Canal Treatment of teeth #11.

2 -GIC restorations on teeth #37.

3-composite restorations on teeth #25,26,37,45,46.

4 -extracted teeth # 14,15,16,27,36,47.

Past dental history

.

8

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Oral hygiene activity:Patient brushes her teeth 1 time per day

with a Hard brush and horizontal scrub technique

-Doesn’t use floss or mouth wash.

-Doesn’t visit the dentist regularly .

Habits and oral hygiene activity

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Clinical examination

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Extra Oral Examination

All within normal

limit

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Intra oral examination

1-Floor of the mouth:No abnormality detected.

2-oral mucosa:No abnormality detected.

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Intra oral examination

3 -tongue:No abnormality detected.

4 -palate: No abnormality detected

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Pretreatment photographs:

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Frontal view

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Maxillary occlusal view

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MANDIBULAR OCCLUSAL VIEW

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Right lateral view:

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Left lateral view

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Diagnostic tools

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I-Radiographs:OPG

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BitewingsRight side

Left side

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PeriapicalsUpper Anterior

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Lower Anterior

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Right upper and lower posteior

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Left upper and lower posterior

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II-Mounted cast (frontal view)

Upper midline:Normal.

Lower midline:Normal.

Overbite:3mm

2mm.:Overjet

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Mounted cast (right side)

Right molar relationship:Not applicable.

Right canine relationship:Not applicable.

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Mounted cast ( left side)

Left molar relationship:Not applicable.

Left canine relationship:Not pplicable.

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Mounted cast (upper and lower)

.Lower U sha

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Laboratory investigation:

Saliva viscosity :Watery.

Saliva Buffer capacity:High

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Caries risk test (CRT)

Results have revealed the following:

S.M = 3 > 100,000 CFU High Risk

L.B = 3 > 100,000 CFU High Risk

Mutans streptococci Lactobacilli

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FINDINGS AND DIAGNOSIS

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Oral hygiene:Gingival examination ( Gingival index )

BY SILLNESS & LOE 1967

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

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

Total : 1.70 Moderate inflammation , redness, edema,

glazing & bleeding on probing.

2 22

2 211

2 22 2

2

222

21 1

1

12 2

2

2

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Oral hygiene Oral hygiene (plaque index) BY SILLNESS & LOE 1967

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

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

222

2 2

222

1

1111

22

2

Total 1.79 Moderate accumulation of soft deposits within

the gingival pocket or the tooth & gingival margin which can be seen with naked eye

2 22

2

222

2

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PSR (periodontal screening and recording)

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1 1 1

1 2 1

Code1: Pocket depth <3.5 mm bleeding on probing .Code2: Pocket depth <3.5 mm bleeding on probing and calculus .

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Calculus indexBY Procter & Gamble 1987

locklized slight calculus accumulation.

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Periodontal charting

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Maxillary arch

+ + + + + + B

M-CEJ 222 212 222 212 223 323 313 221 212 233 PD

CAL 28 27 26 25 24 23 22 21 11 12 13 14 15 16 17 1

8Tooth#

+ + + + +

+ + + + + B

M-CEJ 32

2223 223 222 222 222 111 222 322 222 PD

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

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Mandibular arch+ + + + + + B

M-CEJ 313 222 232 222 322 222 222 222 223 222 223 323 PD

CAL 38 3

736 35 34 33 32 31 41 42 43 44 45 46 47 48 Tooth#

+ + + + + + B

M-CEJ 212 222 312 22

2312 222 21

332

332

3222 33

1323 PD

CAL 38 3

736 35 34 33 32 31 41 42 43 44 45 46 47 48 Tooth#

323

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Diagnosis and prognosis

Plaque Calculus

Contributing factors: Defective FPD :

Multiple extracted teeth # Multiple defective restorations.

Periodontal diagnosis : generalized moderate plaque induced gingivitisOverall prognosis: good .

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DENTAL CHARTING

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Charting (Maxilla):

CariesMissing

Substandard RCT

Restoration

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Charting ( mandible )

CariesMissing

Restoration

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1)Plaque and calculus accumulation.2)Caries : 18,21,24,37.

3)Previous Root Canal Treatment of teeth #11.

4)GIC restorations on teeth # 37.

5)composite restorations on teeth #25,26,45,46.

6)Missing teeth # 14,15,16,36,38,47.

Findings and diagnosis

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TREATMENT PLAN

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Phase 1

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Oral hygiene activity recommendation:

Tooth brush type: soft ,nylon bristle tooth brush.

Brushing frequency 3 times per a day.

Brushing method: modified bass technique.Interdental aids: fluoridated dental floss.

Phase 1(preventive phase)

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Phase 1:(periodontal therapy)Condition : generalized moderate plaque induced gingivitis.Proposed treatment:

Oral hygiene instructions and plaque control.Supra and sub gingival scaling .

Re-evaluation: 4-6 weeks.Maintenance phase:6 months.

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Phase 2 :(operative and endodontic treatment)

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Proposed treatment: Dental problem Tooth number:

Extraction.Extraction.

Badly decay & no opposing teeth.Remining root .

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17

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Proposed treatment: Dental problem Tooth number:

Root canal treatment . Substandard root canal treatment.

11

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Proposed treatment: Dental problem Tooth number:

Class IV composite restoration .

Distal caries. 21

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Proposed treatment: Dental problem Tooth number:

Extraction . Remining root. 23

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Proposed treatment: Dental problem Tooth number:

24

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Proposed treatment: Dental problem Tooth number:

Finishing and polishing . Old dull occlusomesial composite restoration.

Occlusal composite restoration.

25

26

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Proposed treatment: Dental problem Tooth number:

Extraction. Remining root. 28

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Proposed treatment: Dental problem Tooth number:

Composite Re do class IRestoration.

Fissur sealnt . Deep fissur .

37

34

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Proposed treatment: Dental problem Tooth number:

Fissur sealnt .

Finishing and polishing .

Deep fissur.

Old occlusal compositerestoration

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4546

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Proposed treatment: Dental problem Tooth number:

Extraction Remining root. 48

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Phase V ( prosthetic phase ):

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Maxillary arch.

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Mandible 1st option

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2nd option

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3rd option

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Phase VI :Recall and maintenance

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Phase VI :Recall and maintenance

Recall the patient every 3 months to: Emphasize on the oral hygiene.

Do periodontal maintenance.

Recall the patient every 6 months to: Do full mouth X-Ray, check all

restorations and prosthesis.

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Treatment objective:

Educate the patient about dental problems). Nutrition consultation for the patient. Improve the oral hygiene. Disease control. Restore the function and aesthetic. Maintenance.

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