Periodontal Case Study

Reina LigeraldeDEH 235.30.08

Patient Profile and Chief Complaint

Name: Abby Fraction

Age: 27

Ethnicity: Asian

Occupation: graduate student

Chief complaint: teeth cleaning

Medical History Childhood vaccinations in 1981

Completed hepatitis B vaccination series in 1997

Menstruates regularly, every 30 days

Paternal grandfather had liver cancer and type II diabetes mellitus

Practices birth control: Ortho Tri-Cyclen Lo

Takes a multivitamin daily

BP: 110/65, P: 73, R: 16

ASA II

Dental History Four 3rd molars extracted 3/00

Porcelain crown on 7 in 2006

Last dental exam and teeth cleaning: 9/07

Last dental x-rays: FMX at RCC 4/08

Clinical Findings

E & I

Periodontal Exam

Calculus

Radiographic Exam

ADA and AAP Classification

E & I Bilateral 3 mm X 2 mm nevi on auricles

Bilateral palpable submandibular nodes

Left side of TMJ clicking

Bilateral mandibular tori

Torus palatinus

Bilateral linea alba

Erythemic papilla on the anterior portion of the dorsal surface of the tongue

Periodontal Exam Free gingiva

generalized coral pink with localized cyanotic gingiva between 6 and 7 due to P crown on 7, generalized scalloped, generalized firm, generalized smooth

Attached gingiva generalized coral pink, generalized firmly bound

down to underlying bone, generalized stippled Adequate salivary flow Skeletal classification: mesognathic Angle’s classification: class I bilateral molar

relation with crowding in the mandibular anteriors

Maximum opening: 44 mm

Periodontal Exam (continued) MBI: 0%, BOP: 8.3%

Probing depths range 1-3 mms with localized 4 mms 30D & 31M

Recession 2 mm 2B, 3B; 1 mm 4B, 5B; 1 mm 10F, 11F; 2 mm

12B; 1 mm 14B; 1 mm 15L, 14L; 1 mm 3L; 2 mm 2L; 3 mm 31B, 30B; 1 mm 29B, 28B; 3 mm 27F; 3 mm 22F, 21B, 20B, 19B, 18B; 1 mm lingual surfaces of 18, 22, 24-26, 28-31

Clinical Attachment Loss 2 mm 2B; 1 mm 3B; 1 mm 12B; 1 mm 15L; 1 mm 3L;

2 mm 2L; 3 mm 31B, 30B; 1 mm 29B, 28B; 2 mm 27F; 2 mm 22F, 21B, 20B; 3 mm 19B, 18B; 1 mm 18L, 31L

Mobility: + on 5, 7-10, 20-27 Fremitus: + on 8-10, 12 Furcation: none noted

Periodontal Exam and Calculus

Abfraction: 2-4, 11-12, 18-20

Attrition: 22-27

RCC calculus code: light

Radiographic Exam 1, 16, 17, 32 extracted Restorations

7 has a P crown, 8 & 9 have facial composites, margins intact

Tooth findingsPossible decay: none notedNo radiolucencies around the apices of teeth

notedNo internal or external root resorption notedNo dilacerations notedAtypical tooth findings: 24-26 attrition

Radiographic Exam (continued) Critique of angulation

Because the vertical angulation is off in the PAs, I would use the BWX for the periodontal interpretation.

Trabecular pattern Consistent throughout

Lamina dura Present and consistent throughout, becoming fuzzy

Alveolar crest Blunted in the posterior teeth and sharp in the anterior

teeth, greater than 1.5-2 mm apical to the CEJ, 1 mm bone loss at 3M, 12M, 13M, 15M, 20M, 21M, 28M, 29M, 30M

PDL space 3D, 4M, 5D, 6MD, 14M, 18M, 19D, 20D, 21D, 24M, 26D

Radiographic Exam (continued) Furcation - interradicular

radiolucency 19 noted

Calculus7M noted

General osseous interpretationNo radiopaque or radiolucent lesions

noted

Critique of RadiographsVertical angulation

Can see the occlusal plane in all the posterior PAs

Maxillary right posterior PAs and maxillary left molar PA need to increase angle of PID

Maxillary left premolar PA and mandibular posterior PAs need to decrease angle of PID

The maxillary premolar PAs should have been placed more parallel to the arch.

Horizontal angulation The following films should have been adjusted to

see interproximally.Slightly: mandibular right molar PA and

mandibular left posterior PAsSeverely: premolar BWXs, anterior PAs, maxillary

right posterior PAs, maxillary left premolar PA, and mandibular right premolar PA

ADA and AAP Classification ADA II

AAP: generalized slight chronic periodontitis due to mechanical forces modified by plaque and calculus

Dental Health Education

Oral plaque therapy

aids

Appt 1

Appt 2

Appt 3

Type/Agen

t

Method taught

Disclosing 5.1.08

GUM

Toothbrushing

5.1.08

soft Bass: – twice/day

Floss 5.15.08

Glide C-shape:once/day

Pockets/Probing

4.24.08

Nightguard 5.15.08

daily

Rationale for Case Selection Medical history/systemic health

Birth control Systemic & oral risk factors

Grinding, mechanical forces Dental hygiene diagnosis

Perio: uncontrolledCaries: controlledOHI: adequate Influencing cultural & social factors: young

with stress as a graduate student

Rationale for Case Selection (continued)

Oral health education/strategiesSoft brush with Bass methodFlossACT mouth rinse with fluorideNightguard

Reevaluations19 buccal due to decayAbfraction areas: 2-4, 11-12, 18-20

Rationale for Case Selection (continued)

Referrals19 buccal due to decayAbfraction areas: 2-4, 11-12, 18-20 for

possible restorationsNightguard

Recall: interval: 4 months

Rationale: check referrals and bone levels

Goals

Maintain good oral homecare and bone levels

Maintain MBI & BOP to less than 10%

Reduce PI each appointment

Treatment (Tx) Plan & Implementation

Treatment Plan Sequence

Start Date

Finish Date

Appt 1X-ray check 4.24.08 4.24.08

FMX 4.24.08 4.24.08

Assessments 4.24.08 4.24.08

DDS Exam 4.24.08 4.24.08

Appt 22nd check-in 5.1.08 5.1.08

PI, OHI 5.1.08 5.1.08

LR scale 5.1.08 5.1.08

Tx Plan & Implementation (continued)

Treatment Plan Sequence Start Date

Finish Date

Appt 3

UR, LL, UL scale 5.15.08

5.15.08

Selective polish 5.15.08

5.15.08

Fluoride 5.15.08

5.15.08

4-month recare

Pictures Facial

Pictures Maxillary arch lingually

Pictures Mandibular arch lingually

Pictures Abfraction on 11-12 & 18-20

Questions?