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Postgraduate clinic Date 13.03.2008
Name
Date of Birth
Observations
Comments### Cardiovascular disease (1) #### Medication (8)### Blood disease (2) #### Smoker (9)### Diabetes (3) #### Cave LA (10)### Rheumatic disease (4) #### Cave Ab (11)### Allergy, hypersensitivity (5) #### Others (12)### Pregnant (6) ####
Regular physician care (7) ####
Comments### Bleeding gums (1) #### Aesthetical problems (7)### Tooth hypersensitivity (2) #### Functional problems (8)### Increased tooth mobility (3) #### Previous perio. treatment (9)### Tooth migration (4) Previous ortho. treatment (10)
Bruxing, clenching (5) #### Family history (11)Food impaction (6) #### Others (12)
Soft tissues Occlusion and function
Hard tissues
GENERAL CASE HISTORY
SPECIFIC CASE HISTORY
General Dentist
Referred for
Treatment of peri-implantitis
Valands Tandvård
Patient Data
T.L
83-year old male in good general health.
20.12.1925
(9) In the clinic of periodontics, Odontologen in Gothenburg (2003). (12) Oral Lichen Planus
(treatment at the Department of Oral Medicine)
Implant-supported full bridge in upper jaw & cross-arch bridge on
INTRAORAL STATUS
lower teeth.Root remnant in the region of 11.
Ulceration in left buccal mucosa & gingiva around tooth 35
PREVIOUS DENTAL TREATMENT
Treatment Planning 2003
• Cause-related periodontal treatment.• Implant-supported full bridge in upper jaw. • Cross-arch bridge on lower teeth.
Referral to the Brånemark Clinic 2004
PREVIOUS DENTAL TREATMENT
1-year Post-treatment Radiographs
Initial Examination 13.03.2008
Feb 2008
Initial Radiographs
Front•13-23
•43-33
•Front picture
•Front Xray
Tooth H2 12 H1 V1 22 V2### ### ### ### ### ###
m 6 8 5 4
b 5
d 6 8 5 4
l 5 8 5 4
m
bd
Mobility
### ### ### ### ### ###
Tooth 43 42 41 31 32 33### ### ### ### ### ###
m 4
b 4
d
l
b
l
Mobility
Furc
PPD
Furc
PPD
Right
•Right picture
•Right Xray
Tooth 18 17 16 H3 14### ### ### ### ###
m 7
b 6
d 6
l 6
m
bd
Mobility
### ### ### ### ###
Tooth 48 47 46 45 44### ### ### ### ###
m
b
d 4
l 4
b
l
Mobility
PPD
Furc
PPD
Furc
Left•Left picture
Tooth V3 25 26 27 28### ### ### ### ###
m 6
b 4
d 6
l 5
m
bd
Mobility
### ### ### ### ###
Tooth 34 35 36 37 38### ### ### ### ###
m 4 6
b 5
d 5
l 5 4
b
l
Mobility
PPD
Furc
PPD
Furc
Diagnosis: Oral lichen planus
Treatment
• The first 14 days;
Clobetasol gel; In the morning and the evening during the first 14 days.
5 ml after tooth-brushing.
Risk for Candida; Medication should be combined together with Mycostatin mixture, 5ml, 2 times a day.
• The following 15 days:
Clobetasol gel; once a day every morning, 5 ml after tooth-brushing.
• And the final 14 days:
Clobetasol gel; once every second day, 5 ml after tooth-brushing.
Occlusal
•Here put occlusal
•Here occlusal lower
CASE: T.L DATE:
Baseline examination
Tooth 18 17 16 H3 14 H2 12 H1 V1 22 V2 V3 25 26 27 28
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 7 6 8 5 4 6
b 6 5 4
d 6 6 8 5 4 6
l 6 5 8 5 4 5
m
bd
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Tooth 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 4 4 6
b 4 5
d 4 5
l 4 5 4
b
l
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Sites>6mmSites>4 mmSites<4 mm
12Plaque %
Number of teeth
31
75% 25%65%35%
1775%
13.03.2008
12
BOP %
PPD
Furc
PPD
Furc
CASE: T.L DATE:
Baseline examination
Tooth 18 17 16 H3 14 H2 12 H1 V1 22 V2 V3 25 26 27 28
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 7 6 8 5 4 6
b 6 5 4
d 6 6 8 5 4 6
l 6 5 8 5 4 5
m
bd
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Tooth 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 4 4 6
b 4 5
d 4 5
l 4 5 4
b
l
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Sites>6mmSites>4 mmSites<4 mm
12Plaque %
Number of teeth
31
75% 25%65%35%
1775%
13.03.2008
12
BOP %
PPD
Furc
PPD
Furc
18 17 16 H3 14 H2 12 H1 V1 22 V2 V3 25 26 27 28
Mucositis x x x
Peri-implantitis x x x
Periodontal diagnosis
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Gingivitis
Levis
Gravis x x x x x x
..et complicata x
Oral Lichen Planus
Periodontal diagnosis
DIAGNOSES
Generalized severe chronic periodontitis
Peri-implantitis
CASE: T.L DATE:
Baseline examination
Tooth 18 17 16 H3 14 H2 12 H1 V1 22 V2 V3 25 26 27 28
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 7 6 8 5 4 6
b 6 5 4
d 6 6 8 5 4 6
l 6 5 8 5 4 5
m
bd
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Tooth 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 4 4 6
b 4 5
d 4 5
l 4 5 4
b
l
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Sites>6mmSites>4 mmSites<4 mm
12Plaque %
Number of teeth
31
75% 25%65%35%
1775%
13.03.2008
12
BOP %
PPD
Furc
PPD
Furc
WHAT ARE THE PATIENT'S PROBLEMS?
Subjectively
Objectively
Tooth by Tooth Prognosis
8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8
have to be
extracted
questionable
5
can be H3 H2 H1 V1 V2 V3
maintained 4 3 2 3 4
Bleeding gums
Occasional pain when brushing 34-35.
Periodontitis/peri-implantitis
Lichen planus lesions
CASE: T.L DATE:
Baseline examination
Tooth 18 17 16 H3 14 H2 12 H1 V1 22 V2 V3 25 26 27 28
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 7 6 8 5 4 6
b 6 5 4
d 6 6 8 5 4 6
l 6 5 8 5 4 5
m
bd
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Tooth 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 4 4 6
b 4 5
d 4 5
l 4 5 4
b
l
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Sites>6mmSites>4 mmSites<4 mm
12Plaque %
Number of teeth
31
75% 25%65%35%
1775%
13.03.2008
12
BOP %
PPD
Furc
PPD
Furc
Treatment Planning
1. Non surgical cause-related treatment.
2. a- Surgical treatment of peri-implantitis after establishment of adequate
oral hygiene.
b- Reshaping of prosthesis.
3. Evaluation.
Basic Therapy
Arrest the progression of peri-implantitis / periodontitis
Maintain present dentition/implants.
GOAL OF THERAPY
Surgery Upper Jaw
Surgery Upper Jaw
Surgery Upper Jaw
Reshaping of prosthesis at the laboratory
1 month post-surgery
Reexamination 5 months post-surgery
Reexamination 5 months post-surgery
Initial Examination 13.03.2008
Reexamination 02.02.2009
DATE:
Reexamination
18 17 16 H3 14 H2 12 H1 V1 22 V2 V3 25 26 27 28
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
4
4
4 4 4 4
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
5
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
02.02.2009
Sites>6mmSites>4 mm
4129%
12
BOP %
Number of teeth
BI %
7 0
22% 0%15%85%
Plaque % Sites<4 mm25%
CASE: T.L DATE:
Baseline examination
Tooth 18 17 16 H3 14 H2 12 H1 V1 22 V2 V3 25 26 27 28
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 7 6 8 5 4 6
b 6 5 4
d 6 6 8 5 4 6
l 6 5 8 5 4 5
m
bd
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Tooth 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 4 4 6
b 4 5
d 4 5
l 4 5 4
b
l
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Sites>6mmSites>4 mmSites<4 mm
12Plaque %
Number of teeth
31
75% 25%65%35%
1775%
13.03.2008
12
BOP %
PPD
Furc
PPD
Furc
CASE: T.L DATE:
Reexamination
Tooth 18 17 16 H3 14 H2 12 H1 V1 22 V2 V3 25 26 27 28
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 4
b
d 4
l 4 4 4 4
m
bd
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Tooth 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 5
b
d
l
b
l
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
PPD
Furc
PPD
Furc
02.02.2009
Sites>6mmSites>4 mm
4129%
12
BOP %
Number of teeth
BI %
7 0
22% 0%15%85%
Plaque % Sites<4 mm25%
Corrective Therapy
1- SPT
2- Re-evaluation
Arrest the progression of peri-implantitis / periodontitis
Maintain present dentition/implants
Treatment Planning
Maintain present dentition/implants.
Arrest the progression of peri-implantitis / peridontitis
INITIAL GOAL OF THERAPY
REVISED GOAL OF THERAPY
Fracture 21 09.07.2009
Removal of the prosthesis and repair at the laboratory
Final Examination 19 months after initial examination
Initial Examination 13.03.2008
Reexamination 02.02.2009
Final Examination 05.10.2009
Final Examination 19 months after initial examination
Maintenance Therapy
1- SPT
2- Follow-up examination
Treatment Planning
CASE: T.L DATE:
Final examination
Tooth 18 17 16 H3 14 H2 12 H1 V1 22 V2 V3 25 26 27 28
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 4 4 4
b
d 4
l 4 4 4 4
m
bd
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
Tooth 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
m 5
b
d
l
b
l
Mobility
### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
PPD
Furc
PPD
Furc
05.10.2009
Sites>6mmSites>4 mm
3127%
12
BOP %
Number of teeth
BI %
17 8
18% 17%35%65%
Plaque % Sites<4 mm16%
The patient will remain in our clinic for supportive periodontal therapy and regular controls for the time being (every 2nd month).
• Implant therapy in the upper jaw and cross-arch bridge in the lower jaw was performed at the Brånemark clinic in 2004. The patient was referred to us in 2008 because of peri-implantitis.
• Implant therapy in the upper jaw and cross-arch bridge in the lower jaw was performed at the Brånemark clinic in 2004. The patient was referred to us in 2008 because of peri-implantitis.
• The patient is undergoing treatment of oral lichen planus at the department of oral medicine.
• Implant therapy in the upper jaw and cross-arch bridge in the lower jaw was performed at the Brånemark clinic in 2004. The patient was referred to us in 2008 because of peri-implantitis.
• The patient is undergoing treatment of oral lichen planus at the department of oral medicine.
• At the reexamination, it was noted that 12 was fractured. The patient did not mention any subjective concerns until 21 also fractured.
• Implant therapy in the upper jaw and cross-arch bridge in the lower jaw was performed at the Brånemark clinic in 2004. The patient was referred to us in 2008 because of peri-implantitis.
• The patient is undergoing treatment of oral lichen planus at the department of oral medicine.
• At the reexamination, it was noted that 12 was fractured. The patient did not mention any subjective concerns until 21 also fractured.
• The patient will be kept in our clinic for supportive periodontal therapy, aiming at keeping the plaque control at as high a level as possible and thus maintaining the result of the treatment. We chose short intervalls of 2 months between recall appointments for the first year.
• Implant therapy in the upper jaw and cross-arch bridge in the lower jaw was performed at the Brånemark clinic in 2004. The patient was referred to us in 2008 because of peri-implantitis.
• The patient is undergoing treatment of oral lichen planus at the department of oral medicine.
• At the reexamination, it was noted that 12 was fractured. The patient did not mention any subjective concerns until 21 also fractured.
• The patient will be kept in our clinic for supportive periodontal therapy, aiming at keeping the plaque control at as high a level as possible and thus maintaining the result of the treatment. We chose short intervalls of 2 months between recall appointments for the first year.
• The general prognosis might be viewed as good, but it is very much related to the patient’s future compliance. Tooth 35 is still considered questionable.
Front Photo
Front Rx
Right Photo
Right Rx
Left Photo
Left Rx
Front Photo
Front Photo
2004
2008
2009
