1. Comprehensive Care Case
Prepared & Presented by:
Dhafer Abdullah Alyami
Supervised by:
Dr . Mohammed Awadhallh Alsaleh
1

2. PERSONAL DATA
Age
Sex:
:22 years old
Male
Nationality

: Saudi
Occupation : Student
Marital
& Social Status : Single
Patient
attitude : Fairly cooperative
2

3. Chief Complaint
 Patient Said :“My front tooth was
fractured, I want to fix it.”
History of Chief Complaint
Patient had trauma since six months ago.
3

4. MEDICAL HISTORY

Significant medical problems : Asthma

Medication :ventolin

History of allergic reaction : None
Past MEDICAL HISTORY

No significant medical problems but the patient
had asthma attack about 2 years ago.
FAMILY MEDICAL HISTORY

No significant medical problems.
4

5. Past Dental History:

Root Canal Treatment # 11 , 21
since 2 years ago.
5

6. Habits and Oral Hygiene Activity
•
Tooth brushing
None
•
Flossing
None
•
Mouth wash
None
•
Meswak
Sometimes
6

7. Diet Analysis
1- Patient is taking 3-main meals during the day.
2- Medium sugar consumption.
3- Minimum vegetable & fruit intake.
7

8. Clinical Examination
Extra-oral Examination
• Skin
NAD
• Head
NAD
• Neck
NAD
• Lips
NAD
• Muscles
NAD
TMJ :
•Clicking
NAD
•Pain
NAD
•Limitation on opening
NAD
•Deviation on opening
8
NAD

9. Intra-oral Examination
Soft tissues :
•Lips
NAD
•Labial Mucosa
NAD
•Buccal Mucosa
NAD
•Hard/soft Palate
NAD
•Vestibule
NAD
•Tongue
NAD
•Floor of the mouth
NAD
•Gingiva
reddness
•Saliva
NAD
Hard tissues :
• Teeth
Plaque,calculus & caries
9

10. Extra-oral photo
Frontal View
10

11. Lateral View
11

12. PRE-TREATMENT
PHOTOGRAPHS
Frontal View
12

13. Upper arch
13

14. Lower arch
14

15. Right Side
15

16. Left Side
16

17. Periodontal examination
17

18. Periodontal examination
Periodontal scoring
2
2
2
2
2
2
Probing depths:
Generalized ( 2-3) mm
Mobility:
NO significant tooth mobility
Furcation:
NO furcation involvement
18

19. Charting
II. Intra – Oral Examination
Charting (Maxillary)
1
2
3
2
2
3
3
3 3
3 2
2
2
2
2
2
RCT
19

20. Cont’
II. Intra – Oral Examination
Charting (Mandibular)
Mobility : 0
Recession : 0
P.D. Initial
Existing Rest.: 0
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2

21. Diagnosis
Periodontium:
Generalized chronic Marginal Gingivitis
21

22. OPG
22

23. Mounted Diagnostic Cast
23

24. FMX
24

25. PA Posterior Teeth
25

26. PA Anterior Teeth
26

27. Bite wing Pre-operative
27

28. Occlusal radiograph
Upper
Lower
28

29. Operational Diagnosis
And
Treatment Plan
29

30. Treatment Phases
Phase I :
Phase II :
Phase III :
Phase IV :
Emergency/ Preventive / surgical Treatment.
Operative & Endodontic Treatment.
Prosthodontic Treatment.
Recall & Maintaince.
30

31. Treatment Objectives
To
eliminate pathology.
To
restore function.
To
improve esthetics.
To
motivate the patient to improve his
oral hygiene .
To
educate the patient & enforce
knowledge about oral & dental
awareness.
31

32. Risk Factors

Substandard dental care.

Poor oral hygiene.

Habits.
32

33. Treatment Plan
Tooth no. Condition
Recommendation
16
Occlusal caries
Composite restoration
11
Substandard RCT
Retreatment RCT & composite resto.
21
Substandard RCT &
fractured crown
Retreatment RCT & fiber post &
composite build-up & crown
26
Occlusal caries
Composite restoration
27
Occlusal caries
Composite restoration
36
Occlusal caries
Composite restoration
46
Occlusal caries
Composite restoration
47
Occlusal caries
Composite restoration
33

34. Upper arch
Condition: #16
-occlusal caries
Condition: #26,27
-occlusal caries
34

35. Lower arch
Condition: #36
-occlusal caries
Condition: #46,47
-occlusal caries
35

36. Upper arch
Recommendation:
#16,27,26
-composite restoration
36

37. Lower arch
Recommendation:
36,46,47
-Composite
restoration
37

38. Endodontic Phase
Condition: #11,21
-Substandard RCT
- Fractured crown #21
Recommendation:
Retreatment endodontic
38

39. Prosthodontic Phase
Recommendation: #11,21
- # 11 Composite restoration
- #21 (Fractured crown)
-
Post space preparation & cementation of FP
-
Biuld-up composite restoration
Preparation for full crown.
Temporary crown.
Final crown cementation (IPS e.max)
39

40. IPS e.max® System
• It is the ultimate in metal-free esthetics and durability offering highstrength materials for both the PRESS and the CAD/CAM technique.
• It is a lithium disilicate glass ceramic that has optimized translucency,
durability and strength for full anatomical restorations.
• IPS e.max lithium disilicate restorations exhibit superior durability
featuring 360-400 MPa of flexural strength.
•
The opalescence, translucency and light diffusion properties of IPS
e.max lithium disilicate were all designed to replicate natural tooth
structure for beauty and undetectable restorations
40

41. CEMENTATION
The high strength of IPS e.max lithium disilicate offers dentists a choice to adhesively
bond or conventionally cement their restorations.
Self-Adhesive Resin Cements
Adhesive Resin Cements
High-strength restorations only
Lithium disilicate (e.g. IPS e.max)
All types of restorations
Including Feldspathic and Leucite
Metal & Metal-Ceramic
Oxide Ceramic (Zirconia, Alumina)
Adequate retention in prep design
Less than 8 degree taper
Any preparation design
Retentive and non-retentive
Minimum 4mm height
Adequate thickness of restoration
Greater than 1.0mm for anterior
Any thickness
Including “thin” veneer restorations
Greater than 1.5 mm for posterior
Copyright © 2013 • Ivoclar Vivadent • All Rights Reserved • Terms & Conditions • Contact Us
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41

42. Before & After
Treatment
42

43. Frontal View
BEFORE
AFTER
43

44. Right Side
BEFORE
AFTER
44

45. Left Side
BEFORE
AFTER
45

46. Upper Arch
BEFORE
AFTER
46

47. Lower Arch
BEFORE
AFTER
47

48. Bite wing Post operative
48

49. OPG
49

50. Prognosis
Overall:
•
Good if the patient maintain good OH
& attend to the recall & maintenance
visit.
50

51. Thank you
51