Rania saeed l12 case presentation

RIYADH COLLEGES OF DENTISTRY &
PHARMACOLOGY

COMPREHENSIVE CASE PRESENTATION

Prepared by:
Aljohara Alfaqeeh
ID #:
42820042
Level:
12
ALJOHARA ALFAQEEH 42820042 1

PHARMACOLOGY

Personal Data:

 Age: 33 years old.
 Gender: Female.
 Nationality: Sudanese.
 Occupation: Housewife.
 Social Status: Married.
 Patient’s Cooperation: Cooperative.
 File Number : 42538.


PHARMACOLOGY

Chief Complain:

“ Do a general check up because I have a lot of decayed & corroded teeth. ”


PHARMACOLOGY

Medical History:

She is medically fit.
She takes OCP pills for birth control.


PHARMACOLOGY

Family Medical History:

There is no significant family medical history mentioned.


PHARMACOLOGY

Past Dental History:

Multiple root canal treated teeth.
Multiple restored teeth.
Multiple extracted teeth.
1 FPD unit.


PHARMACOLOGY

Oral Hygiene Activity:
-Good Oral Hygiene.
- Patient uses:
Tooth brush : once & sometimes twice/day.
Tooth Brush : soft brush.
Brushing technique : horizontal (scrub) technique.
Dental floss/ Meswak / Mouth wash : none.


PHARMACOLOGY

Recommended:
- Tooth brush type: Soft Nylon bristle tooth brush.
- Brushing Frequency: 2-3 times per day.
- Brushing Methods: modified bass technique.
- Interdental Aids: Dental floss.


PHARMACOLOGY

Clinical Examination


PHARMACOLOGY

I. Extra Oral Examination:

Skin
TMJ
Lymph nodes All within normal
(Cervical, Submandibular) limits.
Neck


PHARMACOLOGY

II. Intra Oral Examination (soft tissue):

Lips.
Vestibules.
Soft palate . All within normal
Tongue . limits.
Floor of the mouth.

Hard Palate  Patient has torus palatinus.


PHARMACOLOGY

II. Intra Oral Examination (dentition):

Maxillary arch


PHARMACOLOGY

II. Intra Oral Examination (dentition):

Mandibular arch


PHARMACOLOGY

Pretreatment Photographs


PHARMACOLOGY


PHARMACOLOGY

Periodontal Chart


PHARMACOLOGY

Gingival Index By: “Silness and Loe,1967”

1 1
1 1 1 1
1 1

1 1 1
1 2 2 1 1 1
1 1 1

Total = 1.1  Moderate gingival
inflammation of the gingiva


PHARMACOLOGY

Plaque Index: By: “Silness and Loe,1967”

2 0
2 2 0 0
1 1

1 1 1
1 2 1 0 1 1
1 0 0

Total = 0.75  Mild plaque accumolation


PHARMACOLOGY

Calculus Score:
Initial generalized calculus deposits.


PHARMACOLOGY

PSR (Periodontal Screening & Recording):

3 3 1
3

3 3 3


Bleeding
M-CEJ
M-PD 113 532 332 123 212 212 212 224 212 323 323
CAL
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28

18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
M-CEJ
M-PD 344 545 222 223 212 212 222 212 221 322 121
CAL
Bleeding ALFAQEEH 42820042
ALJOHARA 27

Bleeding
M-CEJ
M-PD 345 222 212 312 311 211 212 212 211 112 323 433 324 422
CAL
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38

48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
M-CEJ
M-PD 433 222 322 212 213 313 212 114 113 313 114 215 314 315
CAL
Bleeding ALFAQEEH 42820042
ALJOHARA 28

PHARMACOLOGY

 Mobility assessment
0  No detectable mobility other than physiologic.

 No Furcation involvement.
 Local factors:
Plaque.
Calculus.
Iatrogenic factors : defective bridge and restorations.


PHARMACOLOGY

Diagnosis:
Generalized mild Chronic Periodontitis.
Overall Prognosis:
Good.


PHARMACOLOGY

Diet analysis:
- 3 meals/day.
- Snacks between meals.
- High sugar amount added to tea.
- A lot of coffee and dates.


PHARMACOLOGY

Recommendations:

- Reduction of Carbohydrates intake.
- Reduce the amount of coffee and tea.
- Include fruits and vegetables in her diet.


PHARMACOLOGY

CRT (Caries Risk Test):

Saliva buffer capacity High
Saliva viscosity Viscous


PHARMACOLOGY

CRT (Caries Risk Test):

Mutans Streptococci : High Risk
Lactobacilli : High Risk

According to the “
Standard chart”


PHARMACOLOGY

Salivary Flow Rate:
STIMULATED SALIVARY FLOW RATE :
1.2ml / min
NORMAL VALUES:
STIMULATED 0.7-1.5 ml/min.


PHARMACOLOGY

Diagnostic tools:

Radiographs.
Mounted Cast.


PHARMACOLOGY


PHARMACOLOGY

Right Bitewings


PHARMACOLOGY

Left Bitewings


PHARMACOLOGY

Right Side Periapicals


PHARMACOLOGY

Left Side Periapicals


PHARMACOLOGY

Upper & Lower
Anteriors Periapicals


PHARMACOLOGY

• Mounted Diagnostic Cast

-Midline:
Upper midline is normal
Lower midline deviated to the Right side by
2 mm.
Mild Diastima  frenectomy.
-Vertical Overbite: 60%
-Horizontal Over jet: 3 - 4mm

Anterior Cross bite.
Lingual Cross bite.


PHARMACOLOGY


Canine Relationship:
Class I.

Molar Relationship:
Non applicable.


PHARMACOLOGY

Canine Relationship:
Class I.

Molar Relationship:
Non applicable.

 Over eruption of
the canine due the
Lingual Cross bite.


PHARMACOLOGY


 No crowding.
 Mild spacing.
 Upper molars are rotated ( #18, #17, #27, #28).


PHARMACOLOGY

Vitality & Percussion Test


PHARMACOLOGY

Application of Endo Frost (-50° C) on suspected teeth.

Tooth # Cold test V. Percussion H. Percussion Pulp Periapical
test test Diagnosis Diagnosis
#17 +ve -ve -ve Normal Normal


PHARMACOLOGY


#14 -ve +ve -ve Previously Symptomatic
Treated Apical
Periodontitis


PHARMACOLOGY


#12 -ve -ve -ve Previously Normal
Treated


PHARMACOLOGY


Treated


PHARMACOLOGY




PHARMACOLOGY


#45 +++ve -ve -ve Irriversable Normal
Pulpitis
(symptomatic)


PHARMACOLOGY


#46 -ve +ve -ve Previously Asymptomatic
Treated Apical
Periodontitis


PHARMACOLOGY

TREATMENT OBJECTIVES:
- CONTROL ACTIVE DISEASES.
- EXTRACT NON RESTORABLE TEETH.
- IMPROVE ORAL HYGIENE.
- CARIES CONTROL.
- RESTORE FUNCTION AND ESTHETICS.
- MAINTAIN THE RESULTS.


PHARMACOLOGY

Treatment Plan


PHARMACOLOGY

Treatment Phases:
Phase I : Emergency/ Preventive Treatment.
Phase II : Operative Treatment.
Phase III : Endodontic Treatment.
Phase IV : Pre-Prosthetic / Surgical Treatment.
Phase V : Prosthodontic Treatment.
Phase VI : Recall & Maintenance.


PHARMACOLOGY

Problem Proposed treatment

Generalized mild Chronic Periodontitis.  Extraction of Hopeless teeth.
 OHI instructions & plaque control.
 Supragingival scaling & polishing.
 Correction of iatrogenic factor.
 Re-evaluation after 4 – 6 weeks.
 Maintenance every 3 months.


PHARMACOLOGY

Tooth Proposed treatment

#18  Occlusal Caires Class I Composite
restoration.


PHARMACOLOGY


#17  Under prepared Prepare the tooth for
abutment. surveyed crown.


PHARMACOLOGY


#16, #15 Missing. Implant.
RPD.


PHARMACOLOGY


#14  Extensive Caries. Extraction.


PHARMACOLOGY

#12  Substandard RCT. + Root  Remove Gp block the wall with MTA
Resorption because of the trauma from and wait till the internal wall of the
occlusion (cross bite). tooth regenerate. After that RCT +
post & core + Crown.
Or
 Extract the tooth and replace it by
:Implant
PFM
RPD

PHARMACOLOGY


#11  Broken incisors + Remove screw post +
malformed restoration + Redo RCT + post & core +
Substandard RCT + Root porcelain crown.
Resorption.


PHARMACOLOGY


#21  Broken incisors + Remove pin + Redo RCT
malformed restoration. + post & core + porcelain
crown.


PHARMACOLOGY


#22 Recurrent caries. Redo Class III composite
restoration.


PHARMACOLOGY


#23  Distal Caries Class III composite
restoration.


PHARMACOLOGY


#24 #25 #26 Missing. Implant.
RPD.


PHARMACOLOGY


#27 Faulty Restoration. Redo Restoration.


PHARMACOLOGY


#28  Occlusal Caries. Class I Composite
restoration.


PHARMACOLOGY


#37 Faulty Restoration Redo Restoration.
+ recurrent caries.


PHARMACOLOGY


#36 Over hanged Redo Restoration.
amalgam restoration.


PHARMACOLOGY


#42 #43 Over Eruption. Shave the teeth to create
more space for the upper
#12 & to relief the trauma
from occlusion.


PHARMACOLOGY


#34 Distal pit Caries. PRR.


PHARMACOLOGY


#44 Pit Caries. PRR.


PHARMACOLOGY


#45  Extensive Caries. Endo + Post and core &
Crown ( tooth will need
crown lengthening ).


PHARMACOLOGY


#46  Extensive Caries. Extraction.


PHARMACOLOGY


#47 Missing. Implant.
RPD.


PHARMACOLOGY


#48 Occlusal Caries. Class I Composite
restoration.


PHARMACOLOGY

Pre- Prosthetic/ Surgical Phase IV:

Torus Palatinus:
Treatment:
Surgically remove the torus palatinus
because if it will interfere with the placement
of the denture and replace it with skin graft.

But in our case we wont remove it because
our major connector is horse shoe.


PHARMACOLOGY

Prosthetic Phase V:


PHARMACOLOGY
Wax Up


PHARMACOLOGY

Prosthodontic Treatment:

RPD Design Major Direct Indirect
for Upper Arch Connector Retainers Retainers
Class III Horse Shoe #17  #13, #23 
modification I Surveyed Cingulum Rest
Crown #17, #27 
#17 #27 Mesial Rest
Aker Clasp
#13, #23 T bar.


PHARMACOLOGY

Prosthodontic Treatment:

RPD Design Major Direct Indirect
for Lower Arch Connector Retainers Retainers
Class III Lingual Bar #45 #45, #36 
Surveyed Distal Rest.
Crown #48, #37 
#45, #48  Mesial Rest.
Aker Clasp #33, #43 
#37, #36  Cingulum Rest.
Double Aker
Clasp

PHARMACOLOGY

Recall & Maintenance Phase VI:
Recall Patient every 3 months :
For periodontal maintenance .

Recall Patient every 6 months :
To take full mouth radiographs and to check the restorations , prosthesis and RCT .


PHARMACOLOGY

Treatment Phases:
Phase I : Emergency/ Preventive Treatment.
Phase II : Operative Treatment.
Phase III : Endodontic Treatment.
Phase IV : Pre-Prosthetic / Surgical Treatment.
Phase V : Prosthodontic Treatment.
Phase VI : Recall & Maintenance.


PHARMACOLOGY

THANK YOU


Rania saeed l12 case presentation

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Rania saeed l12 case presentation