This presentation is about a clinical case. All photos are not property of the author of the presentation.

1. Problem Based Learning:
Clinical case
L E B A N E S E U N I V E R S I T Y- S C H O O L O F D E N T I S T R Y
DUB1-DRE
S T E P H A N I E M O U AWA D
0 9 - 0 3 - 2 0 11

2. Case presentation
Localized hypersensitivity
Mr. I.
Cervical lesions
Age: 75 Chronic periodontal disease
Sex: Male Occlusal overload
Diastemas

3. 1- Defining the problems
Localized hypersensitivity
Possible causes:
 Pulp exposure and potential pulpal
pathology
 Exposed root
 Enamel loss with exposed dentin
#14

4. Cervical lesions on premolars and molars
 Tensile stresses causing
abfraction,
 Associated with other local
chemical and biomechanical
factors, causing erosion and
abrasion
 Increased stress (tooth # 14:
opposing crown)

5. Severe chronic periodontal disease with gingival recession
 Poor oral and dental
RECESSION
hygiene
 Occlusion problems
and bad parafunctional
habits
SEVERE
BONE LOSS

6. Occlusal overload
Malocclusion
Parafunctional habits (bruxism)
Incisal WEAR

7. Important upper and lower anterior Diastemas
•Periodontal disease
•Occlusal overload
•Inter-arch tooth size
discrepancies

8. 2- Elaboration of a treatment planning
A- Medical History
The patient is asked to declare any medical
condition (present and past)

9. B- Sequencing of treatment
1- Chief complaint
2- Preventive measures (motivation to oral care)
3- Interdisciplinary discussion (periodontist/ orthodontist)
4- Discussion of treatment options with patient (take
consent to proceed)
5- Treatment procedure

10. 1- CHIEF COMPLAINT: Tooth # 14
Indirect pulp RCT
capping

11. 2- Preventive measures

12. 3-Interdisciplinary discussion
Occlusion adjustment
Root scaling

13. Orthodontic treatment (?)

14. 4- Discussing the options with the patient
Option 1
Direct composite Veneers

15. Post. teeth Tooth #14
Tooth #44
Crown replacement
ClV composite Cl V comp/
Endo+ Crown

16. Option 2
Orthodontic

17. 13 11 23
14
Cl V composite
Cl V composite/ crown Cl I Incisal
16
15
45 44 41 31
46
Cl V composite Crown replacement Cl IV composite

18. PS
If Orthodontic movement creates large
posterior space, then consider RPD
with dento-mucosal support

19. Option 3

20. Option 4
13 11 23
14
Cl V composite/ crown
Cl V composite
Cl I Incisal
16
15
45 44 41 31
46
Cl V composite Crown replacement Cl IV composite

21. splinting
Stabilization of loose teeth and occlusion
Types:
- Fixed: Wire & composite splints, Ribbond
- Removable appliances: Hawley, Clear tray

22. Wire & composite
technique

23. Ribbond
unfilled bonding adhesive
filled composite

24. flowable composite

26. ? Removable
appliances
+ night guard??

27. Review
Treatment Aesthetics Preservation Resistance Cost Time
*Direct ok short
Veneers(C)
+ - -
(large gaps
* ClV post
= large
*Crown 44
teeth)
And or
Crown 14
*Splinting

28. Treatment Aesthetics Preservation Resistance Cost Time
*Orthodontic High Long
*ClV, ClIV,
+++ +++ +++
ClI(C)
*Crown 44
And or Crown
14
*Splinting
and retention

29. Treatment Aesthetics Preservation Resistance Cost Time
*Full mouth High Ok
restorations
+ -- ++
with crowns (long
*Splinting
crowns)

30. Treatment Aesthetics Preservation Resistance Cost Time
*Keep the - Low short
diastemas
+++ +++
*ClV, ClIV,
ClI(C)
*Crown 44
And or
Crown 14
*Splinting

31. +
Age
+
Motivation
+
Patient Preferences

32. 5- Proceeding with the treatment
Option # 4 Keep the diastemas, treat all other lesions
Option # 1 Direct composite Veneers

33. Maintenance and recall
Check the state of the splints/effect of night guard
Check for gum health and bone support
checkups every 6 months for overall treatment control

34. Thank you