duy american board of periodontology narrative report

8/10/2019 Duy American Board of Periodontology Narrative Report

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American Board of Periodontology Narrative Report

Slide#:

1. AAP title slide

2. Personal profile:

The patient as referred to !"S $epartment of Periodontology for a comprehensive

periodontal e%amination &y her general dentist on !ct 1'( 2))'. The patient is a *+ yearold ,a-casian female ho resides in S Portland( !R. She or/s as a self employed

graphic artist. The patient as asymptomatic at her initial visit and her chief complaint

as( 0 ant to save my teeth from falling o-t.

+. 3edical and Social "istory:

4ital signs ere recorded on !ct. 1'( 2))' and ere 5N6. The patient considers herself

to &e in good health. The patient sees a medical doctor tice a year for ro-tine chec/7

-ps. The patient has &een diagnosed ith hypercholesterolemia and depression at thetime of the comprehensive periodontal e%amination. Patient reports no history of

inherita&le diseases and &oth parents have healthy dentitions. The patient states shesocially smo/ed cigarette to&acco and socially im&i&es alcohol. $-ring the co-rse of

treatment( ith enco-ragement( the patient 8-it smo/ing. Patient denies recreational -se

of dr-gs. Patient shos great motivation in achieving oral health and retaining teeth.

9. 3edications:

She reports ingesting prescription medications of l-o%etine72)mg;day for depression

and Atorvastatin72)mg; day for high cholesterol.The patient states she is allergic to penicillin.

*. %tra;ntraoral "istory and indings:,linical e%traoral history and findings( intraoral history and findings incl-ding

periodontal e%amination( occl-sal analysis( and radiographic findings ere doc-mented.

Please refer to yo-r case report s-mmary.

'. Pre7Treatment ,hart:

,A6( B!P( pro&ing depths( presence of pla8-e( gingival recession( f-rcation

involvement( tooth mo&ilities( and other clinical findings are ill-strated. Please refer tothe pre7treatment case report record for f-rther details.

ected as if yo- are sitting

on the patient=s tong-e.

?. Anterior 4ie:


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@ingiva appears pin/ to erythemato-s

Papillary gingival conto-r appears pointed to &l-nted

3arginal gingival conto-r appear rolled and thic/ened@ingival te%t-re is smooth ith localied areas of stippling

@ingival consistency as &oggy and edemato-s

3issing teeth #=s ' and 11@ingival recession on teeth #=s


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Slightly raised ro-nd &lac/ish &l-e lesion distal to tooth #1?.

Porcelain restorations on teeth #1? and 1

1ected ere ta/en Novem&er 11( 2))ected radiographs verify generalied horiontal &one loss.

3arginal ridge discrepancy &eteen #2?;2( 2;+)( and +);+1

21. 6eft Posterior Periapicals

"oriontal moderate &one loss is visi&le on #1271* and #1?72)

,onical roots #19 (1* and 1?Radioopacities interpreted as amalgams is visi&le on #12 and 19( and cron on tooth #1?

and 1

P-lp canals and root apices appear normal ith no evidence of periapical pathology6amina d-ra and P$6s appear contin-o-s

Bone tra&ec-lation appears normal

!pen contact evident &eteen #1? and #1

22. 6eft Biteings

The pro>ected radiographs emphasies horiontal pattern of &one loss.

,onfirms open contact evident &eteen #1? and #1 seen in PA radiographs


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!pen contact evident &eteen #1 and 2)

2+. The periodontal diagnosis is

Pla8-e nd-ced @ingivitis

@eneralied Severe ,hronic Periodontitis!ther $iagnoses

Secondary occl-sal tra-ma #19

,aries #+( 19( 1*Noct-rnal Br-%ism

29. tiology: Primary actor:

$ental Pla8-e Biofilm

"ost response and s-scepti&ility

Ris/ actor:

Poor oral hygiene ,igarette smo/ing

S-&gingival restorations

!pen contacts

$epression

2*. Prognosis

Short TermShort Term 6ong Term6ong Term

avora&leavora&le All teeth e%cept teeth thoseAll teeth e%cept teeth those

&elo&eloAll teeth e%cept those &eloAll teeth e%cept those &elo

H-estiona&leH-estiona&le 2( +( 19( 1*( 22( 2+( 2( +12( +( 19( 1*( 22( 2+( 2( +1 2( +( 19( 1*( 22( 2+( 2( +12( +( 19( 1*( 22( 2+( 2( +1

nfavora&lenfavora&le 29( 2*29( 2* 29( 2*29( 2*

2'. Treatment Plan

o-r Phases:

1. Phase Treatment: Non7S-rgical

2. Phase Treatment: S-rgical

+. Phase Treatment: Restorative9. Phase 4 Treatment: 3aintenance

!verall @oal:

1. To esta&lish a dentition and periodonti-m hich the patient and theprovider can maintain in health( comfort( f-nction( and aesthetically

accepta&le long term.

@oals o-ld &e accomplished thro-gh:

1. limination or control of primary factors and ris/ factors


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2. !" reinforcement

+. ns-ring patient compliance

2


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+*. 6ing-al ncisions

Similar to the &-ccal( intras-lc-lar incisions to the alveolar crest as made from the

distal line angle of tooth #2< to the distal facial line angel of #+1.

+'. B-ccal lap ReflectedA f-ll thic/ness m-coperiosteal flap as elevated( tiss-e degran-lated( SRP completed(

and no osseo-s reconto-ring as performed. ntra&ody defects ere vis-alied on the

mesial of #2 and +1. Both defects ere com&ination defects ith three alled defectsapically and one alled defects coronally.

+-st &elo the periosteal elevator.

+?. Allograft and 3em&rane PlacedPhoto -navaila&le for this slide.

Root s-rface f-rther modified -sing tetracycline &-rnished onto the root s-rface for 1min-te -sing cotton pellets. $efects grafted ith $$BA and covered ith resor&a&le

collagen mem&rane.

+. B-ccal 4ie S-t-res

laps replaced and sec-red ith interr-pted 97) sil/ s-t-res.

Post operative instr-ction ere given ver&ally and ritten to the patient.

&-profen '))mg % 2? caps-les( 1 caps-les &y mo-th 9 times a day as need for painPatient declined narcotic pain medications

Patient instr-cted to rinse B$ ith ).12E chlorhe%idine gl-conate. Patient as to

contin-e ith chlorhe%idine for at least 1 ee/Patient as sched-led for post7op visit 1 ee/ later( !" emphasied

9). 6ing-al 4ie S-t-resAgain( flaps replaced and sec-red ith interr-pted 97) sil/ s-t-res.

91. 2 5ee/ Post7!p B-ccal 4ieNo complaints or complications reported and s-t-res removed after one ee/. Slide

shos 2 ee/ post operative ith tiss-es healing 5N6( !" reinforced

92. 2 5ee/ Post7!p 6ing-al 4ie

Tiss-es healing 5N6.

9+. ' 3onth Post7!p B-ccal 4ie

No complaints reported. Tiss-es healing 5N6.

Papillae are &l-nted and gingiva is pale pin/

3arginal tiss-e is slightly rolled


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99. ' 3onth Post7!p 6ing-al 4ie

Tiss-es appear to have healed 5N6.Papillae are &l-nted and gingiva is pale pin/

3arginal tiss-e is slightly rolled

9*. 3a%;3an Anterior CPost7TreatmentF

Post7treatment photographs are appro%imately ' months folloing the last s-rgery of the

mandi&-lar right 8-adrant@ingiva appears pin/ ith ell demarcated m-cogingival >-nction

Papillae are generally &l-nted ith areas that are pointed

@ingival margins appear slightly rolled

@ingival te%t-re reveals a&sence of stippling@ingival consistency firm

9'. 3a% Anterior Palatal CPost TreatmentF

Papillary and marginal gingiva is pale pin/Papillary gingival conto-rs appear slightly &l-nted to pointed

3arginal gingival conto-r appears slightly rolled@ingival te%t-re is smooth

@ingival consistency is firm

9


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*2. 6eft 3a%illary Posterior Palatal

@ingiva appears pin/( firm3arginal gingival conto-rs appear slightly rolled

Papillae are &l-nted

B-l&o-s tiss-e evident on distal of #1*

*+. 6eft 3andi&-lar Posterior 6ing-al

@ingiva appears pin/ ith firm consistency@ingival te%t-re appears smooth and glossy

3arginal gingival consistency appears soft and appears slightly rolled

*9. 3a%illary;3andi&-lar Anterior PeriapicalsRadiographic impression is that the alveolar &one height appears similar to that of the

pre7treatment radiographs ith the apparent e%ception of slight &one fill in the ang-lar

defect on the mesial of tooth #?.

**. Right Posterior Periapical

Radiographic impression of the ma%illary se%tant is that the alveolar &one height appearsslightly more apical compared to pre7treatment radiographs

Radioopacity on the mesials of teeth #2 and +1 is interpreted as &one fill of the ang-lar

defects.

*'. Right Biteings

The pro>ected radiograph verifies the interpretation of &one fill in the ang-lar defect of

teeth #2 and +1Alveolar &one height of the ma%illa appears slightly more apical compared to pre7

treatment radiographs

*


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'). val-ation of Res-lts Pla8-e free score ??E

Bleeding on pro&ing *E of sites

3o&ility has decreased on teeth #1+( 19( 22 and 2+ and fremit-s no longer e%ist

on tooth #19 Pro&ing depths range from 27* mm e%cept for one

duy american board of periodontology narrative report

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