full mouth case with with 21 months follow up2

8/10/2019 Full Mouth Case With With 21 Months Follow Up2

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1Dr. MOHAMMED ALSHEHRI R 4

SAUDI COUNCIL FOR HEALTH

SPECIALTIES

SBARD

Case Presentation


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Case NO. : 05/USC-RKH/R2 04

Date Started: 04 Sep. 2004

Date Completed: 05 Apr. 2005

Treatment Duration: 7 months

Total Number Of Visits : 35

Number Of Visits Attended: 34

Number Of cancelled visits: 1


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Age: 27 years old.

Sex: Female

Nationality: Saudi

Education: Secondary school

Occupation: House wife

Marital & social status: Married

Patient attitude: Positively co-operative

Personal Data


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Medical History

Significant Medical Problems : None

Physical Classification : ASA I

History of Allergic Reaction : None

Family Medical History

None


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I had a sever pain related to upper right side and I do not

like the color of my teeth.

Pain started 3 weeks ago.

Severe fluorosis which led to difficult oral hygiene and

unacceptable esthetic.

Dental Chief Complaint


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Dental History

Pain History Form


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Past Dental History

Patient had one restoration.

The last dental visit 1year ago for restoration.

Patient Attitude

The patient is rational, well balanced and intelligent.


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Tooth brushing : Twice / day

Interproximal cleaning : None

Meswak : Once / week

Mouth wash : None

Smoking : None

Habits and Oral Hygiene Activity


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Dietary Survey

,

3

----

----4

2

3

12

---- 1

15

----

3

----

---- ----


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Conclusion

3 meals / day.

High sugar intake.

Low amounts of fruits and vegetables.

Snacks between meals .

7 Cups of tea and coffee (three tea spoon of sugar) / week.

Dietary advice

Encourage reduction of sugar and carbohydrates intake.

Increase the intake of fruits and vegetables.

Confine snacks intake to meals time.


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Clinical Examination

Facial asymmetry NAD

Swelling NAD

Skin NAD

Lips Competent

Muscular Tenderness NAD

Extra-Oral Examination


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Clicking : NAD

Crepitus : NAD

Pain : NAD

Limitation On Opening : NAD

Deviation On Opening : NAD

TMJ


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Alveolar Mucosa NAD

Tongue NAD

Cheek NAD

Palate NAD

Floor of the mouth NAD

Frenum attachment NAD

Intra-Oral Examination (Soft Tissue)


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Intra-Oral Photographs


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Gingiva

Generalized inflammation of the gingiva and interdentalpapillae with bleeding upon gentile propping


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Oral Hygiene

Date Sep. 4 04Plaque

score

76%

Bleedingscore

55%

* Silness J and Loe,H. 1964

*

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17

PP

PP

BOP

BOP

Plaque : Generalized

Calculus : Generalized supra-gingival


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Oral Hygiene

PSR (Periodontal screening & recording system)

Probing depth :

- Generalized: 2-3 mm

Mobility : None Furcation: None

2 2 2

2 2 2


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Occlusion (Angels Classification)

Rt. Class II canine relationship.

Lt. Class I canine relationship.

Rt. & Lt. Class I molar relationship.

Anterior

Horizontal overlap : 1-2 mm.

Vertical overlap : 2 mm.

Mid line shift to the Rt. Side 2 mm

Clinical findings

Rt.

Lt.


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Diagnostic Tools

1. FMX and OPG.

2. Diagnostic Casts & Diagnostic wax up.

3. 4Rs System :

R1: Patients report

R2: Radiographic findings

R3: Stimulus response testing:

P1: Pulp testing using Co2

P2: Periodontal condition

P3: Palpation

P4: Percussion

R4: Restorative index


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FMX


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FMX


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FMX


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Diagnostic Casts

T i T Pl


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Tentative Treatment Plan

Tooth Condition Recommendation

# 1(18) Missing ---------------------------------------

# 2(17) Occ. & B. caries Cl. I ama. & Cl. V comp.

# 3(16) O.D. caries

Necrotic pulp

RCT, post & core & PFMcrown.

# 4(15) O.D. caries

Irreversible pulpitis

RCT, post & core & PFMcrown.

# 5(14) O.D. & P. caries &sever fluorosis

Cl. II , Cl. V composite &Porcelain veneer.

T i T Pl


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# 6(13) Severe fluorosis &facial caries Porcelain veneer

# 7(12) Severe fluorosis Porcelain veneer





T t ti T t t Pl


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# 12(24) O.D. Caries & severfluorosis

Cl. II composite & Porcelainveneer.

# 13(25) MOD caries

irreversible pulpitis

RCT, post & core & PFM

crown.

# 14(26) O.D.P caries & severfluorosis

Composite build up & PFMcrown.

# 15(27) O.M.P. & B. caries Cl. II ama. & Cl. V comp.

# 16(28) Missing ---------------------------------------

T t ti T t t Pl


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# 17(38) Missing --------------------------------------

# 18(37) O.M. & B. caries Cl II & V amalgam resto.

# 19(36) O.D. caries Cl II amalgam restoration.

# 20(35) O. Caries & Severefluorosis Cl I composite & porcelainveneer.

# 21(34) O.D. caries & Severefluorosis

Cl II composite & porcelainveneer.

T t ti T t t Pl


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Tooth Condition Recommendation# 22(33) Defective restoration

& Severe fluorosisCl. V composite & porcelain

veneer.

# 23(32) Severe fluorosis Porcelain veneer.




# 27(43) D. caries & Severefluorosis

Cl. III composite & porcelain

veneer.



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# 28(44) M.O. Caries &Severe fluorosis Cl. II comp. & Porcelainveneer.

# 29(45) O.D. caries &Severe fluorosis

Cl. II comp. & Porcelainveneer.

# 30(46) M.O. & O.D. caries Cl. II amalgam restoration.

# 31(47) O. & B Caries Cl. I & V amalgam resto.

# 32(48) Missing -------------------------------------

Problem List


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I had a sever pain related to upper right side and I do not likethe color of my teeth

Problem List

Chief complaint :

Problem List


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Problem List

Risk Factors :

Poor oral hygiene.

Diet high carbohydrate & sugar

Sever fluorosis.

Treatment provided


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dental fluorosis at or above a TFI score of 3

had higher levels of dental caries than thosewith milder degrees of fluorosis present. This

finding suggests that if fluoride intake is toohigh, severe enamel hypomineralization may

result in increased caries risk.

Treatment provided

Cortes DF, et al.

J. of Public Health Dentistry 1996

Treatment provided


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More severe degrees of enamel fluorosis are

associated with an abnormally highincidence of caries. There is thus no doubt

that a high degree of enamel fluorosis causesan increased tendency to caries.

Treatment provided

Carlsson A.

Lakartidningen 1978

Treatment provided


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Children with severe fluorosis have a

significantly higher caries experience than dochildren with lesser degrees of fluososis

Treatment provided

Driscoll WS et. al.

J Am Dent Assoc. 1986

Problem List


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Problem List

Caries lesions : #2(17), 3(16), 4(15), 5(14), 6(13), 12(24),

13(25), 14(26), 15(27), 18(37), 19(36), 20(35), 21(34),

27(43), 28(44), 29(45), 30(46), 31(47) T = 18T = 18

Defective restorations : #22(33)

Generalized severe fluorosis .

Restorative :

Problem List


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Problem List

Periodontal :

Generalized early to moderate plaque induced

gingivitis.

Generalized plaque and calculus .

Problem List


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Problem List

Endodontic :

Irreversible pulpitis : #4(15), 13(25).

Necrotic : #3(16).

T = 2T = 2

Treatment Objectives


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Treatment Objectives

To educate & motivate the patient to improve her oral

hygiene.

To treat caries .

To restore esthetics .

To restore function .

Treatment Phases


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Treatment Phases

Phase I : Clinical diagnosis, ER, prevention, consultationand provisionalization.

Phase II : Resto, endo, & posting .

Phase III: Surgery .

Phase IV: Prosthodontic treatment .

Phase V : Recall & maintenance .

Treatment provided


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Phase I: preventive dentistry phase

Clinical diagnosis

ER treatment

Consultation

Case presentation

Prevention:

Oral Hygiene Instructions

Scaling, root planning and Prophylaxis Fluoride application

Diet analysis

ea e p ov ded

Phase I


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Endodontic emergency treatment #4(15),3(16).

Negotiation Measurements Initial condensation Final

#4(15)


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Measurements Initial condensation Initial condensation Final

#3(16)

Phase II


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Phase II: Resto., endo., & posting

Oral hygiene assessment & reinforcement.

Restoration of teeth:#2(17), 3(16), 4(15), 5(14), 6(13), 12(24), 13(25), 14(26),

15(27), 18(37), 19(36), 20(35), 21(34), 27(43), 28(44),

29(45), 30(46), 31(47)

Endodontic treatment of teeth:

#13(25)

Oral hygiene assessment & reinforcement


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Tooth brushing : 3 Times / day Interproximal cleaning : Once / day


Diet : Patient reduce sugar intakeprognosis : good

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17

yg

Date Sep 18 04

Plaque

score

26%

Bleedingscore

19%


*

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

PP

PP

BOP

BOP

Phase II


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Restoration of teeth:#2(17), 15(27), 18(37), 19(36), 30(46), 31(47)

Phase II


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Inverse relationship between shear bond

strength and severity of fluorosis.

Awliya WY et al.

Inter. Dent. Journal 1999

Phase II


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Restoration of teeth:# 20(35), 21(34), 27(43), 28(44), 29(45)

Phase II


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Endodontic treatment of tooth #13(25)Negotiation

measurement

Initial

condensationFinal

obturation


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Having 1 mm of vertical tooth wall between

the margin of the core and the shoulder of thepreparation provide a ferrule effect,

enhancing fracture resistance by 80% to139%.

Sorensen JA, Engelman MJ.

J Prosthet Dent 1990


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67% of the amalgam cores tested in an in

vitro study survived 1,000,000 cycles of 75-lbloading, while 17% of composite resin cores

survived.

Kovarik RE, Breeding LC, Caughman WF.

J Prosthet Dent 1992

Phase IV


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After initial preparation of Maxillary teeth, enamel where

easily chipped in the proximal surfaces with areas of enamel

defect, So treatment modified to a full coverage restoration.


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Cases in which more than 50% of outermost

enamel Loss, i.e. TFI 8 & 9, The teeth shouldbe crowned.

Akpata E S.



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With more severe forms of fluorosis, caries

risk increases because of pitting and loss ofthe outer enamel.

Levy SM

J. of the Canadian Dent Assoc 2001

Diagnostic Wax Up


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Phase IV


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Oral hygiene assessment & reinforcement.

PFM crown # 3(16), 4(15), 5(14), 6(13), 7(12), 8(11),

9(21), 10(22), 11(23), 12(24), 13(25), 14(26).T = 12T = 12

Porcelain veneers #20(35), 21(34), 22(33), 23(32),

24(31), 25(41), 26(42), 27(43), 28(44), 29(45) T = 10T = 10

Oral hygiene assessment & reinforcement


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Tooth brushing : 3 Times / day

Interproximal cleaning : Once / day


Prognosis : good

32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17

Date Nov.13

04

Plaque

score

17%

Bleeding

score

15%


*1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

PP

PP

BOP

BOP

Phase IV


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PFM crown # 3(16), 4(15), 5(14), 6(13), 7(12), 8(11), 9(21),

10(22), 11(23), 12(24), 13(25), 14(26).

Phase IV


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Porcelain veneers #20(35), 21(34), 22(33), 23(32), 24(31),

25(41), 26(42), 27(43), 28(44), 29(45)

Treatment provided


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Clinical experience had shown that pitted

fluorosed teeth (TFI _ 5 ) can seldom besuccessfully managed by micro-abrasion,

such cases are therefore restored with

composite resin or laminate veneers.

Akpata E S.


Phase IV


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Temporization

Phase IV


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Metal try in.

FMX


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FMX


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FMX


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OPG


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Intraoral Photograph


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Phase V: Recall & maintenance phase


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(3 months)

Date Jul. 10 05

Plaque

score

19%

Bleeding

score

21%


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Date Oct. 10 05

Plaque

score

16%

Bleeding

score

19%

(6 months)

Date Apr. 11 06


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Plaquescore 19%

Bleeding

score

25%

(12 months)


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(21 months)


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Date Jan. 7 07

Plaque

score

23%

Bleedingscore

24%


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Treatment summary


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Treatment Duration : 7 MonthsTreatment Duration : 7 Months

Recall & maintenance : 4 visitRecall & maintenance : 4 visit

No. of Restorations : 18No. of Restorations : 18

No. of Crowns : 12No. of Crowns : 12

No. of Veneers : 10No. of Veneers : 10

Objectives where achievedObjectives where achieved


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312312313313 212212 223223 312312 222222 323323 322322 232232 323323 323323 223223 233233 223223

Mobility

Recession

Probing depth

Existing Rest.

1 2 3 4 5 6 71 2 3 4 5 6 7 8 9 10 11 12 13 14 158 9 10 11 12 13 14 15 1616


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++++ ---- ++ ++ ++ ++ ++ ++ ++ ++ ++

Defective Surface (s)

Carious Surface (s)

CO2

F

A

C

I

A

L

P

A

L

A

T

A

L

Recession

Probing depth

Existing Rest.

U

P

P

E

R

324324 324324 222222 212212 313313 211211 211211 112112 212212 222222 224224 324324 433433 224224

323323 322322 222222 322322 222222

22

22

22

22

22

22

22

22

22

22

22

22

233233 322322 322322 333333 332332

MobilityMobility

Recession & BleedingRecession & Bleeding

Probing depthProbing depth

Existing Rest.Existing Rest.

32 31 30 29 28 27 26 2532 31 30 29 28 27 26 25 24 23 22 21 20 19 18 1724 23 22 21 20 19 18 17


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++ ++ ++ ++ ++ ++ ++ ++ ++ ++ ++ ++ ++ ++

Defective Surface (s)Defective Surface (s)

Carious Surface (s)Carious Surface (s)

CO2CO2

F

A

C

I

A

L

L

I

N

G

U

A

L

L

O

W

E

R

RecessionRecession

Probing depthProbing depth

Existing Rest.Existing Rest.

323323 323323 222222 212212 313313 211211 211211 112112 212212 222222 223223 323323 233233 223223

full mouth case with with 21 months follow up2

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