Treatment Plan Seminar 10 - 04 - 2018

Patient’s Profile Age 19 years Gender Female Occupation Nationality Student Nationality Saudi Marital Status Single Cooperative Patient

Medical History The Patient is not aware of any medical conditions. Random Blood Sugar 120 mg/dl Blood Pressure 124/80 mmHg Height 153 cm Weight 65 kg

“I have bad oral odor and bleeding during brushing” Chief Complaint “I have bad oral odor and bleeding during brushing”

Dental History Year Procedure 2008 Restorations for teeth # 16 and 36 2012 Restorations for teeth # 45 and 47 2014 Restorations for teeth # 25, 26, 27, 37, and 35 2016 Scaling

Oral Hygiene Type of Tooth Brush Medium Brushing Technique Scrubbing Frequency One time a day

Extra-Oral Examination Lymph Nodes: No masses, swelling or Lymphadenopathy. Temporomandibular Joints: Right and left without clicking or deviation.

Intra-Oral Examination

Radiographic Examination

Periodontal Examination

DB B MB DP P MP CAL Mobility Diagnosis PD CEJ-GM Tooth Number DB B MB DP P MP CAL Furcation Mobility Diagnosis M D #17 PD 4 3 5 - II-A2 CEJ-GM 2 1 #16 6 #15 #14

#13 3 1 5 2 4 #12 #11 #21 #22 #23 Tooth Number DB B MB DP P MP CAL Furcation Mobility Diagnosis M D #13 PD 3 1 5 2 4 - II-A2 CEJ-GM #12 #11 II-A1 #21 #22 #23

DB B MB DP P MP CAL Mobility Diagnosis PD CEJ-GM Tooth Number DB B MB DP P MP CAL Furcation Mobility Diagnosis M D #24 PD 2 1 5 3 - II-A2 CEJ-GM #25 II-A1 #26 #27 4

DB B MB DL L ML CAL Mobility Diagnosis PD CEJ-GM Tooth Number DB B MB DL L ML CAL Furcation Mobility Diagnosis M D #37 PD 5 3 4 2 - II-A2 CEJ-GM 1 #36 II-A1 #35 #34

#33 2 1 #32 #31 #41 #42 #43 Tooth Number DB B MB DL L ML CAL Furcation Mobility Diagnosis M D #33 PD 2 1 - II-A1 CEJ-GM #32 #31 #41 #42 #43

DB B MB DL L ML CAL Mobility Diagnosis PD CEJ-GM Tooth Number DB B MB DL L ML CAL Furcation Mobility Diagnosis M D #44 PD 2 1 - II-A1 CEJ-GM #45 4 3 II-A2 #46 5 15 12 7 8 III II II-A3 #47

Oral Findings Plaque Index 86 % Bleeding Index 71 %

Oral Findings Caries in teeth # 12,13, 22, 23, 24, 25, 36, 44, 45, 46. Crowding upper and lower teeth

Pre-treatment Consultation Prosthodontics. Orthodontics.

Periodontal Diagnosis Generalized moderate chronic periodontitis AAP Classification 1999

Etiology Primary: Dental Plaque (Löe et al. 1965). Secondary: Supra and subgingival calculus (Schroeder et al. 1969). Crowding (Poulton 1961). Metal band on tooth # 16

Overall Individual Prognosis Favorable Hopeless #46 (Kwok & Caton 2007)

Treatment Plan

Initial Treatment Plan Phase I: Case presentation and Patient motivation. Oral hygiene instructions: Soft tooth brush ( Oral B ). Dental Floss. Brushing technique: Modified Bass brushing technique

Initial Treatment Plan Phase I: Supra and subgingival scaling and root planning Restoration of carious teeth Extraction of impacted third molars

Initial Treatment Plan Phase I: # 46 Extraction with socket preservation Delayed implant placement. (After completion of orthodontic treatment) Re-evaluation of tissue response after 4 weeks

Initial Treatment Plan Phase II: #15-17 Open Flap Debridement for accessibility and pocket reduction (Heitz-Mayfield 2002). Orthodontic treatment

Initial Treatment Plan Phase III: #46 Prosthetic crown of dental implant

Initial Treatment Plan Phase IV: Recall interval every 6 months (Yang2015).

Re-evaluation

Before After

Before After

Before After

Before After

Tooth Number DB B MB DP P MP Before After #17 PD 4 2 3 5 #16 6 #15 1 #14 #13 PD 3 2 1 5 #12 4 #11 #21 #22 #23 #24 PD 2 1 5 3 #25 #26 #27 4

Tooth Number DB B MB DL L ML Before After #37 PD 5 3 2 4 #36 #35 1 #34 #33 PD 2 1 #32 #31 #41 #42 #43 #44 PD 2 1 #45 4 #46 - #47 5 3

Before After Plaque Index 86 % 31 % Bleeding Index 71 % 15 %

Definitive Treatment Plan

Definitive Treatment Plan Phase II: # 46 implant placement.

Definitive Treatment Plan Phase III: #46 Prosthetic crown of dental implant

Definitive Treatment Plan Phase IV: Recall interval every 6 months (Yang2015).

Periodontal Surgery

Extraction of Tooth # 46

Extraction of Tooth # 46

Extraction of Tooth # 46

Extraction of Tooth # 46

Socket Preservation for Socket of tooth # 46

After 3 Months

Implant Placement of Tooth #46

Implant Placement of Tooth #46

After Two Weeks

Thank you