Comprehensive case presentation Wejdan AL- Marzooq 42920166 L 9 G 2

Cooperative and willing to attend her appointments regularly. Personal data 40 Age Female Gender sudanese Nationality House wife Occupation Married Marital and social status Cooperative and willing to attend her appointments regularly. Patient cooperation

In the patients own words: Chief complaint In the patients own words: (I heat how my upper front tooth looks like)

History of Chief complaint

She is medically fit and she is not under any medications. Medical history: She is medically fit and she is not under any medications.

There is no significant family medical history mentioned.

Past dental history 1-Previous Root Canal Treatment of teeth #11 . 2- GIC restorations on teeth #37. 3-composite restorations on teeth #25,26,37,45,46. 4- extracted teeth # 14,15,16,27,36,47 . .

Habits and oral hygiene activity Patient brushes her teeth 1 time per day with a Hard brush and horizontal scrub technique - Doesn’t use floss or mouth wash . - Doesn’t visit the dentist regularly .

Clinical examination

Extra Oral Examination All within normal limit skin Neck TMJ Lymph Nodes

Intra oral examination 1-Floor of the mouth: No abnormality detected. 2-oral mucosa:

Intra oral examination 3- tongue: No abnormality detected. 4- palate : No abnormality detected

Pretreatment photographs:

Frontal view

Maxillary occlusal view

Mandibular occlusal view

Right lateral view:

Left lateral view

Diagnostic tools

I-Radiographs: OPG

Bitewings Right side Left side

Periapicals Upper Anterior

Lower Anterior

Right upper and lower posteior

Left upper and lower posterior

II-Mounted cast (frontal view) Upper midline: Normal. Lower midline: Overbite: 3mm 2mm.:Overjet

Mounted cast (right side) Right molar relationship: Not applicable. Right canine relationship:

Mounted cast ( left side) Left molar relationship: Not applicable. Left canine relationship: Not pplicable.

Mounted cast (upper and lower) Lower U sha .

Laboratory investigation: Saliva viscosity: Watery. Saliva Buffer capacity: High

Results have revealed the following: Caries risk test (CRT) Results have revealed the following: S.M = 3 > 100,000 CFU High Risk L.B = 3 > 100,000 CFU High Risk Lactobacilli Mutans streptococci

FINDINGS AND DIAGNOSIS

Oral hygiene: Gingival examination ( Gingival index ) BY SILLNESS & LOE 1967 16 15 14 13 12 11 21 22 23 24 25 26 27 28 18 17 2 2 2 2 2 1 1 2 2 2 2 2 1 2 2 2 2 1 1 2 2 2 1 2 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 Total : 1.70 Moderate inflammation , redness, edema, glazing & bleeding on probing .

Oral hygiene Oral hygiene (plaque index) BY SILLNESS & LOE 1967 16 15 14 13 12 11 21 22 23 24 25 26 27 28 18 17 2 2 2 2 2 2 2 2 2 2 2 2 1 1 2 2 2 1 1 2 2 2 1 2 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38 Total 1.79 Moderate accumulation of soft deposits within the gingival pocket or the tooth & gingival margin which can be seen with naked eye

1 2 2 PSR (periodontal screening and recording) Code1: Pocket depth <3.5 mm bleeding on probing . Code2: Pocket depth <3.5 mm bleeding on probing and calculus .

Calculus index locklized slight calculus accumulation. BY Procter & Gamble 1987 locklized slight calculus accumulation.

Periodontal charting

Maxillary arch + B M-CEJ PD CAL 13 Tooth # + B M-CEJ PD CAL 13 Tooth # 222 212 223 323 313 221 233 PD CAL 28 27 26 25 24 23 22 21 11 12 13 14 15 16 17 18 Tooth # + B M-CEJ 322 223 222 111 PD CAL 28 27 26 25 24 23 22 21 11 12 13 14 15 16 17 18 Tooth #

Mandibular arch + 43 + 43 B M-CEJ PD CAL 37 34 33 32 31 41 42 44 47 48 313 222 232 322 223 323 PD CAL 38 37 36 35 34 33 32 31 41 42 43 44 45 46 47 48 Tooth # 323 + B M-CEJ 212 222 312 213 323 331 PD CAL 38 37 36 35 34 33 32 31 41 42 43 44 45 46 47 48 Tooth #

Diagnosis and prognosis Plaque Calculus Contributing factors : Defective FPD : Multiple extracted teeth # Multiple defective restorations . Periodontal diagnosis : generalized moderate plaque induced gingivitis Overall prognosis: good.

DENTAL CHARTING

Charting (Maxilla): Caries Restoration Missing Substandard RCT

Charting ( mandible ) Restoration Caries Missing

3)Previous Root Canal Treatment of teeth #11. Findings and diagnosis 1)Plaque and calculus accumulation. 2)Caries : 18,21,24,37. 3)Previous Root Canal Treatment of teeth #11. 4)GIC restorations on teeth # 37. 5)composite restorations on teeth #25,26,45,46. 6)Missing teeth # 14,15,16,36,38,47 .

Treatment plan

Phase 1

Phase 1(preventive phase) Oral hygiene activity recommendation: Tooth brush type: soft ,nylon bristle tooth brush. Brushing frequency 3 times per a day. Brushing method: modified bass technique. Interdental aids: fluoridated dental floss.

Phase 1:(periodontal therapy) Condition : generalized moderate plaque induced gingivitis. Proposed treatment : Oral hygiene instructions and plaque control. Supra and sub gingival scaling . Re-evaluation: 4-6 weeks. Maintenance phase:6 months.

Phase 2 :(operative and endodontic treatment)

Proposed treatment: Dental problem Tooth number: Extraction. Badly decay & no opposing teeth. Remining root. 18 17

Proposed treatment: Dental problem Tooth number: Root canal treatment. Substandard root canal treatment. 11

Proposed treatment: Dental problem Tooth number: Class IV composite restoration . Distal caries. 21

Proposed treatment: Dental problem Tooth number: Extraction. Remining root. 23

Proposed treatment: Dental problem Tooth number: 24

Proposed treatment: Dental problem Tooth number: Finishing and polishing. Old dull occlusomesial composite restoration . Occlusal composite restoration. 25 26

Proposed treatment: Dental problem Tooth number: Extraction. Remining root. 28

Proposed treatment: Dental problem Tooth number: Composite Re do class I Restoration. Fissur sealnt. Deep fissur . 37 34

Proposed treatment: Dental problem Tooth number: Fissur sealnt. Finishing and polishing. Deep fissur. Old occlusal composite restoration 44 45 46

Proposed treatment: Dental problem Tooth number: Extraction Remining root. 48

Phase V ( prosthetic phase ):

Maxillary arch.

Mandible 1st option

2nd option

3rd option

Phase VI :Recall and maintenance

Recall the patient every 3 months to: Emphasize on the oral hygiene. Phase VI :Recall and maintenance Recall the patient every 3 months to: Emphasize on the oral hygiene. Do periodontal maintenance. Recall the patient every 6 months to: Do full mouth X-Ray, check all restorations and prosthesis.

Treatment objective: Educate the patient about dental problems). Nutrition consultation for the patient. Improve the oral hygiene. Disease control. Restore the function and aesthetic. Maintenance.