1. Comprehensive case presentation
Wejdan AL- Marzooq
L 9 G 2

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

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

4. History of Chief complaint

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

6. There is no significant family medical history mentioned.

7. 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 . .

9. 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 .

10. Clinical examination

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

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

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

14. Pretreatment photographs:

15. Frontal view

16. Maxillary occlusal view

17. Mandibular occlusal view

18. Right lateral view:

19. Left lateral view

20. Diagnostic tools

21. I-Radiographs:
OPG

22. Bitewings
Right side
Left side

23. Periapicals
Upper Anterior

24. Lower Anterior

25. Right upper and lower posteior

26. Left upper and lower posterior

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

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

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

30. Mounted cast (upper and lower)
Lower U sha .

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

32. 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

33. FINDINGS AND DIAGNOSIS

34. Oral hygiene: Gingival examination ( Gingival index )
BY SILLNESS & LOE 1967 2 2 2 2 2 1 1 2 2 2 2 2 1 2 2 2 2 1 1 2 2 2 1 2
Total : 1.70
Moderate inflammation , redness, edema, glazing & bleeding on probing .

35. Oral hygiene Oral hygiene (plaque index) BY SILLNESS & LOE 1967 2 2 2 2 2 2 2 2 2 2 2 2 1 1 2 2 2 1 1 2 2 2 1 2
Total 1.79
Moderate accumulation of soft deposits within the gingival pocket or the tooth & gingival margin which can be seen with naked eye

36. 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 .

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

38. Periodontal charting

39. 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 #

40. 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 #

41. 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.

42. DENTAL CHARTING

43. Charting (Maxilla):
Caries
Restoration
Missing
Substandard RCT

44. Charting ( mandible )
Restoration
Caries
Missing

45. 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 .

46. Treatment plan

47. Phase 1

49. 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.

50. 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.

51. Phase 2 :(operative and endodontic treatment)

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

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

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

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

56. Proposed treatment:
Dental problem
Tooth number: 24

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

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

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

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

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

62. Phase V ( prosthetic phase ):

64. Maxillary arch.

65. Mandible 1st option

66. 2nd option

67. 3rd option

68. Phase VI :Recall and maintenance

69. 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.

70. 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.