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Comprehensive case
presentation
Wejdan AL- Marzooq
42920166
L9G2
1
Personal data
2
Age
40
Gender
Female
Nationality
sudanese
Occupation
House wife
Marital and social status
Married
Patient cooperation
Cooperative and willing to attend her
appointments regularly.
In the patients own words:
(I heat how my upper front tooth
looks like)
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4
Medical history:
She is medically fit and she is not under any
medications.
5
Family medical history:
There is no significant family medical
history mentioned.
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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 .
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8
Habits and oral hygiene activity
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 .
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10
skin
Lymph
Nodes
All within
normal
limit
TMJ
11
Neck
1-Floor of the mouth:
No abnormality detected.
2-oral mucosa:
No abnormality detected.
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Intra oral examination
3- tongue:
No abnormality detected.
4- palate :
No abnormality detected
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14
15
16
17
Right lateral view:
18
19
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I-Radiographs:
OPG
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Bitewings
Right side
Left side
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Upper Anterior
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Lower Anterior
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Right upper and lower posteior
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Left upper and lower posterior
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II-Mounted cast (frontal view)
Upper midline:
Normal.
Lower midline:
Normal.
Overbite:
3mm
Overjet:2mm.
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Mounted cast (right side)
Right molar relationship:
Not applicable.
Right canine relationship:
Not applicable.
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Mounted cast ( left side)
Left molar relationship:
Not applicable.
Left canine relationship:
Not pplicable.
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Mounted cast (upper and lower)
Lower U sha
.
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Laboratory investigation:
Saliva viscosity:
Watery.
Saliva Buffer capacity:
High
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Caries risk test (CRT)
Mutans streptococci
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Lactobacilli
FINDINGS AND DIAGNOSIS
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Oral hygiene:
Gingival examination ( Gingival index )
BY SILLNESS & LOE 1967
18 17 16
2
2 2
2
15 14
13
12
2
2 2
2
48 47
34
46
45
44 43
11 21 22
2
1 1
2
1
23
24 25 26
2
2 2
2
2
1 1
1
42
41 31
27 28
2 2
2
32
33
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Total : 1.70
Moderate inflammation , redness, edema,
glazing & bleeding on probing .
35 36
37 38
Oral hygiene
Oral hygiene (plaque index)
BY SILLNESS & LOE 1967
18 17
16
15 14
13
12
11 21
23
2
2
2 2
2
1
46
45
44 43
24 25 26
1
1 1
1
42
41 31
2
32
33
34
2 2
2
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
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27 28
2
2 2
2
2 2
2
2 2
2
48 47
22
PSR (periodontal screening and recording)
1
1
1
1
2
1
2
Code1: Pocket depth <3.5 mm bleeding on probing .
Code2: Pocket depth <3.5 mm bleeding on probing and calculus .
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Calculus index
BY Procter & Gamble 1987
locklized slight calculus accumulation.
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Periodontal charting
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Maxillary arch
+
B
+
+
+
+
+
212
221
313
323
223
212
222
212
222
13
12
11
21
22
23
24
25
26
+
+
M-CEJ
233
PD
CAL
Tooth # 18
17
16
+
+
+
B
15
14
+
+
+
27
+
28
+
M-CEJ
222
PD
CAL
322
222
111
222
222
222
223
223
322
13
12
11
21
22
23
24
25
26
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Tooth #
18
17
16
15
14
27
28
Mandibular arch
+
+
+
223
222
223
222
222
222
322
222
232
222
313
46
45
44
43
42
41
31
32
33
34
35
B
+
+
+
M-CEJ
323
PD
323
CAL
Tooth #
48
47
+
B
+
+
+
+
36
37
38
+
M-CEJ
323
PD
331
222 323
323 213
222
42
41
312 222
312
222
212
33
34
35
CAL
Tooth #
40
48
47
46
45
44
43
31
32
36
37
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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.
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DENTAL CHARTING
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Charting (Maxilla):
Caries
Missing
Substandard RCT
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Restoration
Charting ( mandible )
Caries
Missing
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Restoration
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 .
45
46
47
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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.
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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.
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Phase 2 :(operative and endodontic treatment)
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Tooth number:
18
17
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Dental problem
Badly decay & no
opposing
teeth.
Remining root.
Proposed treatment:
Extraction.
Extraction.
Tooth number:
11
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Dental problem
Substandard root canal
treatment.
Proposed treatment:
Root canal treatment.
Tooth number:
21
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Dental problem
Distal caries.
Proposed treatment:
Class IV composite
restoration .
Tooth number:
23
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Dental problem
Remining root.
Proposed treatment:
Extraction.
Tooth number:
24
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Dental problem
Proposed treatment:
Tooth number:
25
26
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Dental problem
Old dull occlusomesial
composite restoration .
Occlusal composite
restoration.
Proposed treatment:
Finishing and polishing.
Tooth number:
28
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Dental problem
Remining root.
Proposed treatment:
Extraction.
Tooth number:
Dental problem
37
34
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Deep fissur .
Proposed treatment:
Re do class I Composite
Restoration.
Fissur sealnt.
Tooth number:
60
Dental problem
Proposed treatment:
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Deep fissur.
Fissur sealnt.
45
46
Old occlusal composite
restoration
Finishing and polishing.
Tooth number:
48
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Dental problem
Remining root.
Proposed treatment:
Extraction
Phase V ( prosthetic phase ):
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Maxillary arch.
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Mandible 1st option
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2nd option
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3rd option
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Phase VI :Recall and maintenance
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Phase VI :Recall and maintenance
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Treatment objective:
70
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