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‫ارائه تشخیص و طرح درمان‪ -‬واحد درمان جامع‪ -‬غزاله دریاکناری‬
Name: F. E.
Gender: Female
Age: 33
Current state: Single, living with parents,
no jobs
Address: Afsarie, Tehran
• Patient visits a dentist due to
severe pain in the right side of
lower jaw.
• Lower right molar teeth are both
suffering from caries.
• Tooth # 31 is then restored and #
30 is prepared for endodontic
treatment.
• Further efforts of the GP to treat
tooth # 30 fails and the patient is
referred to Tehran University,
Faculty of dentistry.
• No present or previous history of systemic/acute
illnesses.
• No drug is taken by the patient at present.
• Patient was hospitalized in summer 1391 for
“gallbladder laparoscopy”. The procedure was done
with no complications and patient is in a steady
condition at the moment.
• No other significant information.
• All is normal.
• Slight facial asymmetry.
• Right TMJ click on opening (translation phase).
• Slight deviation of the jaw to the left, while opening
the mouth.
• Soft tissues: Normal, slight inflammation of gingiva where there is plaque
present.
• Normal saliva flow.
• Class I molar relation on both sides.
• Bilateral posterior cross bite.
• Anterior open bite.
Slight inflammation of gingiva, and grade I
bleeding on probing
Amalgam fillings: # 31, 29, 17, 18, 19, 20
Decays: # 31, 17
Amalgam fillings: # 2, 5, 14, 15
Composite fillings: # 3, 7, 8, 9, 10
Prosthetics: # 4, 12, 13
=Panoramic view=
No pathologies and no imbedded teeth
Root canal treatments: # 4, 12, 13
Post & cores: # 4, 12, 13
Overhang
lucency
Carious
lesions on
both teeth
Bone defect
Defects
under crown
Tooth # 4 has a distal
pocket with carious
lesions under the crown
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Root canal therapy of the teeth with irreversible pulpitis/necrosis
of the pulp
o After sensitivity tests, tooth # 31 was also diagnosed with irreversible
pulpitis. So teeth # 31, 30 are treatment priorities due to patient’s pain.
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All active caries should be restored with temporary restorations.
o Teeth # 14, 21 should be restored.
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Tooth # 17 has a class I restoration and distal caries plus a distal
pseudo pocket. There is no counter tooth and the lesion is
difficult to reach for restoration treatment, so it is suggested that
the tooth is extracted.
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Supra and sub gingival scaling and root planning should be
done.

Prognosis of tooth #4 should be determined after the
removal of the defective crown and underlying caries.

Patient’s oral hygiene should be assessed and redirected to
a better self oral care.

Follow ups are needed.

Fixed prosthodontics restoration for teeth with surface loss/root
canal treated.
o Teeth # 31, 30, 14 are best restored with single full coverage crowns
due to severe tooth surface loss.

Final restoration of tooth # 21 with composite.

Final esthetic treatments with patients agreement
o Incisor teeth of upper jaw are previously filled with composite, no
reoccurrence of caries is detected in clinical examination but the fillings
are not esthetically suitable.

No orthodontic treatment is indicated considering patient’s age
and current status. She is happy with the way things are.