APPROVED CASE :
▪ Operative
▪ Periodontics
▪ Fixed prosthodontics
DEMOGRAPHIC DATA
▪ Age: 23 years old
▪ Gender: Male
▪ Nationality: Saudi
▪ Occupation: Student
▪ Marital status: Single
CHIEF COMPLAINT
“I have pain in my lower posterior teeth & I want
to restore my broken teeth"
History of Chief complaint:
▪ Onset: 9 month ago
▪ Duration: Seconds
▪ Severity: mild pain
▪ Triggering factor: sweets
▪ Relieving factor medication: Analgesics
MEDICAL HISTORY
▪ ASA classification: ASA II (Smoker)
▪ Drug allergy: NKDA
▪ Medication taken: No Meds
▪ Family History: DM
DENTAL HISTORY
RCT on tooth #12 ( 9 years ago )
PATIENT ATTITUDE
▪ House's classification: Class I (Philosophical)
▪ Brushing and flossing frequency:
- Brushing frequency: once a day
- Never uses floss
DIET ANALYSIS
▪ Number of meals: 2-3 meals\ day
▪ Sugary foods & liquids: 3 times\ day
▪ Snacks between meals : 1 time \ day
EXTRA-ORAL EXAMINATION
▪ Symmetrical Face
▪ Convex profile
▪ TMJ: WNL
▪ Lymph nodes: WNL
INTRA-ORAL EXAMINATION
Lips: WNL
Palate:WNL
Floor of the mouth: WNL
Buccal mucosa: WNL
Frenum: WNL
Tongue: WNL
Lateral border of the tongue : WNL
CARIES RISK ASSESSMENT
®
CRT buffer
Buffer capacity : Low
CRT ® bacteria
- Mutans Streptococci - Lactobacilli
≥105 ≥105
STUDY CAST
GINGIVAL CRITERIA
Color Generalized pale pink with brown pigmentation
Generalized normal sized gingival margins
Size
G.M: Generalized rolled G.M
Shape
IDP: Generalized blunted papilla
Consistency Generalized firm & resilient
Texture Generalized present stippling
Exudate None
Mucogingival problems None
CAL 222 201 000 101 100
101 011 221 103 222 103 122 112 112
CAL 111 201 001 101 001
121 100 201 100 111 201 110 313 101
CAL 214 311 213 212 101 210 102 122 211 222 211 200 100
202 101
CAL 203 302 202 202 203 213
221 211 202 212 212 212 211 211 001
PERIODONTAL EXAMINATION
Hygiene Poor
CAL Mild: 93.6% Moderate: 6.3% Severe: 0
Supra: Medium
Calculus
Sub: Medium
Generalized moderate stains limited to the cervical 1/3 and
Stain
not more than ½ of the tooth and extrinsic stain
PERIODONTAL DIAGNOSIS
▪ Bleeding Index: 62%
▪ Plaque Index: 41%
▪ Etiologic factors:
- Local factor: plaque & calculus.
- Systemic factor: smoking.
▪ Diagnosis: Generalized mild chronic periodontitis
with localized moderate chronic periodontitis.
▪ Prognosis:
- Overall: Questionable .
- Individual: hopeless #12 #15 #36
OPERATIVE DIAGNOSIS
Tooth Condition Clinical Picture
No.
#11 Mesial caries
#12 Badly decayed
#14 Occlusal caries
#16 Occlusal and mesial caries
#17 Occlusal caries
#18 Occlusal caries
#21 Cervical caries
#22 Mesial caries
#24 occlusal caries
#25 Occlusal and mesial caries
#26 Occlusal caries
#27 Occlusal caries
#28 Occlusal caries
OPERATIVE DIAGNOSIS
Tooth
Condition Clinical Picture
No.
#38 Occlusal caries
#37 Occlusal caries
#36 Badly decayed
Occlusal and distal caries with
#46 buccal pit
#47 Occlusal caries
#48 Occlusal caries
ENDODONTIC DIAGNOSIS
Tooth
Cold test Percussion Palpation Diagnoses
No.
Pulpal: reversible Pulpitis.
#11 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#12 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#14 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#16 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#17 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#22 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#24 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#25 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#27 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#28 +ve - -
Apical: Normal
ENDODONTIC DIAGNOSIS
Tooth Cold
Percussion Palpation Diagnoses
No. test
Pulpal: reversible Pulpitis.
#34 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#35 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#37 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#38 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#46 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#47 +ve - -
Apical: Normal
Pulpal: reversible Pulpitis.
#48 +ve - -
Apical: Normal
PROSTHODONTIC DIAGNOSIS
- Partially edentulous maxilla (Kennedy
CL III Mod 1)
- Partially edentulous mandible (Kennedy
CL III)
ALTERNATIVE TREATMENT PLAN
Preliminary phase :
▪ Extraction of hopeless teeth #12, #15, #36
Phase I:
▪ Caries risk assessment
▪ Patient education and motivation and OHI
▪ Smoking cessation protocol
▪ Plaque control
▪ Scaling and root planing (SRP)
Excavation of carious teeth and final restoration
▪ #11,#14,#16,#17,#18,#21,#22,#24,#25,#26,#27,#28,#37,#38,
▪ #46,#47,#48
▪ Re-evaluation
Phase II:
▪ NA
Phase III:
▪ Fixed-fixed bridge (PFM) 3 units : (11-X-13)
▪ Fixed-fixed bridge (PFM) 3 units : (14-X-16)
▪ Fixed-fixed bridge (PFM) 3 units : (35-X-37)
Phase IV:
▪ Caries risk assessment
▪ Maintenance and recall every 3 months
WAX UP
TREATMENT
Preliminary phase :
▪ Extraction of hopeless teeth #12, #15, #36
PHASE I
▪ Patient education
and motivation
▪ OHI and Plaque
control
▪ smoking cessation
protocol
Caries excavation and restoration
#18, #17: OCCLUSAL CARIES
#16: OCCLUSAL AND MESIAL CARIES.
#14: OCCLUSAL AND DISTAL CARIES.
#11: MESIAL AND DISTAL CARIES
#21:CERVICAL CARIES
#22: MESIAL CARIES
#24: OCCLUSAL AND DISTAL CARIES
#25: OCCLUSAL AND MESIAL CARIES
#26: OCCLUSAL CARIES
#27, #28 :OCCLUSAL CARIES
#38, #37: OCCLUSAL CARIES
#48: OCCLUSAL CARIES
#47: OCCLUSAL AND MESIAL CARIES
#46: OCCLUSAL AND DISTAL CARIES
RE-EVALUATION OF PHASE I
CAL 221 201 000 101 100
101 011 221 102 222 103 122 122 111
CAL 111 201 001 101 001
121 100 201 100 111 201 110 213 101
CAL 213 311 211 212 101 210 101 022 211 212 111 200 100
102 001
1 1 3 3 0 2 2 02 202 221 211 212 211
202 213
202 212 212 211 001
CAL
▪ Bleeding Index: 17%
▪ Plaque Index: 19%
PHASE III
PHASE IV
Caries risk assessment
❑ Saliva buffer capacity : High
▪ Maintenance and recall every
3 months
POST-TREATMENT RADIOGRAPHIC
EXAMINATION FULL MOUTH X-RAY
BEFORE AND AFTER
