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LOGO RIYADH COLLEGE OF DENTISTRY AND PHARMACY
Comprehensive Case Comprehensive Case PresentationPresentation
Prepared By:Prepared By:p yp y
Sultan Sultan RkeebRkeeb alal--ShammeryShammery
LevelLevel
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Age : 25
Gender : Male
Nationality : Yamani
Occupation : receptionist
Marital & Social Status : Single
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In theتصبغات في •i ’ ي ب
األسنان األمامية
patient’s own
d :wordsاألمامية
•History of Chief Complaint
Long time agog g3
Medical HistoryMedical History
••Within NormalWithin Normal
••Within NormalWithin Normal
Family Medical HistoryFamily Medical History
••Within NormalWithin Normal
Past Dental HistoryPast Dental History
•Just for check up
Past Dental HistoryPast Dental History
p
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No habits He use tooth brush twice abrush twice a day
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II Extra Extra Oral ExaminationOral ExaminationII. Extra . Extra –– Oral ExaminationOral Examination
SwellingSwellingSwellingSwelling
SkinSkin NADSkinSkin
TMJTMJ
NAD
TMJTMJ
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IIII Intra Intra Oral ExaminationOral ExaminationIIII. Intra . Intra –– Oral ExaminationOral Examination
NAD
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IIIIII Oral HygieneOral HygieneIII . III . Oral HygieneOral Hygiene
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Gingival Index ► 1 mild inflammation
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38373635343332314142434445464748
Plaque Index ► 1
28272625242322211112131415161718
Plaque Index ► 1
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38373635343332314142434445464748 38373635343332314142434445464748
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PRE-TREATMENT PHOTOGRAPHS
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Frontal viewFrontal view
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Maxillary Occlusal viewMaxillary Occlusal view
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Mandibular Occlusal viewMandibular Occlusal view
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Right lateral viewRight lateral view
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Left lateral viewLeft lateral view
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Pa o amicPanoramic
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Bitwing RadiographBitwing Radiograph
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Diagnostic CastsDiagnostic Casts
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1 2 3
li d Carious teeth Extractiongeneralized sever enamel fluorosis with stains
Carious teeth
16 17 18
Extraction
28 38stainsaffecting all of the permanent teeth
16 , 17 , 18 , 27, 37 , 47 , 48
28 , 38
teeth
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CariesCaries
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CariesCaries
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Diagnosis Diagnosis Diagnosis Diagnosis
G li d ild i i itiG li d ild i i itiGeneralized mild gingivitisGeneralized mild gingivitisPeriodontium:
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Ph I Perio treatment Phase I
Condition:Generalized mild gingivitisGeneralized mild gingivitis
Recommendation :Polishing Oral hygiene instructionsPolishing , Oral hygiene instructions
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Op ti t tm ntPhase II Operative treatment Phase II
Condition:# # 18 18 O C ries O C ries # # 18 18 , O. Caries , O. Caries
Recommendation :Class I composite restoration
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Condition:# # 17 17 O C ries O C ries # # 17 17 , O. Caries , O. Caries
Recommendation :Class I composite restoration
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Condition:# # 16 16 Dist l P l t l C ries Dist l P l t l C ries # # 16 16 , Distal , Palatal Caries , Distal , Palatal Caries
Recommendation :P.R.R
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Condition:# # 27 27 , O. Caries , O. Caries
Recommendation :Recommendation :Class I composite restoration
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Condition:# # 37 37 , O. Caries , O. Caries
Recommendation :Recommendation :P.R.R
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Condition:# # 4 4 # # 48 48 , O. Caries , O. Caries
Recommendation :Recommendation :Class I composite restoration
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Condition:# # 4 4 # # 47 47 , O. Caries , O. Caries
Recommendation :Recommendation :P.R.R
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Condition:# # 38 38 , impacted teeth, impacted teeth
Recommendation :Recommendation :Extraction
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Phase III Surgical TreatmentPhase III Surgical Treatment
Condition:# # 28 28 , traumatize and No , traumatize and No opposing after extraction tooth # 38
Recommendation :Extraction
After discussing the Surgical After discussing the Surgical treatment plan with the patient , The patient said (No need to go surgery at this time , Because No g y ,any symptoms or pain in this time
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U t i t thUpper anterior teeth
Condition:Sever dental fluorosis of TFI = 6-9 with yellow/brown TFI = 6 9 with yellow/brown discoloration, based on the 1978 dental flourosis classification scheme of Thylstrup and FejerskovThylstrup and Fejerskov
Recommendation optionsoptions :- Bleaching ??- Veneer
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preparation ( 0.5 – 0.8 ) mm midfacially ( 0 3 – 0 5 )mm along midfacially , ( 0.3 – 0.5 )mm along
the gingival margin
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Temporary composite restoration
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p y p
After veneer cementation
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L t i t thLower anterior teeth
Condition:Sever dental fluorosis of TFI = 6-9 with yellow/brown TFI = 6 9 with yellow/brown discoloration, based on the 1978 dental flourosis classification scheme of Thylstrup and FejerskovThylstrup and Fejerskov
Recommendation optionsoptions :- Bleaching or microabrasion( coast?? Pt need ?? )
- VeneerVeneer
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MicroabrasionMicroabrasion
Conservative treatmentBleaching
Conservative treatment
Veneer
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Mi b iMicroabrasion
( No any Effect )
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Bleaching ( ZOOM2)Bleaching ( ZOOM2)49
Bleaching ( ZOOM2)eac g ( OO )
isolation
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Bleaching ( ZOOM2)eac g ( OO )
Whitening Gel
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Bleaching ( ZOOM2)eac g ( OO )
ZOOM light g( 45 – mint )
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After Bleaching
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After 1 month
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VeneerVeneer
After 1 month , patient come back to evaluate the lower anterior shade color . The CC In the patient’s own words anterior shade color . The CC In the patient s own words لون األسنان ما عجبنيوارغب في عمل ترآيبات لألسنان السفلية
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Temporary composite restoration
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After veneer cementationReturn
POST-TREATMENT PHOTOGRAPHS
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Frontal viewFrontal view
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Maxillary Occlusal viewMaxillary Occlusal view
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Mandibular Occlusal viewMandibular Occlusal view
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Right lateral viewRight lateral view
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Left lateral viewLeft lateral view
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1 restore esthetic and function
T T
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improve his OHITreatment Treatment ObjectivesObjectives2
control caries
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LOGO
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office bleaching with 35% hydrogen peroxide does not significantly affect the color and luminosity of fluorotic teeth
Konsl 2007 , dental digest journal
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tooth whitening Conservative treatment options such as gpseverely improve can dramatically and microabrasion
discoloured fluorosed teeth. This can provide a satisfactory interim outcome or minimize the removal ofsatisfactory interim outcome or minimize the removal of discoloured enamel and dentine prior to the provision of veneers
Manton DJ , 2007 Australian dental journal
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A chronic endemic form of hypoplasia of the dental enamel caused by drinking water with a high e a e caused by d g ate t a gfluorine content during the time of tooth formation, and characterized by defective , ycalcification that gives a white chalky appearance to the enamel, which gradually pp , g yundergoes brown discoloration.
ReturnJablonski's Dictionary of Dentistry, 1992, p286
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