Njood AlYousef – 42820071 .

Level – 11 .

COMPREHENSIVE CASE PRESENTATION

NJOOD ALYOUSEF 42820071 1

PERSONAL DATA

• Age : 31 years old.

• Gender : Male.

• Nationality : Pilipino.

• Social Status : Married.

• Occupation : Driver.

• Patient’s Attitude : Co-operative.

• File Number : 43925

NJOOD ALYOUSEF 42820071 2

CHIEF COMPLAINS

“ Regular Check up.”

NJOOD ALYOUSEF 42820071 3

MEDICAL HISTORY

• No significant history.

• No significant history.

FAMILY MEDICAL HISTORY

NJOOD ALYOUSEF 42820071 4

PAST DENTAL HISTORY

• Multiple extractions done within the past seven years without

any complications .

• All dental visits were for extractions.

• Trauma 6 months ago.

Last dental visit was a couple of years ago for an extraction.

NJOOD ALYOUSEF 42820071 5

CLINICAL DIAGNOSIS

NJOOD ALYOUSEF 42820071 6

I. EXTRA-ORAL EXAMINATION

• Skin.

• TMJ.

• Lymph Nodes.

• Neck.

All within normal limits.

NJOOD ALYOUSEF 42820071 7

II. INTRA-ORAL EXAMINATION

• Floor of the mouth: Torus mandibularis.

• Palate.

• Oral Mucosa.

• Lips.

NJOOD ALYOUSEF 42820071 8

All within normal limits.

CONT II. INTRA-ORAL EXAMINATION

Maxillary Arch

Caries

NJOOD ALYOUSEF 42820071 9

Abrasion

CONT II. INTRA-ORAL EXAMINATION

Mandibular Arch

NJOOD ALYOUSEF 42820071 10

Caries Abrasion

HABITS & ORAL HYGIENE ACTIVITY

• He brushes his teeth twice a day (Hard brush).

• Doesn’t floss neither uses mouth wash.

• He visits the dentist periodically.

NJOOD ALYOUSEF 42820071 11

PRE-TREATMENT PHOTOGRAPHS

NJOOD ALYOUSEF 42820071 12

FRONTAL VIEW

NJOOD ALYOUSEF 42820071 13

MAXILLARY OCCLUSAL VIEW

NJOOD ALYOUSEF 42820071 14

MANDIBULAR OCCLUSAL VIEW

NJOOD ALYOUSEF 42820071 15

RIGHT LATERAL VIEW

NJOOD ALYOUSEF 42820071 16

LEFT LATERAL VIEW

NJOOD ALYOUSEF 42820071 17

1. Radiographs.

2. Diagnostic Cast.

DIAGNOSTIC TOOLS

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PANORAMIC

NJOOD ALYOUSEF 42820071 19

BITEWINGS

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RIGHT SIDE PA

NJOOD ALYOUSEF 42820071 21

ANTERIOR PA

NJOOD ALYOUSEF 42820071 22

LEFT SIDE PA

NJOOD ALYOUSEF 42820071 23

MOUNTED DIAGNOSTIC CAST (FRONTAL)

NJOOD ALYOUSEF 42820071 24

MOUNTED DIAGNOSTIC CAST (RIGHT & LEFT)

RIGHT LEFT

NJOOD ALYOUSEF 42820071 25

Molar Relationship: Not applicable Canine Relationship: Class I

DIAGNOSTIC CAST (MAX. & MAND.)

MAXILLARY OCCLUSAL MANDIBULAR OCCLUSAL

NJOOD ALYOUSEF 42820071 26

PERIODONTAL CHARTING

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GINGIVAL EXAMINATION (GINGIVAL INDEX)

• Silness & Loe, 1967

1622 25

44 41 36

• Score: 0.08 Mild gingival Inflammation.

• redness, edema , and glazing.

NJOOD ALYOUSEF 42820071 28

0

0

0

0

0

0

0

0

0

0

0 0 0

0

0

00

1

00

0

0 01

ORAL HYGIENE (PLAQUE INDEX)

• Silness & Loe, 1967

1622 25

44 41 36

1 0

0

01

11

1

0 1

0

11

1

00

• Score: 0.4 – Mild plaque accumulation.

• Mild accumulation of soft deposits in the free gingival margin seen by using the probe or disclosing

solution.

NJOOD ALYOUSEF 42820071 29

0

0 0

0

00

0

1

ORAL HYGIENE (CALCULUS INDEX)

• Procter & Gamble, 1987

• Moderate accumulation.

• Supra and Subgingival Generalized calculus accumulation.

NJOOD ALYOUSEF 42820071 30

28272625242322211112131415161718

010010M-CEJ

133334312222322121222121332M-PD

223344CAL

+++Bleeding

Bleeding

010M-CEJ

444313112213222112212212212M-PD

232CAL

28272625242322211112131415161718

NJOOD ALYOUSEF 42820071 31

38373635343332314142434445464748

010210M-CEJ

222232223223311111211222211222222M-PD

233430CAL

+++Bleeding

+Bleeding

M-CEJ

223111111111212111211222211111111M-PD

CAL

38373635343332314142434445464748

NJOOD ALYOUSEF 42820071 32

PSR

2 1 3

2 2 2

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ETIOLOGIC & RISK FACTORS

• Plaque.

• Caries.

• Calculus.

NJOOD ALYOUSEF 42820071 34

PERIODONTAL DIAGNOSIS

• Generalized Mild to Moderate Chronic Periodontitis.

• Over all prognosis:

Good

NJOOD ALYOUSEF 42820071 35

VITALITY TEST

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PULP TEST

• Application of Endo Frost (-50° C) on suspected teeth.

• History of tooth: Trauma.

Tooth

#

Cold

Test

V

.Percussio

n

H.

Percussion

Pulp

Diagnosis

Periapical

Diagnosis

12 +ve -ve -ve Normal NormalNJOOD ALYOUSEF 42820071 37

PULP TEST

• Application of Endo Frost (-50° C) on suspected teeth.

• History of tooth: Trauma.

Tooth

#

Cold

Test

V

.Percussio

n

H.

Percussion

Pulp

Diagnosis

Periapical

Diagnosis

11 +ve -ve -ve Normal NormalNJOOD ALYOUSEF 42820071 38

PULP TEST

• Application of Endo Frost (-50° C) on suspected teeth.

• History of tooth: Trauma.

Tooth

#

Cold

Test

V

.Percussio

n

H.

Percussion

Pulp

Diagnosis

Periapical

Diagnosis

22 +ve -ve -ve Normal NormalNJOOD ALYOUSEF 42820071 39

PULP TEST

• Application of Endo Frost (-50° C) on suspected teeth.

• History of tooth: Trauma.

Tooth

#

Cold

Test

V

.Percussio

n

H.

Percussion

Pulp

Diagnosis

Periapical

Diagnosis

33 +ve -ve -ve Normal NormalNJOOD ALYOUSEF 42820071 40

PULP TEST

• Application of Endo Frost (-50° C) on suspected teeth.

• History of tooth: Trauma.

Tooth

#

Cold

Test

V

.Percussio

n

H.

Percussion

Pulp

Diagnosis

Periapical

Diagnosis

32 +ve -ve -ve Normal NormalNJOOD ALYOUSEF 42820071 41

PULP TEST

• Application of Endo Frost (-50° C) on suspected teeth.

• History of tooth: Trauma.

Tooth

#

Cold

Test

V

.Percussio

n

H.

Percussion

Pulp

Diagnosis

Periapical

Diagnosis

31 +ve -ve -ve Normal NormalNJOOD ALYOUSEF 42820071 42

PULP TEST

• Application of Endo Frost (-50° C) on suspected teeth.

• History of tooth: Trauma.

Tooth

#

Cold

Test

V

.Percussio

n

H.

Percussion

Pulp

Diagnosis

Periapical

Diagnosis

41 +ve -ve -ve Normal NormalNJOOD ALYOUSEF 42820071 43

PULP TEST

• Application of Endo Frost (-50° C) on suspected teeth.

• History of tooth: Trauma.

Tooth

#

Cold

Test

V

.Percussio

n

H.

Percussion

Pulp

Diagnosis

Periapical

Diagnosis

42 +ve -ve -ve Normal NormalNJOOD ALYOUSEF 42820071 44

PULP TEST

• Application of Endo Frost (-50° C) on suspected teeth.

• History of tooth: Trauma.

Tooth

#

Cold

Test

V

.Percussio

n

H.

Percussion

Pulp

Diagnosis

Periapical

Diagnosis

43 +ve -ve -ve Normal NormalNJOOD ALYOUSEF 42820071 45

FINDING & DIAGNOSIS

• Plaque accumulation.

• Calculus.

• Carious teeth : #18, #16, #14, #13, #12, #11, #22, #25, #27,

#28, #37, #35, #34, #44, #45.

• Missing teeth : #17, #15, #21, #24, #26, #38, #36, #46, #47,

#48.

• Cross-bite : #11, #25

NJOOD ALYOUSEF 42820071 46

TREATMENT PLAN

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TREATMENT OBJECTIVES

• Improve oral hygiene.

• Caries control.

• Restore function and esthetics.

• Maintain the results.

NJOOD ALYOUSEF 42820071 48

PREVENTIVE TREATMENT

• Periodontal diagnosis :

Generalized Mild to Moderate Chronic Periodontitis.

• Treatment plan:

• OHI and plaque control.

• Supragingival scaling / subgingival scaling.

• Polishing.

Re-evaluation after 4-6 weeks.

Maintenance every 3 months.

NJOOD ALYOUSEF 42820071 49

# 18

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Finding Treatment

- Occlusal

Caries with

Buccal

Extension.

- Over eruption.

Extraction.

Finding Treatment

Occlusal caries

with Palatal

Extension.

- Class I

Restoration

with Palatal

extension

Restoration.

# 16

NJOOD ALYOUSEF 42820071 51

Finding Treatment

- Occlusal Caries.

- Buccal abrasion.

- Class I

Restoration.

- Class V

Restoration.

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# 14

Finding Treatment

Cingulum Caries. Class I

restoration.

# 13

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Finding Treatment

Mesial Caries. Class III

Composite

Restoration.

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# 12

Finding Treatment

Distal Caries. Class III Composite

Restoration.

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# 11

Finding Treatment

Cingulum Caries. Class I Restoration.

# 22

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Finding Treatment

Occlusal Caries. Class I

Restoration.

# 25

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Finding Treatment

Occlusal Caries

with Palatal

Extension.

Class I

Restoration with

Palatal

Extension

Restoration.

# 27

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Finding Treatment

- Occlusal

Caries With

Palatal

Extension.

- Over

Eruption.

- Extraction

# 28

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Finding Treatment

Occlusal Caries

with Buccal

Extension.

Class I

Restoration with

Buccal

Extension

Restoration.

# 37

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NJOOD ALYOUSEF 42820071 61

- Extraction

- RPD

Finding Treatment

- Occlusal Caries.

- Buccal abrasion.

- Class I

Restoration.

- Class V

Restoration.

# 35

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Finding Treatment

- Pit Caries.

- Buccal abrasion.

- Preventive Resin

Restoration.

(PRR)

- Class V

Restoration.

# 34

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Finding Treatment

- Pit Caries.

- Buccal abrasion.

- Preventive Resin

Restoration.

(PRR)

- Class V

Restoration.

# 44

# 45

NJOOD ALYOUSEF 42820071 64

Finding Treatment

- Pit Caries.

- Cervical Caries.

- Preventive Resin

Restoration.

(PRR)

- Class V

Restoration.

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ORTHODONTIC AND PROSTHETIC

TREATMENT OPTIONS

NJOOD ALYOUSEF 42820071 66

• Canine relationship: Class I

• Molar relationship: Not applicable

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Anterior cross-bite in tooth #11

Posterior cross-bite in tooth #25

ORTHODONTIC TREATMENT OF CROSS-BITE

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5 mm

11 mm

6 mm

5.5 mm

- Rotation correction for teeth #16, #27

- Mesialization and correction of the

cross bite for #25*Space gained 8-9 mm for #26*

ORTHODONTIC TREATMENT

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ORTHODONTIC TREATMENT

5 mm

2 mm available

- Rotation correction for tooth #37

- Mesialization for teeth #35, #34*Space gained for #36 is 8-9 mm*

NJOOD ALYOUSEF 42820071 70

6 mm

ORTHODONTIC TREATMENT

No need for intrusion.

(enough space for teeth replacement).

NJOOD ALYOUSEF 42820071 71

- #15

- #11

- #24

- #26

- #36

- #46

REPLACEMENT WITH ORTHODONTIC

TREATMENT

Implant :

NJOOD ALYOUSEF 42820071 72

Fixed Partial Denture:

- #15 (16-14).

- #21 (11-22 ).

- #24 (23-25)

- #26 ( 25-27)

- #36 (37-35)

REPLACEMENT WITH ORTHODONTIC

TREATMENT

PIER ABUTMENT

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PIER ABUTMENT

BY DR. DEVENDRA CHOPRA,

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REPLACEMENT WITHOUT ORTHODONTIC

TREATMENT

Implant :

- #15

- #11

- #24

- #46

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Fixed Partial Denture:

- #15 (16-14).

- #21 (11-22 ).( #21 may need elective RCT to

adjust the cross-bite).

- #24 (23-25)( #25 may need elective RCT to

adjust the cross-bite).

No enough space to replace #26 &

#36

REPLACEMENT WITHOUT ORTHODONTIC

TREATMENT

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REPLACEMENT WITH OR WITHOUT

ORTHODONTIC TREATMENT

Removable Partial Denture.

TREATMENT PHASES

• Phase I : Emergency/Preventive Treatment.

• Phase II : Operative Treatment.

• Phase III : Endodontic Treatment.

• Phase IV : Pre-prosthodontics/Surgical Treatment.

• Phase V : Prosthodontics Treatment.

• Phase VI : Recall & Maintenance.

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THANK YOU

NJOOD ALYOUSEF 42820071 78