COMPREHENSIVE CARE GROUP CASE PRESENTATION: CRYSTAL STINSON Dr.

WILSON Group Leader

MEDICAL AND DENTAL HISTORY

Pt:

Mr MOD Age: 57 DOB 5/XX/1956 Chief complaint: Want implant to replace back lower tooth. Pt medical history and serial BP readings suggest stage 1 hypertension uncontrolled. Pt is taking no medications and NKDA. ASA 2

Dental History

Pt has seen dentist regularly every six months for the past two decades Dentist elects to watch everything and only treat when it is needed. Pt has above average oral hygiene but restorations are not adequate enough to stop disease progression Pt perio type 1 patient. No bleeding at probing and no large pockets as gums receded along with alveolar bone.

Square ovoid facial form

Straight Sagittal Profile

*Generalized gingival recession *None carious Class V abfraction lesions *Traumatic occlusion diagnosed via mounted models

9 11 10

8 7

12 13

6 5

4
14 3

#4,5, 12, 13 rotated distally causing traumatic occlusion and class 5 abfraction lesions

#18

31

30 19

29
20 28

21
22

27 23
24

25

26

Gingival recession on mandibular anteriors Edentulous area #18 chief complaint

PANO

FMX

 Tooth

#2 Had large MO and D amalgam w/ recurrent decay. Excavated resulting in pulpal exposure. Tooth #3 large MOD composite restoration with marginal leakage and secondary decay. ML cusp fractured and B/U completed with Ticore.

PA post RCT therapy #2 Grad Endo

 #8

MILF Class 4 composite with marginal leakage, discoloration and wear #9 PFM crown with post and core with coronal leakage and chronic apical periodontitis #10 PFM crown with post and core with large periapical radiolucency, chronic apical abscess and class 3 mobility

 #12

Class V abfraction lesion #13 Class V abfraction lesion #14 PFM crown.

 #18

edentulous area has been restored with implant #19 PFM crown

#10 Old and New PAs

UPDATE OD
No new evidence of caries

Treatment Plan
Systemic: Acute:
Declined by pt. Tooth #8 and #9 have chronic apical periodontitis with draining sinus tract opening on the facial mucosa adjacent to tooth #10. Implant #18-patients chief complaint Continue to counsel pt on need to see physician for serial BP readings suggesting stage 1 hypertension.

Disease Control:
#2 excavated resulting in pulpal exposure and RCT completed by Grad Endo. Ticore B/U #3 done as ML cusp had fractured off. Prophy completed and OHI given. Pt. type 1 perio. Topical Fl- administered. ODRA and referral to tobacco cessation. Occlusal composites #29, #31 Post-treatment assessment

Definitive:
PFM crown #2, #3, Buccal composites #12, #13-non carious lesions Pt elects to treat #9 and #10 after teeth have fallen out. Currently treatment planned for 8xx11 bridge following extractions. Gingival grafting for severe gingival recession with Grad Perio

Maintenance:
Prophy Recall every 6mons, Occlusal guard, topical Fl-

TREATMENT PLAN

WHERE ARE WE NOW?

Buccal

composites #12, #13 completed Implant #18 seated and restored #2 RCT therapy completed by Grad Endo #2,#3 B/Us completed #2, #3 preps started and in temporaries