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Treatment Plan Presentation

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Presentation on theme: "Treatment Plan Presentation"— Presentation transcript:

1 Treatment Plan Presentation
ตัวอย่าง Treatment Plan Presentation นำเสนอโดย กลุ่ม อาจารย์ที่ปรึกษา

2 Personal Data เพศ หญิง สัญชาติ ไทย อายุ 73ปี ศาสนา อิสลาม
เพศ หญิง สัญชาติ ไทย อายุ ปี ศาสนา อิสลาม ภูมิลำเนา นนทบุรี สถานภาพ หย่า อาชีพ แม่บ้าน

3 Socioeconomic Status ไม่ได้ทำงาน มีบุตรทำงานรัฐวิสาหกิจ
เบิกค่ารักษาพยาบาลได้ หย่าร้างกับสามี ปัจจุบันอาศัยอยู่กับหลาน เจอลูกทุกสุดสัปดาห์

4 Medical history โรคประจำตัว
- ไม่ได้พบแพทย์เป็นประจำ ในอดีตรักษาโรคภูมิแพ้ที่ รพ.ศิริราช Allergy (แพ้อากาศเย็น ผู้ป่วยจะมีอาการน้ำมูกไหลและจาม)

5 Medical history Vital signs BP 123/75 mmHg PR 72 beats/min
ปฏิเสธการแพ้ยา อาหารและสารเคมี BP 123/75 mmHg PR beats/min 29 พ.ย. 54

6 อยากมีฟันหลังเคี้ยวอาหาร
Chief complaint อยากมีฟันหลังเคี้ยวอาหาร

7 Dental history มีประวัติรักษาทางทันตกรรมที่
คณะทันตแพทยศาสตร์ มหาวิทยาลัย มหิดล ปี 2554 ทำการรักษาโรคปริทันต์อักเสบ และรักษาคลองรากฟันซี่ 43 44 รอคิวกับนักศึกษาหลังปริญญาเพื่อทำ ครอบฟันและฟันเทียมบางส่วนถอดได้ ปัจจุบันใช้ฟันหน้าเคี้ยวแทนฟันหลัง

8 Referral Source 6 months
CT (2554) 6 months AD (2554)

9 Lifestyle ของทอด, ผัก, ผลไม้ ของหวาน, ขนมกรุบกรอบ

10 Oral hygiene practice แปรงฟันถูไป-มาในแนวนอน
วันละ 2 ครั้ง(เช้าและก่อนเข้านอน) โดยใช้ยาสีฟันผสมฟลูออไรด์ ไม่ใช้ไหมขัดฟัน

11 Clinical Examination

12 Extraoral Examination
Facial appearance Symmetry Facial profile Concave Lip morphology Competent TMJ WNL Lymph node WNL Muscle of mastication WNL WNL- within normal limit

13 Intraoral Examination

14

15 Intraoral examination
Torus palatinus Exostosis Impingement from 37

16 Intraoral Examination
Generalized attrition and some erosion Partial edentulism 14-17, 25-27, 35-36, 45-47

17 Intraoral Examination
21 D has 5 mm pocket depth and second degree mobility 22 and 23 first degree mobility, no pocket formation 13 (I) erosion tooth 21, 22, 23 1◦traumatic occlusion 24 (O) erosion tooth

18 Intraoral Examination
37(O) Amalgam filling 43 Hx of RCT for 5 years . 44 Hx of RCT for 1 year 43, 44 previously treated tooth with adequate root canal filling

19 Occlusion Molar relationship : Rt & Lt unclassified
Canine relationship :Rt Class III Lt Class III Overbite : 80% Overjet : 5mm

20 Occlusion Right lateral excursion 11/41 12/42 13/44
Protrusive movement 21/31 Left lateral excursion -21/31

21 Periodontal Examination
Upper arch CAL 332 212 232 325 333 233 235 CEJ-GM 110 000 010 023 PD 222 I B 2 1 1 L PD 212 211 215 111 CEJ-GM 000 012 CAL 123

22 Periodontal Examination
Lower arch CAL 211 111 110 011 223 212 232 222 433 CEJ-GM 010 000 00-1 -100 112 101 121 PD 323 B L PD 112 111 323 CEJ-GM 110 010 100 011 CAL 222 121 211 122 212 333

23 Periodontal Diagnosis
Localized severe chronic periodontitis สมาคมปริทันตวิทยาแห่งประเทศไทย 2007

24 Patient’s Expectation
มีฟันเอาไว้ใช้เคี้ยวอาหารได้ดี

25 Dentist’s Expectation
มีสุขภาพร่างกายแข็งแรง มีฟันปลอมที่แข็งแรง ใช้เคี้ยวอาหารได้อย่างมีประสิทธิภาพ สามารถดูแลสุขภาพช่องปากของตนเองได้ดีและสม่ำเสมอ

26 Behavioral Evaluation
มารับการรักษาตามนัดทุกครั้ง ไม่เคยมาสาย มีส่วนร่วมในการตัดสินใจแผนการรักษา

27 Problem Lists Loss of VD (no posterior teeth support)
Torus palatinus and bony exostosis Traumatic occlusion at 21,22 and 23 43,44 Previously treated with adequate root canal filling Generalized attrition with some erosion

28 Areas of Concern Traumatic Loss VD Tooth wear Pulpal disease +/-
No posterior teeth Pulpal disease +/-

29 Loss of VD จำเป็นต้อง raise หรือไม่ raise เท่าไหร่
หลักการ : raise ให้น้อยที่สุดเท่าที่จำเป็น คือให้มีspace พอที่จะrestoration raise เท่าไหร่ raise ได้หรือไม่ อย่างไร

30 Loss of VD จำเป็นต้อง raise?ดูจาก...
การสบฟันของผู้ป่วย---Space available for restoration Determination of OVD---Loss of VD ? Loss of posterior support History of wear ( physiologic wear VS acclerated wear) Phonetic evaluation( the increased space alters /s/ sound to/∫/ Interocclusal rest space ( greater than 2-4 mm.) Facial appearance ( Wrinkles and drooping commissures around mouth) 5 mm คุณป้ามีspaceไม่พอ

31 Loss of VD Raise เท่าไหร่
หลักการ RVD – OVD = 5 mm. = Freeway space แล้วทำการ raise bite ขึ้นมาใหม่ เพื่อสร้าง Freeway space ประมาณ 2-3 mm.

32 Loss of VD Turner’s classification of occlusal wear
Raise อย่างไร ประเมินจากอะไร Turner’s classification of occlusal wear Category 1 : Excessive occlusal wear with loss of vertical dimension with space available to restore the vertical height. Category 2 : Excessive occlusal wear without loss of vertical dimension with space available. Category 3 : Excessive wear without loss of occlusal vertical dimension with limited space ป้าเราเป็น catagory 1 :: ถ้าเป็น catagory 1,2 จะสามารถraise ได้

33 Loss of VD Treatment options Overlay denture Crown & RPD
Implants with crown

34 Areas of Concern Traumatic Loss VD Tooth wear Pulpal disease +/-
No posterior teeth Pulpal disease +/-

35 Generalized attrition with some erosion
Areas of Concern Generalized attrition with some erosion

36 Generalized Attrition with Some Erosion
Etiology Congenital anomalies AI, DI Habit Parafunctional habit Diet Sour Hard Loss of posterior teeth support Treatment Diet advice Prosthesis

37 Generalized Attrition with Some Erosion
Treatment options Diet advice Prosthesis

38 Areas of Concern Traumatic Loss VD Tooth wear Pulpal disease +/-
No posterior teeth Pulpal disease +/-

39 Traumatic occlusion at 21, 22, 23
Etiology Parafunctional habits >>> Nightguard High spot >>> Remove some Missing enough teeth >>> Removable prosthesis, Implant-supported crown bridge Tooth mobility >>> bone graft Excessive force from using anterior teeth to chew because of loss of posterior teeth support

40 Areas of Concern Traumatic Loss VD Tooth wear Pulpal disease +/-
No posterior teeth Pulpal disease +/-

41 43,44 Previously treated with adequate root canal filling
Etiology Severe attrition Treatment options of this area Post & core crown Enameloplasty for supporting overlay denture

42 EtiologySevere attrition
Treatment options of this area

43 Tentative Treatment Plan

44 Pre-treatment Phase Dental consultation Dentist patient discussion
Prosthodontist, Endodontist Dentist patient discussion Preliminary APD design

45 Systemic Phase Patient management (ระวังไม่ให้ผู้ป่วยเกิดการแพ้อากาศเย็น) แนะนำผู้ป่วยตรวจสุขภาพร่างกาย

46 Acute Phase None หมายเหตุ: ไม่สามารถทำTreatmant denture ได้เนื่องจากต้องทำการผ่าตัด torus และexostosis ออกก่อน

47 The Disease Control Phase of Treatment
Torectomy and alveoloplasty Oral hygiene instruction Scaling and root planning and polishing full mouth 13(O) Resin composite filling

48 The Definitive Phase of Treatment
Upper : APD Lower : Overlay denture ทำรูปคลุมฟัน fulldenture

49 The Maintenance Phase of Treatment
Recall 3 months Evaluate oral hygiene and periodontal status Evaluate all restorations and prostheses Recall every 6 months Scaling and root planning X-ray 6 months, 1 year and every year until 4 years

50 Review Full mouth rehabilitation of the patient with severely worn dentition Treatment by occlusal overlay splint, interim fixed restoration and the permanent reconstruction. Regular check-up for the occlusal adjustment and RPD fitting. Result In this clinical report showed successful full mouth rehabilitation. Mi-Young Song, DDS, MSD, Ji-Man Park, DDS, MSD and Eun –Jin Park, DDS, MMsc, PhD Department of Prosthodontics,School of Medicine, Seoul, Korea

51 Overlay Denture Definition
“Overlay removable partial dentures, a subset of overdentures, are often referred to as an RPD that has part of their components covering the occlusal surface of the abutment teeth to restore them into a functional occlusion.”

52 Overlay Denture Advantages Psychological benefit Proprioception
Patient still has his teeth Proprioception Periodontal mechanoreceptors allow a finer discrimination of food texture, tooth contact, and levels of functional loading more control over mandibular Movement and chewing food Effect on ridge resorption Preserve the edentulous ridge, by reducing the amount of resorption

53 Overlay Denture Advantages Improve stability and retention
Mechanical retention Minimizing horizontal forces on the abutment teeth Correction of occlusion and aesthetics VDO is maintained

54 Overlay Denture Disadvantages
Protecting the bacteria from mechanical wash and the chemical activity of the saliva that can help in the teeth protection chance for dental caries is going to increase It might initiate periodontal disease Considerable space or height is required. Difficult to use in a short interocclusal situation

55 Tentative treatment plan
Alternative treatment plan I Alternative treatment plan II

56 Treatment Plan Tentative Treatment Alternative Treatment I Alternative
Treatment II APD/Overlay Denture Implant & Bridge RPD/RPD & Crown

57 Treatment Plan Tentative Treatment Alternative Treatment I Alternative
Treatment II Pre-treatment phase Dental consultation: Prosthodontist Patient-dentist discussion Preliminary prostheses design Pre-treatment phase Dental consultation: Prosthodontist CT Scan Patient-dentist discussion Preliminary prostheses design Pre-treatment phase Dental consultation: Prosthodontist Patient-dentist discussion Preliminary prostheses design

58 Treatment Plan Tentative Treatment Alternative Treatment I Alternative
Treatment II Systemic phase Medical consideration แนะนำให้ผู้ป่วยตรวจสุขภาพ Patient management (ระวังไม่ให้ผู้ป่วยเกิดการแพ้อากาศเย็น) Systemic phase Medical consideration แนะนำให้ผู้ป่วยตรวจสุขภาพ Patient management (ระวังไม่ให้ผู้ป่วยเกิดการแพ้อากาศเย็น) Systemic phase Medical consideration แนะนำให้ผู้ป่วยตรวจสุขภาพ Patient management (ระวังไม่ให้ผู้ป่วยเกิดการแพ้อากาศเย็น)

59 Treatment Plan Tentative Treatment Alternative Treatment I Alternative
Treatment II Acute phase - Acute phase Torectomy Treatment denture (Overlay) Acute phase Torectomy Treatment denture (Overlay) Disease control phase Torectomy Oral hygiene instruction Scaling and polishing 13(O) Resin composite filling Treatment denture for edentulous area Disease control phase Oral hygiene instruction Scaling and polishing 13(O) Resin composite filling Disease control phase Oral hygiene instruction Scaling and polishing 13(O) Resin composite filling Torectomy above tx dent alter1 2

60 Treatment Plan Tentative Treatment Alternative Treatment I Alternative
Treatment II Definitive phase Definitive phase Definitive phase Treatment denture (Overlay) 43,44 PFM crown 42,41,31,32,33 crown Implant & Bridge 34-44 crown RPD/RPD

61 Treatment Plan Tentative Treatment Alternative Treatment I Alternative
Treatment II Maintenance and recall Maintenance and recall Maintenance and recall Recall 3 months Evaluate oral hygiene and periodontal status Evaluate all restorations and prostheses Recall 3 months Evaluate oral hygiene and periodontal status Evaluate all restorations and prostheses Recall 3 months Evaluate oral hygiene and periodontal status Evaluate all restorations and prostheses

62 Treatment Plan Tentative Treatment Alternative Treatment I Alternative
Treatment II Maintenance and recall Maintenance and recall Maintenance and recall Recall every 6 months Scaling and root planning Endodontically treated teeth 43,44 X-ray 6 months, 1 year and every year until 4 years Recall every 6 months Scaling and root planinng Endodontically treated teeth 43,44 X-ray 6 months, 1 year and every year until 4 years Recall every 6 months Scaling and root planning Endodontically treated teeth 43,44 X-ray 6 months, 1 year and every year until 4 years X-ray (+bite guide) check implant 6 months, every 1 yr. until 5 yrs. and every 5 yrs.

63 Treatment Plan Tentative Treatment Alternative Treatment I Alternative
Treatment II 12,130 บาท 172,130 บาท 4,130 บาท

64

65 Review Traumatic occlusion
repeated excessive force in closure of the teeth that injures the teeth, the periodontal tissues, the residual ridge, or other oral structures. The closure extends beyond the reparative ability of the attachment apparatus (cementum, periodontal ligaments, and alveolar bone). Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.

66 Traumatic occlusion Clinical sign and symptoms - Tooth migration
- Pain - Wear facets

67 Traumatic occlusion 1. primary traumatic occlusion
Type of traumatic occlusion 1. primary traumatic occlusion 2.secondary traumatic occlusion

68 Traumatic occlusion Primary occlusal trauma
- occurs when greater than normal occlusal forces - parafunctional habits ,various chewing ,or biting habits , biting fingernails and pencils or pens - will occur when normal periodontal attatchment ,no periodontal disease.

69 Traumatic occlusion Secondary occlusal trauma
- occurs when normal occlusal forces are placed on teeth with compromised periodontal attachment

70 Traumatic occlusion Etiology and treatment
Parafunctional habits >>> nightguard Higth spot >>> remove some Missing enough teeth >> removable prosthesis, implant-supported crown-bridge Tooth mobility >> bone graft

71 The effects of occlusion on periodontitis.
Gher ME. Despite volumes of publications on the theory of occlusion, occlusal design, and equilibration techniques, there have been few well-designed human studies directed at answering the question does occlusal trauma modify the progression of attachment loss in periodontitis. The articles reviewed indicate that occlusal forces can cause changes in the alveolar bone and periodontal connective tissue both in the presence and in the absence of periodontitis. These changes can affect and clintooth mobility ical probing depth. Although occlusal forces do not initiate periodontitis, results are inconclusive as to if or how these forces affect attachment loss owing to plaque-induced inflammatory periodontal disease. Although some studies reported a relationship between increased attachment loss and tooth mobility, others found no relationship between attachment loss and abnormal occlusal contacts. Tooth mobility results from a variety of factors, including alveolar bone loss, attachment loss, disruption of the periodontal tissues by inflammation, widening of the PDL in response to occlusal forces (physiologic adaptation), PDL atrophy from disuse, and other processes that effect the periodontium. PMID: [PubMed - indexed for MEDLINE] Apr;42(2):

72 Review Dent Res J (Isfahan). 2009 Autumn; 6(2): 71–74.
Examination for signs of trauma from occlusion, such as fremitus test, presence of wear facets and mobility. Dent Res J (Isfahan) Autumn; 6(2): 71–74.

73 Torectomy Indication Large/Middle torus
Extension/Retention of prosthesis Traumatic ulcer Undercut Speech/Swelling problem Mental problem

74 Complication Hemorrage Hematoma Perforation of the floor of the nose
Fracture of palate Slough of the palatal mucosa

75 Examination for older women
Physical examination Chest X-ray Ultrasound whole abdomen Digital Mammogram PV & ThinPrep Pap test EKG Exercise stress test (EST) or Echocardiography Bone densitometry FBS CBC Creatinine SGPT, SGOT, alkaline phosphatase Total cholesterol, Triglyceride, HDL-C, LDL-C direct Anti HBs, HbsAg Uric acid Urine analysis

76

77 Occlusal Wear Generation of interocclusal space
Adhesive resin Overlay splint Cobalt chromium device Evaluation of patient adaptation Teeth comfort Muscle tenderness Temporomandibular comfort Phonetics


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