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............................................................................ Treatment Plan Presentation.

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

1 Treatment Plan Presentation

2 Personal Data 73

3 Socioeconomic Status

4 Medical history -. 1.Allergy ( )

5 Medical history Vital signs BP 123/75 mmHg PR 72 beats/min BP 123/75 mmHg PR 72 beats/min

6 Chief complaint

7 Dental history

8 AD (2554) CT (2554) Referral Source

9 Lifestyle,,,

10 Oral hygiene practice - 2 ()

11 Clinical Examination

12 Extraoral Examination Facial appearance Symmetry Facial profile Concave Lip morphology Competent TMJWNL Lymph nodeWNL Muscle of masticationWNL 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, 44 previously treated tooth with adequate root canal filling 43 Hx of RCT for 5 years. 44 Hx of RCT for 1 year

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

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

21 Periodontal Examination CAL CEJ -GM PD Upper arch B L PD CEJ -GM CAL I 21

22 Periodontal Examination CAL CEJ- GM PD Lower arch B L PD CEJ- GM CAL

23 Periodontal Diagnosis Localized severe chronic periodontitis 2007

24 Patients Expectation

25 Dentists Expectation

26 Behavioral Evaluation

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 Loss VD Tooth wear No posterior teeth Pulpal disease Traumatic +/-

29 Loss of VD raise : raise spacerestoration raise

30 raise? 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) Loss of VD 5 mm

31 Raise RVD – OVD = 5 mm. = Freeway space raise bite Freeway space 2-3 mm.

32 Loss of VD Raise Turners 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

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

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

35 Generalized attrition with some erosion Areas of Concern

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

37 Generalized Attrition with Some Erosion Treatment options Diet advice Prosthesis

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

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

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

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 Etiology Severe attrition Treatment options of this area

43 Tentative Treatment Plan

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

45 Systemic Phase Patient management ()

46 Acute Phase

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

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 o 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 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

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

57 Treatment Plan Alternative Treatment I Alternative Treatment I Alternative Treatment II Alternative Treatment II Tentative Treatment Tentative Treatment 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 Alternative Treatment I Alternative Treatment I Alternative Treatment II Alternative Treatment II Tentative Treatment Tentative Treatment Systemic phase Medical consideration Patient management ( ) Systemic phase Medical consideration Patient management ( ) Systemic phase Medical consideration Patient management ( )

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

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

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

62 Treatment Plan Alternative Treatment I Alternative Treatment I Alternative Treatment II Alternative Treatment II Tentative Treatment Tentative Treatment Maintenance and recall 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 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 X-ray (+bite guide) check implant 6 months, every 1 yr. until 5 yrs. and every 5 yrs. 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

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

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 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. 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] 1998 Apr;42(2):

72 Review 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 1. Physical examination 2. Chest X-ray 3. Ultrasound whole abdomen 4. Digital Mammogram 5. PV & ThinPrep Pap test 6. EKG 7. Exercise stress test (EST) or Echocardiography 8. Bone densitometry 9. FBS 10. CBC 11. Creatinine 12. SGPT, SGOT, alkaline phosphatase 13. Total cholesterol, Triglyceride, HDL-C, LDL- C direct 14. Anti HBs, HbsAg 15. Uric acid 16. 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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