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Comprehensive Care Case

Prepared & Presented by:

Dhafer Abdullah Alyami

Supervised by: Dr . Mohammed Awadhallh Alsaleh

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Age :22 years old

Sex: Male

Nationality : Saudi

Occupation : Student

Marital & Social Status : Single

Patient attitude : Fairly cooperative

PERSONAL DATA

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Chief Complaint Patient Said :“My front tooth was

fractured, I want to fix it.”

History of Chief Complaint

Patient had trauma since six months ago.

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Significant medical problems : Asthma

Medication :ventolin

History of allergic reaction : None

No significant medical problems but the patient had asthma attack about 2 years ago.

MEDICAL HISTORY

FAMILY MEDICAL HISTORY No significant medical problems.

Past MEDICAL HISTORY

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Past Dental History:

Root Canal Treatment # 11 , 21 since 2 years ago.

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Habits and Oral Hygiene Activity

• Tooth brushing None

• Flossing None

• Mouth wash None

• Meswak Sometimes

1 -Patient is taking 3-main meals during the day.

2 -Medium sugar consumption.

3 -Minimum vegetable & fruit intake.

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Diet Analysis

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Extra-oral Examination• Skin NAD

• Head NAD

• Neck NAD

• Lips NAD

• Muscles NAD

TMJ :• Clicking NAD

• Pain NAD

• Limitation on opening NAD

• Deviation on opening NAD

Clinical Examination

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Soft tissues :

• Lips NAD

• Labial Mucosa NAD

• Buccal Mucosa NAD

• Hard/soft Palate NAD

• Vestibule NAD

• Tongue NAD

• Floor of the mouth NAD

• Gingiva reddness

• Saliva NAD

Hard tissues :

• Teeth Plaque,calculus & caries

Intra-oral Examination

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Frontal View

Extra-oral photo

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Lateral View

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PRE-TREATMENT PHOTOGRAPHS

Frontal View

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Upper arch

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Lower arch

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Right Side

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Left Side

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Periodontal examination

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Probing depths:

Generalized ( 2-3) mm

Mobility:

NO significant tooth mobility

Furcation:

NO furcation involvement

2 2 2

2 2 2

Periodontal scoring

Periodontal examination

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Charting

Existing Rest.

P.D. Initial

Recession: 0

Mobility: 0

Charting (Maxillary)

II. Intra – Oral Examination

RCT

1 2 3 2 2 3 3 3 3 3 2 2 2 2 2 2

Existing Rest.: 0

P.D. Initial

Recession : 0

Mobility : 0

Charting (Mandibular)

Cont’ II. Intra – Oral Examination

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

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Periodontium:

Generalized chronic Marginal Gingivitis

Diagnosis

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OPG

DIAGNOSTIC TOOLS

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Mounted Diagnostic Cast

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F M X

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PA Posterior Teeth

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PA Anterior Teeth

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Bite wing Pre-operative

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Occlusal radiograph

Upper Lower

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Operational Diagnosis

And

Treatment Plan

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Phase I : Emergency/ Preventive / surgical Treatment.

Phase II : Operative & Endodontic Treatment.

Phase III : Prosthodontic Treatment.

Phase IV : Recall & Maintaince.

Treatment Phases

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To eliminate pathology.To restore function.To improve esthetics. To motivate the patient to improve his oral hygiene .To educate the patient & enforce knowledge about oral & dental awareness.

Treatment Objectives

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Substandard dental care.

Poor oral hygiene.

Habits.

Risk Factors

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Recommendation Condition Tooth no.

Composite restoration Occlusal caries 16

Retreatment RCT & composite resto. Substandard RCT 11

Retreatment RCT & fiber post & composite build-up & crown

Substandard RCT & fractured crown

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Composite restoration Occlusal caries 26

Composite restoration Occlusal caries 27

Composite restoration Occlusal caries 36

Composite restoration Occlusal caries 46

Composite restoration Occlusal caries 47

Treatment Plan

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Condition: #26,27-occlusal caries

Condition: #16-occlusal caries

Upper arch

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Condition: #36-occlusal caries

Condition: #46,47-occlusal caries

Lower arch

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Recommendation: #16,27,26-composite restoration

Upper arch

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Recommendation: 36,46,47-Composite restoration

Lower arch

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Endodontic Phase

Recommendation:Retreatment endodontic

Condition: #11,21-Substandard RCT- Fractured crown #21

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Recommendation: #11,21- # 11 Composite restoration- #21 (Fractured crown) - Post space preparation & cementation of FP- Biuld-up composite restoration- Preparation for full crown.- Temporary crown. - Final crown cementation (IPS e.max)

Prosthodontic Phase

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IPS e.max® System

• It is the ultimate in metal-free esthetics and durability offering high-strength materials for both the PRESS and the CAD/CAM technique.

• It is a lithium disilicate glass ceramic that has optimized translucency, durability and strength for full anatomical restorations.

• IPS e.max lithium disilicate restorations exhibit superior durability featuring 360-400 MPa of flexural strength.

• The opalescence, translucency and light diffusion properties of IPS e.max lithium disilicate were all designed to replicate natural tooth structure for beauty and undetectable restorations

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CEMENTATIONThe high strength of IPS e.max lithium disilicate offers dentists a choice to adhesively bond or conventionally cement their restorations.

Self-Adhesive Resin Cements Adhesive Resin Cements

High-strength restorations only Lithium disilicate (e.g. IPS e.max)

Metal & Metal-Ceramic

Oxide Ceramic (Zirconia, Alumina)

All types of restorations Including Feldspathic and Leucite

Adequate retention in prep design Less than 8 degree taper

Minimum 4mm height

Any preparation design Retentive and non-retentive

Adequate thickness of restoration Greater than 1.0mm for anterior

Greater than 1.5 mm for posterior

Any thickness Including “thin” veneer restorations

Copyright © 2013 • Ivoclar Vivadent • All Rights Reserved • Terms & Conditions • Contact UsAre you a patient? Visit SmileToTheMax.com to learn more about IPS e.max

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Before & After Treatment

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AFTERBEFORE

Frontal View

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Right Side

BEFORE AFTER

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Left Side

BEFORE AFTER

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BEFORE AFTER

Upper Arch

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Lower Arch

BEFORE AFTER

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Bite wing Post operative

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OPG

Prognosis

Overall: • Good if the patient maintain good OH

& attend to the recall & maintenance visit.

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Thank you