CASE PRESENTATION

PRESENTED BY: DR. TAVLEEN KAUR

CASE HISTORY

 NAME
 AGE/Gender
 OCCUPATION
 FINANCIAL CONDITION
 CHIEF COMPLAINT
 DETAILED HISTORY
 MEDICAL HISTORY
 DENTAL HISTORY
 DIET
 HABITS- TOOTH BRUSHING/SMOKING/TOBACCO/PARAFUNCTIONAL
 GENERAL EXAMINATION-
PHYSICAL EXAMINATION-GAIT,POSTURE
VITALS
SYSTEMIC INVESTIGATIONS if required
 PERSONALITY ASSESSMENT- TYPE
 EXTRA-ORAL EXAMINATION
 TMJ examination, mouth opening
 Facial muscles
 Facial symmetry
 face shape
 Lip examination- length, support, cheilitis
 FUNCTION ANALYSIS
 SPEECH
 SWALLOW PATTERN
 CHEWING PATTERN-mandibular movement
 SMILE ANALYSIS
 INVESTIGATIONS-
 PHOTOGRAPHS- VIEWS-FRONTAL/LATERAL
 EXTRA-ORAL
 INTRA-ORAL
 TMJ IMAGING
 EXTRA-ORAL RADIOGRAPHS
 OPG
 CBCT
 INTRA-ORAL RADIOGRAPHS
 INTRA-ORAL EXAMINATION

 MAXILLARY ARCH:
 SOFT TISSUE EXAMINATION- Frenal attachments,
vestibular depth, gingival contour, biotype,
periodontal health, mobility, mucosa examination,
saliva flow, mucosa, rugae prominence

 HARD TISSUE EXAMINATION: Bony undercut

examination, mid palatine raphe, hard palate
examination(shape, depth) attrition, erosion,
abrasion, caries, restorations
 INTRA-ORAL EXAMINATION

 MAXILLARY ARCH FINDINGS:

 Arch shape-ovoid

 Teeth missing- 11,2123,26,27

765432 2 45  Teeth present-
 Attrition- 17,16,15,14,13,12,22,24,25
5 321 12 4  Distopalatal caries- 22
 Occlusal caries- 24,25
 Restored- 16,14
 Kennedy classification- class II div 2
 INTRA-ORAL EXAMINATION

 MANDIBULAR ARCH-
 Soft tissue examination: Frenal
attachment, Vestibular depth/sublingual
examination, mucosa ,tongue
 Hard tissue examination
 Retromolar pad region, mylohyoid ridge,
buccal shelf , retro mylohyoid curtain
depth, throat form edentulous area bone
width and height assessment, attrition,
caries, restoration, mobility
 INTRA-ORAL EXAMINATION

 MANDIBULAR ARCH FINDINGS –

 Posterior edentulous area- high well
rounded(class 3/4)
 Missing teeth- 34,36,37,43,45,46,47
 Kennedy classification- Class I Div 2
 Teeth restored:35,42(secondary caries)
 Attrition- 35,33,32,31,41,42,44(severe
with pulp chambers calcified)
 OCCLUSION EXAMINATION

 EDGE TO EDGE BITE- Peripheral bone

buttressing due to trauma from
occlusion(Adaptive response)
 SUPRA-ERUPTIONS-17,16,15,14,12,22
 INTER-ARCH SPACE- NIL
 CROWN HEIGHT SPACE
 OCCLUSION CLASSIFATION by Turner and
missirilian- Category III .
 VDO,VDR,FREEWAY SPACE assessment
FRONTAL VIEW – TEETH IN OCCLUSION
 Complete Loss of vertical dimension
DIAGNOSIS

 DIAGNOSTIC RECORDS
 Case History
 Radiographs
 Extra-oral And Intra-oral Photographs
 Facebow Transfers And Diagnostic Mounting- Centric/Lateral
Excursions/Interferences

 ASSESSING INDIVIDUAL TOOTH PROGNOSIS and OVERALL

PROGNOSIS
DIAGNOSIS

 A patient named XYZ of age A, working as M with a philosophical attitude

presented with the chief complain of teeth with reduced height .(difficulty in
chewing/sharp cracked teeth/ pain/sensitivity) Patient might have the habit of
bruxism. On examination, patient seems to have a strong musculature with good
bone regeneration capacity. Patient is partially edentulous in both the arches, the
edentulous area appears to be high well rounded in both maxillary and
mandibular arches. All teeth present have severe attrition. Some are carious,
have secondary caries or are restored. Occlusion shows no space for prosthetic
procedures. Turner and Missirilian Type III category of tooth wear occlusion.
 TREATMENT PLANNING

 COUNSELLING
 Oral hygiene maintenance, habits, Diet counselling
 BASED ON PROGNOSIS of individual tooth
Extraction of teeth with poor prognosis
Retention of teeth with good prognosis
Treatment of teeth with fair prognosis
 Treatment phases-
 Periodontal(surgical osseous recontouring /crown lengthening)
 Endodontics
 Restorative phase
 Prosthetic treatment options:
 Ideal treatment option:
 Full mouth rehabilitation
 FIXED restoration of existing teeth with implant supported
crowns/bridge in edentulous area
 Overlay Splint- at least 1 month( assess muscle tenderness, TMJ ,
swallowing, speech, aesthetics)
 Immediate /Provisional fixed and removable prosthesis
 Definitive restoration
 Type of occlusion- philosophy of FMR- special consideration to strong
muscular and biting forces/Bruxism
 Material of choice for restoration
 PFM
 Metal occlusal surface of posterior teeth
 Gold-acrylic FDP
 Monolithic Zirconia
 Post operative care- nightguard use
 Maintenance of prosthesis
Other treatment options

 Fixed crowns with precision/stud attachments for removable prosthesis

 Removable prosthesis for edentulous regions after fixed restoration of existing teeth
 Preferably CPD with crosslinked acrylic teeth.