UNIVERSITY OF DEBRECEN

FACULTY OF DENTISTRY
ORAL PART OF THE STATE EXAM

CASE PRESENTATION
(73.)
Yasmin Zayer Zafari Shoushtari
MEDICAL HISTORY
• 77 year old male patient.

• General disease: hypertension, ischemic cardial disease, angina

pectoris, paroxymal atrial fibrillation, mitral and aortic valve
insufficiency, pacemaker insertion (2013), stroke, diabetes
mellitus, gall-bladder operation

• Medicine allergy: do not know about it

• Medications: Xarelto, Letrox, Apo-Famotidin, Propafenon,

Bisoprolol, Atorva, Tritace, Furosemid, Kaldyum
DENTAL HISTORY

He would like to have a new denture. According to the

patient, he had no complaints, problems.
X-RAY I. (OPT)
X-RAY II. (PERIAPICAL)
X-RAY II. (PERIAPICAL)
PHOTOS OF THE PATIENT
PHOTOS OF THE CAST

(41, 31 teeth had been removed earlier).

DENTAL STATUS

X X X X CMO CD CD X f/p CD CD CMOD X X X X

8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8

X X X CMO X p X X X X p COD T/C X X X

DENTAL STATUS
Upper Arch:
•18 - Missing
•17 - Missing
•16 - Missing
•15 - Missing
•14 - Caries on Mesiocclusal surface, Abfraction, attrition, plaque
•13 - Caries on Distal surface, Abfraction, attrition, plaque
•12 - Caries Distally, Abfraction, plaque
•11 - Missing

•21 - Calculus and plaque

•22 -Caries on Distal surface, Abfraction, attrition, plaque
•23 - Caries on Distal surface, Abfraction, attrition
•24 - Caries on Mesiocclusodistal surface, Abfraction, attrition, plaque
•25 - Missing
•26 - Missing
•27 - Missing
•28 - Missing
DENTAL STATUS
Lower Arch:
•31 - Severe bone resorption (now missing in the clinical picture)
•32 - Missing
•33 - Mesially tilted, plaque, attrition
•34 - Caries on Occlusodistal surface, Abfraction, attrition
•35 - Class V Filling, secondary caries, abfraction, attrition, plaque
•36 - Missing
•37 - Missing
•38 - Missing

•41 - Severe bone resorption (now missing in the clinical picture)

•42 - Missing
•43 - Root caries, Mesially tilted, plaque, attrition
•44 - Missing
•45 - Caries on Mesiocclusal surface, Abfraction, plaque, attrition
•46 - Missing
•47 - Missing
•48 - Missing
DIAGNOSIS
• Vitality test, percussion and mobility must be assessed for each individual tooth.
• Periodontal charting is necessary:
• Bleeding on probing, plaque index, probing pocket depth, clinical attachment loss..
• Based on X-ray:
• Generalized periodontitis (Stage IV , Grade C)
• Based on clinical image:
• Gingival recession
• Upper arch: Kennedy class I (modification 1), Lower arch: Kennedy class I (modification 2)
• Caries: 14,13,12,22,23,24,34,45
• Secondary caries: 35
TREATMENT PLAN
Periodontal Treatment–Cause related therapy
• Periodontal charting is required prior and following treatment
• Removal of plaque, calculus and stained areas supragingival and subgingivally
• Thorough oral hygiene instructions and education on brushing
• Determination of hopeless teeth
Re-evaluation of periodontal status: Evaluate co-operation of patient, record periodontal status

Oral surgery Treatment

•Extraction of hopeless teeth 31,41 (already extracted in the clinical picture).

Restorative treatment:
• Removal of the caries on 14,13,12,22,23,24,34,35,45 and place composite fillings
• Filling abfractions with sandwich technique (GIC and composite)

Prosthetic treatment:
•Upper Arch: Removable partial denture with anterior-posterior or full palatal fenestrated major connector, Ney IV or
backaction clasp on 14 and 24 and Ney 1 or Roach clasp/T-bar on 12 and 21 with occlusal rest on cingulum.

Alternative option: After adequate periodontal and oral hygine improvement, bridge fabrication for 12-21, ney IV or back
action clasp on 14,24 with butterfly major connector.
TREATMENT PLAN
•Lower Arch: Removable partial denture with lingual bar major connector and Ney I or Roach clasp/Tbar on 33 aand 43
with occlusal rest on cingulum, and Ney IV or backaction clasp on 35 and 45.

Alternative option: After evaluation and ensuring that the periodontal health is good, we can make a bridge using 43,45 as
an abutment and replace the missing 44, and use the same clasp system for removable partial denture replacing the
missing teeth.