‫‪Case comprehensive‬‬

‫تاال عبد الحميد شاهين ‪‬‬ ‫م‪.‬م‬

‫رقم ملف المريضة ‪162070 /85271‬‬
‫‪ 127226‬‬
Introduction

 Gender - female
 Age – 22
 Occupation – house wife
History

 Medical history – caesarean birth

 Medication history – denied taking any medication
 Family history- cancer
 Social history – drinking hookah
 Dental history – restoration two years ago
 Perio history – no perio tx
 Denied allegy history
 Acceptable oral hygiene
Chief complaint

Patient want to extract the remaining roots ,and to clean her

teeth
 Extraoral & intraoral examination

 Extraoral – nothing abnormal detected

 Intraoral :- 1) crowding 2) caries 3) linea alba
 4) fissured tongue
 Radiographs

Periapical
radiographs
Clinical pictures
Diagnosis

 Remaining roots
 15 / 36
 Multiple caries
 14 / 16
 Localized gingivitis
 Treatment plan

 Stabilization phase :-
Prosthodontics treatment
 1) scaling
 2) OHI and patent education and motivation Bridge for missing 36
 Reconstruction phase :-
 1) class 1 on 16
Re-evaluation phase
 2) class 2 on 14 1) After 4 weeks patient referral
 surgery treatment
 1) extraction of 15 Maintenance phase
 2) extraction of 36 Regullar recall every 3 months to
 Periodontal treatment maintain pt oral hygiene health
 Scaling and polishing
Periodontal clinic

Intraoral examination
1) Crowding
 Tooth brushing - 1/ daily 2) Caries
3) Linea alba
 Method of tooth brushing – circular 4) Fissured tongue
 Type of tooth brush – soft
 No auxiliary oral hygiene aids
Risk factors
 She smokes water pipes twice weekly 1) Calculus
2) Class ll
3) Smoking
Periodontal clinic

 Bleeding on probing – 18%

 Plaque index – 26%
 No pockets
 No recession
 No mobility
 Diagnosis is – localized biofilm induced gingivitis
Periodontal clinic
Scaling results
 Surgery clinic results

36 extraction 15 extraction
Conservative clinic

 Tests for tooth 14 Tests for tooth 16

 Cold test –delayed responsed Cold test - responsed
 No tender to percussion No tender to percussion
 No periradicular pathology No periradicular pathology
 Diagnosis – reversible pulpits
Conservative clinic complexity

 During removing the caries in tooth 14 with handpiece , I have found that there is a soft caries near the
pulp , so I switch to the hand instrument ( excavator ) to remove the remaining soft caries , suddenly I
saw a dot of blood ( shadow ) ,l knew that this is a pulp exposure , so i told my supervisor, I start with
direct pulp capping technique as soon as possible and then I controled the situation by :- 1) sodium
hypochlorite on cotton roll to stop bleeding for 1 min 2) after controlling I used calcium hydroxide
at the point of exposure exactly then 3) vitra bond 4) etch and bond 5) composite
 I follow up with the patient in the first 2 days and there was no pain
Conservative clinic

Direct pulp capping on 14

( class 2)
Conservative clinic

Class 1 composite on 16
Prosthodontics clinic

 I have taken an alginate impression for upper and lower

jaw in this semester in the first visit and I will complete
the preparation for the bridge ( 35 – p – 37 )

Bridge site
Referral to orthodontics