Comprehensive Case Presentation Sultan Alshammery

LOGO RIYADH COLLEGE OF DENTISTRY AND PHARMACY

Comprehensive Case Comprehensive Case PresentationPresentation

Prepared By:Prepared By:p yp y

Sultan Sultan RkeebRkeeb alal--ShammeryShammery

LevelLevel

12

1

Age : 25

Gender : Male

Nationality : Yamani

Occupation : receptionist

Marital & Social Status : Single

2

In theتصبغات في •i ’ ي ب

األسنان األمامية

patient’s own

d :wordsاألمامية

•History of Chief Complaint

Long time agog g3

Medical HistoryMedical History

••Within NormalWithin Normal

••Within NormalWithin Normal

Family Medical HistoryFamily Medical History

••Within NormalWithin Normal

Past Dental HistoryPast Dental History

•Just for check up

Past Dental HistoryPast Dental History

p

4

No habits He use tooth brush twice abrush twice a day

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II Extra Extra Oral ExaminationOral ExaminationII. Extra . Extra –– Oral ExaminationOral Examination

SwellingSwellingSwellingSwelling

SkinSkin NADSkinSkin

TMJTMJ

NAD

TMJTMJ

7

IIII Intra Intra Oral ExaminationOral ExaminationIIII. Intra . Intra –– Oral ExaminationOral Examination

NAD

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IIIIII Oral HygieneOral HygieneIII . III . Oral HygieneOral Hygiene

28272625242322211112131415161718

Gingival Index ► 1 mild inflammation

111101

38373635343332314142434445464748

Plaque Index ► 1

28272625242322211112131415161718

Plaque Index ► 1

101101

38373635343332314142434445464748 38373635343332314142434445464748

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PRE-TREATMENT PHOTOGRAPHS

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Frontal viewFrontal view

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Maxillary Occlusal viewMaxillary Occlusal view

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Mandibular Occlusal viewMandibular Occlusal view

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Right lateral viewRight lateral view

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Left lateral viewLeft lateral view

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16

Pa o amicPanoramic

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Bitwing RadiographBitwing Radiograph

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Diagnostic CastsDiagnostic Casts

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20

1 2 3

li d Carious teeth Extractiongeneralized sever enamel fluorosis with stains

Carious teeth

16 17 18

Extraction

28 38stainsaffecting all of the permanent teeth

16 , 17 , 18 , 27, 37 , 47 , 48

28 , 38

teeth

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CariesCaries

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CariesCaries

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Diagnosis Diagnosis Diagnosis Diagnosis

G li d ild i i itiG li d ild i i itiGeneralized mild gingivitisGeneralized mild gingivitisPeriodontium:

24

25

26

Ph I Perio treatment Phase I

Condition:Generalized mild gingivitisGeneralized mild gingivitis

Recommendation :Polishing Oral hygiene instructionsPolishing , Oral hygiene instructions

27

28

Op ti t tm ntPhase II Operative treatment Phase II

Condition:# # 18 18 O C ries O C ries # # 18 18 , O. Caries , O. Caries

Recommendation :Class I composite restoration

29

Condition:# # 17 17 O C ries O C ries # # 17 17 , O. Caries , O. Caries

Recommendation :Class I composite restoration

30

Condition:# # 16 16 Dist l P l t l C ries Dist l P l t l C ries # # 16 16 , Distal , Palatal Caries , Distal , Palatal Caries

Recommendation :P.R.R

31

Condition:# # 27 27 , O. Caries , O. Caries

Recommendation :Recommendation :Class I composite restoration

32

Condition:# # 37 37 , O. Caries , O. Caries

Recommendation :Recommendation :P.R.R

33

Condition:# # 4 4 # # 48 48 , O. Caries , O. Caries

Recommendation :Recommendation :Class I composite restoration

34

Condition:# # 4 4 # # 47 47 , O. Caries , O. Caries

Recommendation :Recommendation :P.R.R

35

36

Condition:# # 38 38 , impacted teeth, impacted teeth

Recommendation :Recommendation :Extraction

37

Phase III Surgical TreatmentPhase III Surgical Treatment

Condition:# # 28 28 , traumatize and No , traumatize and No opposing after extraction tooth # 38

Recommendation :Extraction

After discussing the Surgical After discussing the Surgical treatment plan with the patient , The patient said (No need to go surgery at this time , Because No g y ,any symptoms or pain in this time

38

39

U t i t thUpper anterior teeth

Condition:Sever dental fluorosis of TFI = 6-9 with yellow/brown TFI = 6 9 with yellow/brown discoloration, based on the 1978 dental flourosis classification scheme of Thylstrup and FejerskovThylstrup and Fejerskov

Recommendation optionsoptions :- Bleaching ??- Veneer

40

41

preparation ( 0.5 – 0.8 ) mm midfacially ( 0 3 – 0 5 )mm along midfacially , ( 0.3 – 0.5 )mm along

the gingival margin

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Temporary composite restoration

43

p y p

After veneer cementation

44

45

L t i t thLower anterior teeth

Condition:Sever dental fluorosis of TFI = 6-9 with yellow/brown TFI = 6 9 with yellow/brown discoloration, based on the 1978 dental flourosis classification scheme of Thylstrup and FejerskovThylstrup and Fejerskov

Recommendation optionsoptions :- Bleaching or microabrasion( coast?? Pt need ?? )

- VeneerVeneer

46

MicroabrasionMicroabrasion

Conservative treatmentBleaching

Conservative treatment

Veneer

47

Mi b iMicroabrasion

( No any Effect )

48

Bleaching ( ZOOM2)Bleaching ( ZOOM2)49

Bleaching ( ZOOM2)eac g ( OO )

isolation

50

Bleaching ( ZOOM2)eac g ( OO )

Whitening Gel

51

Bleaching ( ZOOM2)eac g ( OO )

ZOOM light g( 45 – mint )

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After Bleaching

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After 1 month

54

VeneerVeneer

After 1 month , patient come back to evaluate the lower anterior shade color . The CC In the patient’s own words anterior shade color . The CC In the patient s own words لون األسنان ما عجبنيوارغب في عمل ترآيبات لألسنان السفلية

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56

57

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Temporary composite restoration

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After veneer cementationReturn

POST-TREATMENT PHOTOGRAPHS

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Frontal viewFrontal view

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Maxillary Occlusal viewMaxillary Occlusal view

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Mandibular Occlusal viewMandibular Occlusal view

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Right lateral viewRight lateral view

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Left lateral viewLeft lateral view

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1 restore esthetic and function

T T

1

improve his OHITreatment Treatment ObjectivesObjectives2

control caries

jj

3

66

LOGO

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office bleaching with 35% hydrogen peroxide does not significantly affect the color and luminosity of fluorotic teeth

Konsl 2007 , dental digest journal

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tooth whitening Conservative treatment options such as gpseverely improve can dramatically and microabrasion

discoloured fluorosed teeth. This can provide a satisfactory interim outcome or minimize the removal ofsatisfactory interim outcome or minimize the removal of discoloured enamel and dentine prior to the provision of veneers

Manton DJ , 2007 Australian dental journal

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A chronic endemic form of hypoplasia of the dental enamel caused by drinking water with a high e a e caused by d g ate t a gfluorine content during the time of tooth formation, and characterized by defective , ycalcification that gives a white chalky appearance to the enamel, which gradually pp , g yundergoes brown discoloration.

ReturnJablonski's Dictionary of Dentistry, 1992, p286

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