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Periodontal Case Study

Periodontal Case Study. Reina Ligeralde DEH 23 5.30.08. Patient Profile and Chief Complaint. Name: Abby Fraction Age: 27 Ethnicity: Asian Occupation: graduate student Chief complaint: teeth cleaning. Medical History. Childhood vaccinations in 1981

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Periodontal Case Study

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  1. Periodontal Case Study Reina Ligeralde DEH 23 5.30.08

  2. Patient Profile and Chief Complaint • Name: Abby Fraction • Age: 27 • Ethnicity: Asian • Occupation: graduate student • Chief complaint: teeth cleaning

  3. Medical History • Childhood vaccinations in 1981 • Completed hepatitis B vaccination series in 1997 • Menstruates regularly, every 30 days • Paternal grandfather had liver cancer and type II diabetes mellitus • Practices birth control: Ortho Tri-Cyclen Lo • Takes a multivitamin daily • BP: 110/65, P: 73, R: 16 • ASA II

  4. Dental History • Four 3rd molars extracted 3/00 • Porcelain crown on 7 in 2006 • Last dental exam and teeth cleaning: 9/07 • Last dental x-rays: FMX at RCC 4/08

  5. Clinical Findings • E & I • Periodontal Exam • Calculus • Radiographic Exam • ADA and AAP Classification

  6. E & I • Bilateral 3 mm X 2 mm nevi on auricles • Bilateral palpable submandibular nodes • Left side of TMJ clicking • Bilateral mandibular tori • Torus palatinus • Bilateral linea alba • Erythemic papilla on the anterior portion of the dorsal surface of the tongue

  7. Periodontal Exam • Free gingiva • generalized coral pink with localized cyanotic gingiva between 6 and 7 due to P crown on 7, generalized scalloped, generalized firm, generalized smooth • Attached gingiva • generalized coral pink, generalized firmly bound down to underlying bone, generalized stippled • Adequate salivary flow • Skeletal classification: mesognathic • Angle’s classification: class I bilateral molar relation with crowding in the mandibular anteriors • Maximum opening: 44 mm

  8. Periodontal Exam (continued) • MBI: 0%, BOP: 8.3% • Probing depths range • 1-3 mms with localized 4 mms 30D & 31M • Recession • 2 mm 2B, 3B; 1 mm 4B, 5B; 1 mm 10F, 11F; 2 mm 12B; 1 mm 14B; 1 mm 15L, 14L; 1 mm 3L; 2 mm 2L; 3 mm 31B, 30B; 1 mm 29B, 28B; 3 mm 27F; 3 mm 22F, 21B, 20B, 19B, 18B; 1 mm lingual surfaces of 18, 22, 24-26, 28-31 • Clinical Attachment Loss • 2 mm 2B; 1 mm 3B; 1 mm 12B; 1 mm 15L; 1 mm 3L; 2 mm 2L; 3 mm 31B, 30B; 1 mm 29B, 28B; 2 mm 27F; 2 mm 22F, 21B, 20B; 3 mm 19B, 18B; 1 mm 18L, 31L • Mobility: + on 5, 7-10, 20-27 • Fremitus: + on 8-10, 12 • Furcation: none noted

  9. Periodontal Exam and Calculus • Abfraction: 2-4, 11-12, 18-20 • Attrition: 22-27 • RCC calculus code: light

  10. Radiographic Exam • 1, 16, 17, 32 extracted • Restorations • 7 has a P crown, 8 & 9 have facial composites, margins intact • Tooth findings • Possible decay: none noted • No radiolucencies around the apices of teeth noted • No internal or external root resorption noted • No dilacerations noted • Atypical tooth findings: 24-26 attrition

  11. Radiographic Exam (continued) • Critique of angulation • Because the vertical angulation is off in the PAs, I would use the BWX for the periodontal interpretation. • Trabecular pattern • Consistent throughout • Lamina dura • Present and consistent throughout, becoming fuzzy • Alveolar crest • Blunted in the posterior teeth and sharp in the anterior teeth, greater than 1.5-2 mm apical to the CEJ, 1 mm bone loss at 3M, 12M, 13M, 15M, 20M, 21M, 28M, 29M, 30M • PDL space • 3D, 4M, 5D, 6MD, 14M, 18M, 19D, 20D, 21D, 24M, 26D

  12. Radiographic Exam (continued) • Furcation - interradicular radiolucency • 19 noted • Calculus • 7M noted • General osseous interpretation • No radiopaque or radiolucent lesions noted

  13. Critique of Radiographs • Vertical angulation • Can see the occlusal plane in all the posterior PAs • Maxillary right posterior PAs and maxillary left molar PA need to increase angle of PID • Maxillary left premolar PA and mandibular posterior PAs need to decrease angle of PID • The maxillary premolar PAs should have been placed more parallel to the arch. • Horizontal angulation • The following films should have been adjusted to see interproximally. • Slightly: mandibular right molar PA and mandibular left posterior PAs • Severely: premolar BWXs, anterior PAs, maxillary right posterior PAs, maxillary left premolar PA, and mandibular right premolar PA

  14. ADA and AAP Classification • ADA II • AAP: generalized slight chronic periodontitis due to mechanical forces modified by plaque and calculus

  15. Dental Health Education

  16. Rationale for Case Selection • Medical history/systemic health • Birth control • Systemic & oral risk factors • Grinding, mechanical forces • Dental hygiene diagnosis • Perio: uncontrolled • Caries: controlled • OHI: adequate • Influencing cultural & social factors: young with stress as a graduate student

  17. Rationale for Case Selection (continued) • Oral health education/strategies • Soft brush with Bass method • Floss • ACT mouth rinse with fluoride • Nightguard • Reevaluations • 19 buccal due to decay • Abfraction areas: 2-4, 11-12, 18-20

  18. Rationale for Case Selection (continued) • Referrals • 19 buccal due to decay • Abfraction areas: 2-4, 11-12, 18-20 for possible restorations • Nightguard • Recall: interval: 4 months • Rationale: check referrals and bone levels

  19. Goals • Maintain good oral homecare and bone levels • Maintain MBI & BOP to less than 10% • Reduce PI each appointment

  20. Treatment (Tx) Plan & Implementation

  21. Tx Plan & Implementation (continued)

  22. Pictures • Facial

  23. Pictures • Maxillary arch lingually

  24. Pictures • Mandibular arch lingually

  25. Pictures • Abfraction on 11-12 & 18-20

  26. Questions?

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