COMPREHENSIVE CASE
PRESENTATION
Sabah alanazi
ID#42920212
Level 11
Sabah alanazi #42920212
L11
1
PERSONAL DATA
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Age:39
Gender: Female
Marital Status: married
Occupation: house wife
Patient’s Attitude: Cooperative
Patient’s File Number:4856
Sabah alanazi 42920212
2
CHIEF COMPLAINT
As stated by the patient :
”I have pain in my upper right teeth (while
she pointing to the upper right Molar )
History Of Chief Complaint
the tooth was treated with a restoration 5 years ago
and befor 2month pain started
Sabah alanazi 42920212
L11
3
Medical History
The patient is free of any medical
problems.
Medication : None
History of allergic reaction : None
History of hospitalization : None
Family Medical History
No relevant medical history for
any member of the family
Sabah alanazi 42920212
L11
4
Past Dental History
• 10 years ago Multiple teeth extraction due to
caries (#24,#38#37,#36)
 5 years ago
endo treatment for tooth #11 PMF crowns on teeth #12-11 /# 21-22 ,
• two amalgam restoration #15,#27
• composite restoration #17
2 years ago Multiple teeth extraction 47,#46,#45,#44
#and
a long span bridge .
•
LAST DENTAL VISIT :
5 months ago for temporary restoration #14
Sabah al anazi 42920212 L11
5
Habits and Oral Hygiene:
• Tooth brushing : Once a day using Horizontal Technique.
• Flossing : None
• Mouth wash : None
• Visite The Dentist Regularly : None
• Habits:
clenching
Sabah alanazi 42920212
L11
6
Diet Analysis
•
High-Carbohydrate and Sugar Diet.
•
The patient consumes bread, rice, sugar, soft drinks and
sweets everyday.
Sabah alanazi
# 42920212
L11
7
Clinical Examination
Sabah alanazi
# 42920212
L11
8
1. Extra Oral Examination
• Facial Symmetry: Symmetrical.
• Lip: Competent.
• Skin: WNL*.
• Head & Neck: WNL*.
• Lymph Nodes: WNL*.
TMJ: No Clicking or Pain.
No Limitation or deviation on opening.
*Within normal limits
Sabah alanazi 42920212
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1. Extra Oral Examination
Anteroposterior Profile:
Slightly convex profile
Vertical profile:
Slight decrease In
middle Facial Height
Acute naso-labial angel
Sabah alanazi 42920212
L11
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2. Intra Oral Examination
Soft tissues
• Floor of the mouth
• Tongue
WNL*
• Palate
*Within normal limits
Sabah alanazi 42920212
L11
11
2. Intra Oral Examination
Soft tissues
• Lips
• Buccal mucosa
WNL*
*Within normal limits
Sabah alanazi 42920212
L11
12
pre-treatment
photographs
Sabah alanazi 42920212 L11
13
Frontal View
Sabah alanazi 42920212
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14
Maxillary Occlusal View
Sabah alanazi 42920212
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15
Mandibular Occlusal View
Sabah alanazi 42920212
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Right Lateral View
Sabah alanazi 42920212
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17
Left Lateral View
Sabah alanazi 42920212
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Diagnostic Tools
Sabah alanazi 42920212
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A. Radiographs
Nada Softah
43120265
L9
20
Panorama (OPG)
Sabah alanazi 42920212
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21
Full Mouth X-ray
Nada Softah
43120265
L9
22
Right Bitewings
Sabah alanazi 42920212
L11
23
Right Periapical
Sabah alanazi 42920212
L11
24
Anterior Periapical
Sabah alanazi 42920212
L11
25
Left Bitewing
Sabah alanazi 42920212
L11
26
Left Periapical
Sabah alanazi 42920212
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27
B. Mounted Diagnostic Cast
Sabah alanazi 42920212
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Frontal View
Vertical over lap
0.5 mm with
anterior crossbite
on R side
dental MidSabah
linealanazi
Mandibel
is deviated
to the R about
42920212
L11
2mm
29
Right View
Molar
Relationship
Not
applicab
Canine
Relationship
II
Sabah alanazi 42920212
L11
30
Left View
Molar
Relationship
Not
applicable
Canine
Relationship
III
Sabah alanazi 42920212
L11
31
Upper View
Sabah alanazi 42920212
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Lower View
33
C. LABORATORY
INVESTIGATION
34
Caries Risk Test (Buffer)
Medium Buffer Capacity
Sabah alanazi 42920212
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Caries Risk Test (Bacteria)
Mutans Sterptococci (M.S)
< 10^5 CFU/ml Saliva
Lactobacilli (L.B)
>10^5 CFU/ml Saliva
Sabah alanazi 42920212
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D. GINGIVAL AND ORAL HYGIENE
EXAMINATION
Sabah alanazi 42920212
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1. Gingival Index By Leo And Silness 1967:
1
1
2
1
2
1
18
17
16
15
48
47
46
45
14
1
2
1
2
1
13
12
11
21
22
23
24
25
26
27
28
43
42
41
31
32
33
34
35
36
37
38
2
1
1
2
1
1
2
1
1
1
Bleeding Score
1.5
1
1
2
Description
Moderate gingival inflammation.
Characterized by redness, edema and
bleeding on probing.
Sabah alanazi 42920212
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2. Plaque Index By Silness And Leo 1967 :
1
2
1
1
1
1
1
1
1
1
1
1
18
17
16
15
14
13
12
11
21
22
23
24
25
26
27
28
48
47
46
45
44
43
42
41
31
32
33
34
35
36
37
38
1
2
1
1
1
1
1
1
1
1
1
1
Plaque Score
Description
1.3
Moderate plaque accumulation
within the gingival pockets, or the tooth & gingival margin
which can be seen with naked eyes.
Sabah alanazi 42920212
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3. Periodontal Screening And Recording (PSR):
1*
3
1*
1
2
1*
Code1 : pocket depth <3.5, bleeding is present on probing
Code 2 : pocket depth < 3.5mm, bleeding and calculus is present.
Code 3 : pocket depth > 3.5 & < 5.5 mm
40
4. Calculus Index By Protector & Gamble 1987:
score:1
Localized Slight Calculus (In Lower Anterior Lingual
Aspect)
Sabah alanazi 42920212
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E. PERIODONTAL
CHARTING
Nada Softah
43120265
L9
42
Upper Arch Charting
B
++
+++
M-CEJ
111
211
PD
223
213
CAL
334
424
F
L
18
18
17
17
16
16
15
15
+++
111
111
PD
222
111
CAL
333
222
+++
+++
111
314
313
334
334
1
1
1
14
14
13
13
B
M-CEJ
+++
322
222
12
11
322
222
222
223
333
21
22
12
11
21
22
+++
+++
+++
+++
222
222
322
222
Sabah alanazi 42920212
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23
23
222
111
111
223
323
333
334 434
24
24
25
26
27
28
25
26
27
28
222
223
323
333
43
Lower Arch Charting
BM,M
+++
+++
++
M-CEJ
PD
122
222
222
212
222
212
212
212
322
CAL
F
L
BM,M
333
48
48
+++
47
47
46
46
45
45
44
44
43
43
42
42
41
41
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
+++
M-CEJ
PD
211
122
222
222
212
222
212
212
212
CAL
111
211
333
Sabah alanazi 42920212
L11
44
Etiologic & Risk Factors
•
•
•
•
•
Plaque
Calculus
Carious teeth
Poor oral hygiene
Faulty Crown and restoration
Sabah alanazi 42920212
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Periodontal Diagnosis & Prognosis
• Diagnosis:
Generalized Moderate chronic
periodontitis
• Overall Case Prognosis:
Good
46
Periodontal Treatment
DIAGNOSIS
PROPOSED TREATMENT
• Generalized Moderate
chronic periodontitis.
• OHI, caries & Plaque control.
• Supragingival , subgingival
Scalling and root planning
• prescribe mouth wah
• Correcting of local contributing
factors.
• Re-evaluation 4 Weeks after initial
therapy.
• Maintenance every 3 months.
Sabah alanazi 42920212
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F. Dental Charting
Nada Softah
43120265
L9
48
DENTAL CHARTING
missing
amalgam
temporary
Crown
Caries
RCT
OVER
ERUPTION
49
o
DENTAL CHARTING
missing Crown
bridge
50
Treatment plan
51
Treatment Phases
Phase I: Emergency and preventive Treatment.
Phase II : Operative Treatment.
Phase III: Endodontic Treatment.
Phase IV: Pre-Prosthodontic /Surgical Treatment.
Phase V : Prosthodontics Treatment.
Phase VI : Recall & Maintenance
Sabah alanazi 42920212
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•
•
•
•
•
eliminate chief complain
Caries control
Improve and maintain goog oral hygiene
Restore structure , function and esthetic
maintenance
53
#17
DIAGNOSIS
PULP DIAGNOSIS:
symptomatic Irreversible
PERIAPICAL DIAGNOSIS:
Normal
PROPOSED
TREATMENT
Pulp extirpation and
temporization in
emergency phase
Sabah alanazi 42920212
L11
VITALITY TEST
#17
#13
COLD (Endo
Frost -50C)
+++ve
+ve
VERTICAL
PERCUSSION
-ve
-ve
HORIZONTAL
PERCUSSION
-ve
-ve
PALPATION
-ve
-ve
54
Preventive Treatment:
• OHI and plaque control
• Nutritional counseling: reduce carbohydrate &
sugar intake.
• Brushing Technique : Modified Stilman Tech
• Advise the patient to use the night guard
Sabah alanazi 42920212
L11
55
#17
DIAGNOSIS
PROPOSED
TREATMENT
After Pulp extirpation
in
emergency phase
PULP DIAGNOSIS:
symptomatic Irreversible
PERIAPICAL DIAGNOSIS:
Normal




RCT>
Post & Core >
Crown Lengthening
Crown
Sabah alanazi 42920212
L11
VITALITY TEST
#17
#13
COLD (Endo
Frost -50C)
++ve
+ve
VERTICAL
PERCUSSION
-ve
-ve
HORIZONTAL
PERCUSSION
-ve
-ve
PALPATION
-ve
-ve
56
DIAGNOSIS
PROPOSED
TREATMENT
Edentulous area .
 1st Option: Implant
 2nd Option: FPD
 3nd Option: RPD
Sabah alanazi 42920212
L11
57
#15
DIAGNOSIS
Overhang OD amalgam
Restoration
PULP DIAGNOSIS:
asymptomatic Irreversible Pulpitis
PERIAPICAL DIAGNOSIS:
Normal
PROPOSED
TREATMENT

RCT
 Post & Core >
 Crown Lengthening
 Crown
Sabah alanazi 42920212
L11
VITALITY
TEST
#15
#13
COLD (Endo
Frost -50C)
+++
ve
+ve
VERTICAL
PERCUSSION
-ve
-ve
HORIZONTAL
PERCUSSION
-ve
-ve
PALPATION
-ve
-ve
58
#14
DIAGNOSIS
PROPOSED
TREATMENT
O-D temporary restoration  RCT
(IRM)  Post & Core >
PULP DIAGNOSIS:
 Crown Lengthening
 Crown
NECROTIC
PERIAPICAL DIAGNOSIS:
Sabah alanazi 42920212
Normal
L11
VITALITY
TEST
#14
#13
COLD (Endo
Frost -50C)
--ve
+ve
VERTICAL
PERCUSSION
-ve
-ve
HORIZONTAL
PERCUSSION
-ve
-ve
PALPATION
-ve
-ve
59
#13
DIAGNOSIS
Interproximal Caries on The
Mesial surfaces.
PROPOSED
TREATMENT
Class III Composite
Restoration
Sabah alanazi 42920212
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VITALITY
TEST
#13
#23
COLD (Endo
Frost -50C)
+ve
+ve
VERTICAL
PERCUSSION
-ve
-ve
HORIZONTAL
PERCUSSION
-ve
-ve
PALPATION
-ve
-ve
60
#12 #21#22
PROPOSED
TREATMENT
DIAGNOSIS
 faulty PFM crown
Shows greyish discoloration in
anterior region
, bleeding gum, ill fitting FPD
,metal seen in palatal side
Removal of PFM crown 
Vitality assessment 
(pulp test)
 RCT ( if required)
 Fiber post
 crown
Sabah alanazi 42920212
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#11
PROPOSED
TREATMENT
DIAGNOSIS
 faulty PFM crown
 Substandard
RCT
PULP
DIAGNOSIS:
Previously treated pulp
PERIAPICAL DIAGNOSIS:
VITALITY
TEST
#11
#13
VERTICAL
PERCUSSION
+ve
-ve
PALPATION
-ve
-ve
Removal of PFM crown 
 retreatment RCT
 Fiber post
 crown
symptomatic apical periodontitis
Sabah alanazi 42920212
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#23
DIAGNOSIS
PROPOSED
TREATMENT
. Interproximal Caries on
The Mesial surfaces
Class III Composite
Restoration
Sabah alanazi 42920212
L11
VITALITY
TEST
#23
#25
COLD (Endo
Frost -50C)
+ve
+ve
VERTICAL
PERCUSSION
-ve
-ve
HORIZONTAL
PERCUSSION
-ve
-ve
PALPATION
-ve
-ve
63
DIAGNOSIS
Edentulous area
PROPOSED TREATMENT




After adjunctive ortho
1st Option: Implant
2nd Option: FPD
3nd Option: RPD
Sabah alanazi 42920212
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64
#25
DIAGNOSIS
Deep groove
PROPOSED
TREATMENT
fissur Sealant 
Sabah alanazi 42920212
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#26
DIAGNOSIS
PROPOSED TREATMENT
OD Caries with palatal
extension
Class II Composite Restoration ,
(If we will do intrusion).
And Over Eruption
 Elective Root Canal
Treatment.
Sabah alanazi 42920212
L11
66
#27
DIAGNOSIS
Overhang OM amalgam
Restoration
PROPOSED
TREATMENT
Class II Composite
Restoration
Sabah alanazi 42920212
L11
VITALITY
TEST
#27
#23
COLD (Endo
Frost -50C)
+ve
+ve
VERTICAL
PERCUSSION
-ve
-ve
HORIZONTAL
PERCUSSION
-ve
-ve
PALPATION
-ve
-ve
67
#28
DIAGNOSIS
PROPOSED
TREATMENT
Occlusal Caries
Extraction
Sabah alanazi 42920212
L11
68
DIAGNOSIS
Edentulous area
PROPOSED
TREATMENT
1st Option: Implant
(After Bone
Augmentation )
 2nd Option: RPD
Sabah alanazi 42920212
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69
#35#34
DIAGNOSIS
#35:Deep groove
#34Deep groove and Incipient
Caries on D
PROPOSED TREATMENT
 fissur Sealant
 fissur Sealant and
Fluoride application &
Follow Up
Sabah alanazi 42920212
L11
70
#33#32#31#41#42
DIAGNOSIS
Sound teeth with incisal
attrition
PROPOSED
TREATMENT
Fluoride application &
Follow Up
Night gard
Sabah alanazi 42920212
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71
#43
DIAGNOSIS
Faulty long-span PFM
bridge
PROPOSED
TREATMENT
 Removal of PFM
bridge
 Vitality assessment
(pulp test)
 RCT ( if required)
 Fiber post
 crown
Sabah alanazi 42920212
L11
72
DIAGNOSIS
Faulty long-span PFM
bridge
PROPOSED
TREATMENT
After Removal of PFM
bridge
 1st Option: Implant
 2nd Option: RPD
Sabah alanazi 42920212
L11
73
#48
DIAGNOSIS
Faulty long-span PFM
bridge
PROPOSED
TREATMENT
 Removal of PFM
bridge
 Vitality assessment
(pulp test)
 RCT ( if required)
 Post & Core
 crown
Sabah alanazi 42920212
L11
74
75
76
3nd Option
77
Phase VI
Recall & Maintenance
78
Recall Patient every 3months :
To do periodontal maintenance.
Recall Patient every 6 months
 Stress on oral hygiene.
 To take full mouth X-ray & check on restorations & crowns.
Recall Patient every 1 year :
 To check on Implants.
79
THANK YOU!
80