Case PresentationJoint Seminar Series

Prosthodontics – Periodontics - Oral Radiology

Oct. 4th, 2010

Babak Shokati

Gender Male

Age 58 years old

Occupation Small Business owner

Chart # 067751

General Information

Chief Complaint

“I want my lower teeth fixed possibly with implant ”

Social History

Marital Status Married

History of Smoking Quit smoking 1 year ago

Alcohol Consumption Socially

Dental Literacy Average

Financial Status Able to Afford Tx.

Medical History

Medication None

Allergy History Negative

Systemic Disease Negative

Overall Health Good

Extra/O Examinations

Full Face Frontal:Symmetrical

Extra/O Examinations

Right Left

Extra/O Examinations

Lips (Rest) Lips (Smile)

Intra/O Examinations

Present Prosthesis

Maxillary IS-Fixed Complete Denture (1995) No Complication

Periodontal(Excluding

Mandibular Incisors)

Chronic Periodontitis Generalized Moderate/Severe Loss of Attachment (≈ 50%) Tooth Mobility (M1) Probing Depth: 2-3 mm, No Bleeding Furcation Involvement (Degree II)

Missing Teeth Due to Periodontal Disease

Oral Hygiene Currently: Fair

Intra/O Examinations

Labial Mucosa – NSF

Buccal Mucosa – NSF

Tongue – NSF

Hard palate – NSF

Soft palate – NSF

Floor of the Mouth – NSF

Saliva – WNL, Viscous

Intra/O Examinations

Front View

Intra/O Examinations

Mandibular Teeth Front View Periodontal Splint (43,42,41,31,32,33)

Radiographic Findings

Radiographic Findings

2009

2008

Right

Intra/O Examinations

Maximum IntercuspalPosition (MIP)

LateralExcursion

Intra/O Examinations

Left

Maximum IntercuspalPosition (MIP)

LateralExcursion

Remaining Bone support Less then adequate,

Tooth mobility (grade I)

Controlling etiologic factors Genetic / Maintenance

Furcation involvement Grade II

Systemic/environmental factors Quitting smoking no systemic disease

Patient cooperation ???

Risk Factors

• Kao RT. Journal of Periodontol ogy. 2008;79:971-7.

Mordohai N, et al., British Dental Journal. 2007; 202:63-72.

- Are Implants more reliable* when compared to teeth with questionable periodontal prognosis? Under which conditions?

Debate

Treating/maintaining questionable teeth or

replacing them with dental prostheses (implant or conventional)

Decision Making:

- Does the overall Prosthodontic treatment plan - in part - determine whether or not questionable teeth are maintained?

Debate

Decision Making:

Clinical Scenario

Is it Justified extracting a tooth with a relatively good prognosis, but

requiring several pre-treatment procedures IF: the adjacent teeth require restorations (lower risks and costs)

Treatment Planning

-- Exo.: 42, 41, 31, 32 and temporary denture -- Composite Restoration: 43, 44, (possibly 35) -- Exo.: 36 -- IS-Fixed Bridge (42-x-x-32) -- IS-Crown 36 -- Alternatives for 46 Either keeping or IS-crown

Treatment