Periodontal prognosis and prosthetic treatment planing
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Case Presentation Joint Seminar Series Prosthodontics – Periodontics - Oral Radiology Oct. 4 th , 2010 Babak Shokati
Transcript of Periodontal prognosis and prosthetic treatment planing
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
