Periodontal Case Study

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
• Angles 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
Oral plaque therapy aids Appt 1 Appt 2 Appt 3 Type/Agent Method taught
Disclosing 5.1.08 GUM
Toothbrushing 5.1.08 soft Bass twice/day
Floss 5.15.08 Glide C-shape once/day
Pockets/ Probing 4.24.08
Nightguard 5.15.08 daily
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
Treatment Plan Sequence Start Date Finish Date
Appt 1
X-ray check 4.24.08 4.24.08
FMX 4.24.08 4.24.08
Assessments 4.24.08 4.24.08
DDS Exam 4.24.08 4.24.08
Appt 2
2nd check-in 5.1.08 5.1.08
PI, OHI 5.1.08 5.1.08
LR scale 5.1.08 5.1.08
21
Tx Plan Implementation (continued)
Treatment Plan Sequence Start Date Finish Date
Appt 3
UR, LL, UL scale 5.15.08 5.15.08
Selective polish 5.15.08 5.15.08
Fluoride 5.15.08 5.15.08
4-month recare
22
Pictures

• Facial

23
Pictures

• Maxillary arch lingually

24
Pictures

• Mandibular arch lingually

25
Pictures

• Abfraction on 11-12 18-20

26
Questions?