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 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

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

Clinical Findings

E&I
Periodontal Exam

Calculus
Radiographic Exam

ADA and AAP Classification

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

E&I

Free gingiva

Periodontal Exam

generalized

Attached gingiva
generalized

coral pink with localized cyanotic gingiva between 6 and 7 due to P crown on 7, generalized scalloped, generalized firm, generalized smooth coral pink, generalized firmly bound down to underlying bone, generalized

Adequate salivary flow Skeletal classification: mesognathic Angles classification: class I bilateral molar relation with crowding in the mandibular anteriors Maximum opening: 44 mm

stippled

MBI: 0%, BOP: 8.3% Probing depths range

Periodontal Exam (continued)

mms with localized 4 mms 30D & 31M

Recession
2

1-3

Clinical Attachment Loss

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 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

Periodontal Exam and Calculus

Abfraction: 2-4, 11-12, 18-20

Attrition: 22-27 RCC calculus code: light

1, 16, 17, 32 extracted Restorations

Radiographic Exam

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

Radiographic Exam (continued)

Critique of angulation
Because

the vertical angulation is off in the PAs, I would use the BWX for the periodontal interpretation. throughout

Trabecular pattern
Consistent

Lamina dura
Present Blunted

and consistent throughout, becoming fuzzy

Alveolar crest
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 4M, 5D, 6MD, 14M, 18M, 19D, 20D, 21D, 24M, 26D

PDL space
3D,

Radiographic Exam (continued)

Furcation - interradicular radiolucency

19

noted noted radiopaque or radiolucent lesions noted

Calculus
7M

General osseous interpretation

No

 Vertical

Can see the occlusal plane in all the posterior PAs

Maxillary

angulation

Critique of Radiographs

Horizontal

The maxillary premolar PAs should have been placed more parallel to the arch. The following films should have been adjusted to see interproximally.
Slightly:

of PID Maxillary left premolar PA and mandibular posterior PAs need to decrease angle of PID

right posterior PAs and maxillary left molar PA need to increase angle

angulation

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

ADA and AAP Classification

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

Dental Health Education

Oral plaque therapy aids
Disclosing Toothbrushing Floss

Appt 1

Appt 2
5.1.08 5.1.08

Appt 3

Type/Age nt
GUM soft

Method taught

Bass: twice/day C-shape: once/day

5.15.08

Glide

Pockets/ Probing Nightguard

4.24.08
5.15.08 daily

Medical history/systemic health

Birth

Rationale for Case Selection

control mechanical forces

Systemic & oral risk factors

Grinding, Perio:

Dental hygiene diagnosis

uncontrolled Caries: controlled OHI: adequate Influencing cultural & social factors: young with stress as a graduate student

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

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

Goals

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

Treatment (Tx) Plan & Implementation

Treatment Plan Sequence
Appt 1
X-ray check 4.24.08 4.24.08

Start Date

Finish Date
4.24.08 4.24.08 4.24.08
5.1.08 5.1.08 5.1.08

FMX Assessments DDS Exam

4.24.08 4.24.08 4.24.08

5.1.08 5.1.08 5.1.08

Appt 2
2nd check-in PI, OHI LR scale

Tx Plan & Implementation (continued)

Treatment Plan Sequence
Appt 3 UR, LL, UL scale Selective polish Fluoride 4-month recare 5.15.08 5.15.08 5.15.08 5.15.08 5.15.08 5.15.08

Start Date

Finish Date

Pictures

Facial

Pictures

Maxillary arch lingually

Mandibular arch lingually

Pictures

Abfraction on 11-12 & 18-20

Pictures

Questions?