1. a) Chief Complaints:. Patient complains that during orthodontic treatment his gums in the lower anterior region have receded,causing him discomfort during brushing
b) Other periodontal complaints: patient also complains of sensitivity to hot and cold foods in the lower anterior region since last 6 months
2. Systemic History: No relevant medical history
3. Family History: No relevant family history
4. Past dental experience: Patient is currently undergoing orthodontic treatment since last one year
5. Oral hygiene habits: Patient uses toothpaste and brush to clean his teeth twice a day using horizontal scrub manner since childhood. Patient also cleans his tongue everyday.
6. Tissue Abuse/Harmful habits:
7. Dietary enquiry: Patient has vegetarian diet. Patient has a habit of intermittent snacks between meals
8. General examination:
9. Extraoral examination:
- Symmetry of face: Bilaterally symmetrical face
- Lymph nodes: non tender
- TMJ: normal
10. Intraoral examination:
a) General oral hygiene status: Good
b) Examination of gingiva:
- Color: Pink with pigmentation in the maxillary anteriors and reddish pink in the mandibular anteriors. Reddish pink in posteriors.
- Contour: Normal scalloping in all except in 31 where there is deep scalloping
- Consistency: Firm and Resilient with Knife edged margins except in 31
- Surface texture: stippling present
- Size: Normal except in 31 where it is reduced in horizontal dimension.
- Position: At CEJ except in 31 where it is 8 mm below CEJ
- Bleeding: Bleeding on probing in 31
- Suppuration: Absent
c) Width of attached gingiva:
Inadequate in Mandibular anterior region
d) Tension test: Positive in mandibular anterior region
e) Other clinical features (if any): Nil
f) Examination of teeth:
1.Teeth present: 11-17; 21-27, 31-37; 41-47.
2. Alignment: Proclined 31
3. Grades of mobility: ( patient undergoing orthodontic treatment)
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4. Loss of tooth structure: - Nil
5. Restored teeth: - 15,36,46
6. Carious teeth: - none
7. Migration/Drifting: Nil
8. Prosthodontic/Orthodontic treatment (if any): - Undergoing orthodontic treatment
9. Faulty restoration: - Nil
10. Furcation involvement: - Nil
11. Proximal contacts: Tight contacts
12. Food impaction:Nil
13. Dental plaque: Generalized
14. Calculus: Supragingival calculus present
15. Material alba: Present
16. Occlusion: Absence of facets
17. Hypersensitivity: - Hypersensitivity to cold in lower anteriors.
18. Discoloration: - Extrinsic staining present in anteriors
19. Pocket depth (in mm):
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8 |
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20. Total attachment loss (in mm):
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8 |
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11. Etiological factors:
Systemic:
Local: Plaque, calculus, materia alba.,orthodontic brackets,frenal pull
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12. Investigation required: Blood hemogram including blood hemoglobin, Differential Leukocyte Count, Total Leukocyte Count, Bleeding time, Clotting time and Random blood sugar level.
Intraoral periapical radiographs required of :1) 31,32,41,42
13. Radiographic findings:
- Interdental septum 1 mm below CEJ in 31 and 32
- Intact lamina dura in 31,32,41,42
14. Provisional diagnosis:
Chronic generalized plaque induced gingivitis
15. Prognosis:
- Overall:Good
- Individual: Good
- Treatment plan:
- Emergency treatment: - Nil
- Planned treatment:
ETIOTROPIC PHASE (Phase I therapy):
- Diet counseling
- Removal of local irritants (plaque and calculus)
- Root planing
- Minor orthodontic movement for lingual displacement of root of 31
- Advise orthodontic toothbrush and demonstrate bass brushing technique
EVALUATION OF RESPONSE TO PHASE I:
Plaque and calculus
SURGICAL PHASE (Phase II therapy):Free gingival graft for root coverage of 31 along with the purpose of increasing the width of attached gingiva.
RESTORATIVE PHASE (Phase III therapy): _
MAINTENANCE PHASE (Phase IV therapy):
Rechecking:
Plaque and calculus
- Restoration
- Root coverage
- Patient education and motivation using A-V aids, demonstrations and positive reinforcement.
- Plaque control measures including brushing technique and interdental cleaning aids (interdental bottle brush).
- Follow up visit after 1 week, 1 month and 3 months.
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