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: Patientuses 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:
Normal gait
Afebrile
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: Pinkwith 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 exceptin 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)
Minor orthodontic movement for lingual displacement of root of 31
Advise orthodontic toothbrush and demonstrate bass brushing technique
EVALUATION OF RESPONSE TO PHASE I:
Gingival inflammation
Plaque and calculus
Pocket depth
Restoration
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:
Gingival inflammation
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.
Case Studies 2
1. a) Chief Complaints: Patient complains of fractured teeth in the maxillary anterior region due to accidental trauma before 6 months. Patients wants to get his teeth restored. b) Other periodontal complaints: Patient complains of occasional bleeding from gums last 1 year. Bleeding from gums occurs while brushing and also when he wakes up in the morning.
2. Systemic History: Nil
3. Family History: No relevant family history
4. Past dental experience: - Patient had visited a dentist for opinion after accident, but did not undergo any treatment.
5. Oral hygiene habits: Patient brushes his teeth using toothbrush and toothpaste once a day, using horizontal scrub method, since childhood.
6. Tissue Abuse/Harmful habits: No such habits present.
7. Dietary enquiry: Adequate diet. Habit of intermittent snacking between meals
8. General examination:
Normal gait
Afebrile
9. Extraoral examination:
Symmetry of face: Bilaterally symmetrical face
Lymph nodes: non tender
TMJ: normal
10. Intraoral examination:
a) General oral hygiene status: Fair
b) Examination of gingiva:
Color: Pink with pigmentation
Contour: Scalloped with knife edged margins
Consistency: Firm and resilient
Surface texture: Stippling present
Size: Normal
Position: At CEJ
Bleeding: bleeding on probing generalized
Suppuration: absent
c) Width of attached gingiva:
Adequate
d) Tension test: Negative
e) Other clinical features (if any):
f) Examination of teeth:
1.Teeth present: 11-17; 21-27; 31-37; 41-47.
2. Alignment: Well-aligned teeth
3. Grades of mobility:
7
6
5
4
3
2
1
1
2
3
4
5
6
7
4. Loss of tooth structure: - HorizontalCoronal Fracture of 11,21 involving enamel, dentine and pulp at cervical third of crown
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 : 11,21 region
13. Radiographic findings: Bone level at CEJ or just apical to CEJ in 11,21 region
SURGICAL PHASE (Phase II therapy):
Crown lengthening in 11,21 region with apically displaced flap and osseus recontouring using osteoplasty and ostectomy
RESTORATIVE PHASE (Phase III therapy): _
Post and core in 11,21 followed by porcelain fused to metal crowns
MAINTENANCE PHASE (Phase IV therapy): Rechecking:
Gingival inflammation
Plaque and calculus
Pocket depth
Margins of crowns
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.
Case Studies 3
1. a) Chief Complaints: Patient complains of fractured teeth in the maxillary anterior region due to accidental trauma before 6 months. Patients wants to get his teeth restored. b) Other periodontal complaints: Patient complains of occasional bleeding from gums last 1 year. Bleeding from gums occurs while brushing and also when he wakes up in the morning.
2. Systemic History: Nil
3. Family History: No relevant family history
4. Past dental experience: - Patient had visited a dentist for opinion after accident, but did not undergo any treatment.
5. Oral hygiene habits: Patient brushes his teeth using toothbrush and toothpaste once a day, using horizontal scrub method, since childhood.
6. Tissue Abuse/Harmful habits: No such habits present.
7. Dietary enquiry: Adequate diet. Habit of intermittent snacking between meals
8. General examination:
Normal gait
Afebrile
9. Extraoral examination:
Symmetry of face: Bilaterally symmetrical face
Lymph nodes: non tender
TMJ: normal
10. Intraoral examination:
a) General oral hygiene status: Fair
b) Examination of gingiva:
Color: Pink with pigmentation
Contour: Scalloped with knife edged margins
Consistency: Firm and resilient
Surface texture: Stippling present
Size: Normal
Position: At CEJ
Bleeding: bleeding on probing generalized
Suppuration: absent
c) Width of attached gingiva:
Adequate
d) Tension test: Negative
e) Other clinical features (if any):
f) Examination of teeth:
1.Teeth present: 11-17; 21-27; 31-37; 41-47.
2. Alignment: Well-aligned teeth
3. Grades of mobility:
7
6
5
4
3
2
1
1
2
3
4
5
6
7
4. Loss of tooth structure: - HorizontalCoronal Fracture of 11,21 involving enamel, dentine and pulp at cervical third of crown
12. Investigation required: Blood hemogram including blood hemoglobin, Differential Leukocyte Count, Total Leukocyte Count, Bleeding time, Clotting time and blood sugar level.
Intraoral Periapical Radiographs required of : 11,21 region
13. Radiographic findings: Bone level at CEJ or just apical to CEJ in 11,21 region
SURGICAL PHASE (Phase II therapy):
Crown lengthening in 11,21 region with apically displaced flap and osseus recontouring using osteoplasty and ostectomy
RESTORATIVE PHASE (Phase III therapy): _
Post and core in 11,21 followed by porcelain fused to metal crowns
MAINTENANCE PHASE (Phase IV therapy): Rechecking:
Gingival inflammation
Plaque and calculus
Pocket depth
Margins of crowns
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.
Case Studies 4
1. a) Chief Complaints: Patient complains of enlarged gingiva in the lower anterior region since last 3 months. Patient is taking medicine (Amlodipine) for hypertension and the enlargement has started increasing since he has started the medicine since 3 months
b) Other periodontal complaints: Patient complains of occasional bleeding from gums and malodor since last 6 months. Bleeding from gums occurs while brushing and also when he wakes up in the morning. Patient also complains of discomfort while eating due to the enlargement in the lower anterior region.
2. Systemic History: Hypertensive and undergoing medical treatment since last 3 years. Patient is on amlodipine since last 6 months. 3. Family History: No relevant family history
4. Past dental experience: - Patient undergoes scaling of teeth every 3 years since last 10 years.
5. Oral hygiene habits: Patient brushes his teeth using toothbrush and toothpaste once a day, using horizontal and vertical scrub method, since childhood. Patient also cleans his tongue everyday.
6. Tissue Abuse/Harmful habits: No such habits present.
7. Dietary enquiry: Adequate diet. Habit of intermittent snacking between meals
8. General examination:
Normal gait
Afebrile
9. Extraoral examination:
Symmetry of face: Bilaterally symmetrical face
Lymph nodes: non tender
TMJ: normal
10. Intraoral examination:
a) General oral hygiene status: Fair
b) Examination of gingiva:
Color: reddish pinkwith pigmentation
Contour: accentuated scalloping in all
Consistency: Soft and edematous with rolled margins in mandibular anteriors
Surface texture: Stippling present in maxillary arch
Size: Enlarged in horizontal and vertical dimensions in mandibular anterior regions
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 : 34-44 region
13. Radiographic findings: Bone level at CEJ or just apical to CEJ in all teeth
14. Provisional diagnosis: Chronic generalized plaque induced gingivitis along with localized drug associated gingival enlargement
15. Prognosis:
Overall: Good
Individual: Good
Treatment plan:
Emergency treatment: -
Planned treatment:
ETIOTROPIC PHASE (Phase I therapy):
Diet counseling
Removal of local irritants (plaque and calculus)
Root planing
Consultation with patient’s physician for replacement of amlodipine with another group of anti-hypertensive drug
EVALUATION OF RESPONSE TO PHASE I:
Gingival inflammation
Plaque and calculus
Gingival enlargement
SURGICAL PHASE (Phase II therapy):
Gingivectomy, if required after 3 months in regions where enlargement persists after nonsurgical therapy and replacement of drug.
RESTORATIVE PHASE (Phase III therapy): _
Nil
MAINTENANCE PHASE (Phase IV therapy): Rechecking:
Gingival inflammation
Plaque and calculus
Pocket depth
Gingival enlargement
Mobility
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 till completion of orthodontic treatment.
Case Studies 5
1. a) Chief Complaints: Patient complains of enlarged gingiva in the lower anterior region since last 3 months. Patient is taking medicine (Amlodipine) for hypertension and the enlargement has started increasing since he has started the medicine since 3 months
b) Other periodontal complaints: Patient complains of occasional bleeding from gums and malodor since last 6 months. Bleeding from gums occurs while brushing and also when he wakes up in the morning. Patient also complains of discomfort while eating due to the enlargement in the lower anterior region.
2. Systemic History: Hypertensive and undergoing medical treatment since last 3 years. Patient is on amlodipine since last 6 months. 3. Family History: No relevant family history
4. Past dental experience: - Patient undergoes scaling of teeth every 3 years since last 10 years.
5. Oral hygiene habits: Patient brushes his teeth using toothbrush and toothpaste once a day, using horizontal and vertical scrub method, since childhood. Patient also cleans his tongue everyday.
6. Tissue Abuse/Harmful habits: No such habits present.
7. Dietary enquiry: Adequate diet. Habit of intermittent snacking between meals
8. General examination:
Normal gait
Afebrile
9. Extraoral examination:
Symmetry of face: Bilaterally symmetrical face
Lymph nodes: non tender
TMJ: normal
10. Intraoral examination:
a) General oral hygiene status: Fair
b) Examination of gingiva:
Color: reddish pinkwith pigmentation
Contour: accentuated scalloping in all
Consistency: Soft and edematous with rolled margins in mandibular anteriors
Surface texture: Stippling present in maxillary arch
Size: Enlarged in horizontal and vertical dimensions in mandibular anterior regions
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 : 34-44 region
13. Radiographic findings: Bone level at CEJ or just apical to CEJ in all teeth
14. Provisional diagnosis: Chronic generalized plaque induced gingivitis along with localized drug associated gingival enlargement
15. Prognosis:
Overall: Good
Individual: Good
Treatment plan:
Emergency treatment: -
Planned treatment:
ETIOTROPIC PHASE (Phase I therapy):
Diet counseling
Removal of local irritants (plaque and calculus)
Root planing
Consultation with patient’s physician for replacement of amlodipine with another group of anti-hypertensive drug
EVALUATION OF RESPONSE TO PHASE I:
Gingival inflammation
Plaque and calculus
Gingival enlargement
SURGICAL PHASE (Phase II therapy):
Gingivectomy, if required after 3 months in regions where enlargement persists after nonsurgical therapy and replacement of drug.
RESTORATIVE PHASE (Phase III therapy): _
Nil
MAINTENANCE PHASE (Phase IV therapy): Rechecking:
Gingival inflammation
Plaque and calculus
Pocket depth
Gingival enlargement
Mobility
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 till completion of orthodontic treatment.
Case Studies 6
a) Chief Complaints: Patient complains of bleeding gums in the morning, since last 4-5 years. Gums bleed when patient gets up in the morning, and also when patient brushes her teeth.
b) Other periodontal complaints:
Patient also complains of bad breath from her mouth when she wakes up since last 1 year
Patient also complains of mobility in lower anterior teeth since the past 1 year.
2. Systemic History: No relevant medical history 3. Family History: No relevant family history
4. Past dental experience: - First dental visit
5. Oral hygiene habits: Patientuses toothpaste and brush to clean her teeth once in a day using horizontal scrub manner since childhood. Patient also cleans her tongue everyday.
6. Tissue Abuse/Harmful habits: No such habits present.
7. Dietary enquiry: Adequate diet
8. General examination:
Normal gait
Afebrile
9. Extraoral examination:
Symmetry of face: Bilaterally symmetrical face
Lymph nodes: non tender
TMJ: normal
10. Intraoral examination:
a) General oral hygiene status: Poor
b) Examination of gingiva:
Color: reddish pinkexcept in lower anteriors, where it is bluish pink
Contour: normal scalloping in all except in 31-33 and 41-43 where there is deep scalloping
Consistency: Soft and edematous with rolled margins
Surface texture: stippling absent
Size: normal
Position: at CEJ except in 31 and 41 where it is apical to CEJ.
11. Proximal contacts: Overlapping proximal contacts in mandibular anterior
region
12. Food impaction: Present in maxillary posterior region
13. Dental plaque: Generalized
14. Calculus: Supra and Subgingival calculus present
15. Material alba: Present
16. Occlusion: Deep bite present.
17. Hypersensitivity: - In lower anterior region
18. Discoloration: -
19. Pocket depth (in mm):
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
20. Total attachment loss (in mm):
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
11. Etiological factors:
Systemic: -
Local: Plaque, calculus, materia alba.
12. Investigation required: Blood hemogram including blood hemoglobin, Differential Leukocyte Count, Total Leukocyte Count, Bleeding time, Clotting time and Random blood sugar level.
Full mouth Intraoral periapical radiographs required.
13. Radiographic findings:
Crestal bone loss seen in interdental region between 47, 48.
Horizontal Bone defect upto junction of cervical and middle third of root in relation to 32, 41, 42, 13-23
Angular bone defect seen in 31 upto the apex with widening of the Pdl space and break in the lamina dura
14. Provisional diagnosis:
Chronic generalized plaque induced gingivitis with localized chronic periodontitis in 31, 32, 41, 42, 47, 48 region
15. Prognosis:
Overall: Good
Individual: Poor for 31
Fair for 32, 33, 41,42,43
Treatment plan:
Emergency treatment: -
Planned treatment:
ETIOTROPIC PHASE (Phase I therapy):
Extraction of 31
Diet counseling
Removal of local irritants (plaque and calculus)
Root planing
Correction of restorative and prosthetic irritational factors
Occlusal therapy
Provisional splinting in lower anterior teeth
EVALUATION OF RESPONSE TO PHASE I:
Gingival inflammation
Plaque and calculus
Pocket depth
Occlusion
Restoration
Mobility
SURGICAL PHASE (Phase II therapy):
If the pockets persist after 3 weeks of phase I therapy, flap surgery carried out in maxillary and mandibular anterior region and mandibular right posterior region.
RESTORATIVE PHASE (Phase III therapy): Replacement of missing teeth 31
MAINTENANCE PHASE (Phase IV therapy): Rechecking:
Gingival inflammation
Plaque and calculus
Pocket depth
Restoration
Mobility
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.
Case Studies 7
1. a) Chief Complaints: Patient complains of swelling of gums and pain in upper left posterior region.
Swelling since last 8 days
Pain since last 2 days. Pain is dull in nature and occurs duiring mastication and at night
b) Other periodontal complaints: Patient also complains of mobility in lower anterior teeth since the past 5 – 6 months.
2. Systemic History: Patient is diabetic and takes medication for the same.
3. Family History: No relevant family history
4. Past dental experience: - Patient visited a dentist before 2 years after he met with an accident, which resulted in fracture of upper incisors.
5. Oral hygiene habits: Patient uses colgate powder and tooth brush to clean teeth twice a day using horizontal scrub manner since childhood. Patient does not clean his tongue.
6. Tissue Abuse/Harmful habits: Patient chews gutkha 5-6 times a day since last 15 years.
7. Dietary enquiry: Adequate non vegetarian diet
8. General examination:
Normal gait
Afebrile
9. Extraoral examination:
Symmetry of face: Bilaterally symmetrical face
Lymph nodes: non tender
TMJ: normal
10. Intraoral examination:
a) General oral hygiene status: Poor
b) Examination of gingiva:
Color: reddish except in lower posteriors where it is pale pink.
Contour: deep scalloping in all
Consistency: Soft and edematous with rolled margins
Surface texture: stipplings absent
Size: enlarged in horizontal dimension. Gingival enlargement in 24
Position: at CEJ except in 24, where it is 1 mm below CEJ
2. Alignment: Malalignment of lower anterior teeth.
3. Grades of mobility:
I
II
II
II
I
II
II
I
7
6
5
4
3
2
1
1
2
3
4
5
6
7
I
I
I
I
II
II
II
II
II
II
II
4. Loss of tooth structure: -
5. Restored teeth: - 6. Carious teeth: -
7. Migration/Drifting: Mesial Drifting of 44 and 45 8. Prosthodontic/Orthodontic treatment (if any): -
9. Faulty restoration: -
10. Furcation involvement: - Grade II furcation involvement in 26, 27
Grade I furcation involvement in 16, 36,46,47
11. Proximal contacts: Open contacts in lower anterior teeth and tight contacts in upper posterior teeth
12. Food impaction: In upper posterior teeth
13. Dental plaque: Generalized
14. Calculus: Supra and Subgingival calculus present
15. Material alba: Present
16. Occlusion: Absence of facets
17. Hypersensitivity: - hypersensitivity in lower anteriors
18. Discoloration: -
19. Pocket depth (in mm):
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
20. Total attachment loss (in mm):
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
11. Etiological factors:
Systemic: -
Local: Plaque, calculus, materia alba.
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 of
24, 25, 26
14, 15, 16
31, 32, 33, 41, 42, 43
35, 37, 38
13. Radiographic findings: Bone loss upto middle third of root in relation to 35. Bone loss upto junction of cervical and middle third of root in relation to 15,37,38. Incipient bone loss in furcation of 37. Vertical bone loss in relation to 16, 24, 25. Horizontal bone loss upto apical third in 31, 32, 33, 34, 35, 41, 42.
Individual: Poor for 34, 35 and questionable for 31, 32, 33, 41, 42. Good for other teeth.
Treatment plan:
Emergency treatment: -
Planned treatment:
ETIOTROPIC PHASE (Phase I therapy):
Diet counseling
Removal of local irritants (plaque and calculus)
Root planing
Correction of restorative and prosthetic irritational factors
Antimicrobial therapy (systemic)
Tetracycline 200 mg four times daily for 14 days
Occlusal therapy
Provisional splinting in lower anterior teeth
EVALUATION OF RESPONSE TO PHASE I:
Gingival inflammation
Plaque and calculus
Pocket depth
Occlusion
Restoration
Mobility
SURGICAL PHASE (Phase II therapy):
If the pockets persist after 3 weeks of phase I therapy, flap surgery to be carried out in all the quadrants with bone grafting in regions of vertical bone loss.
RESTORATIVE PHASE (Phase III therapy): _
MAINTENANCE PHASE (Phase IV therapy): Rechecking:
Gingival inflammation
Plaque and calculus
Pocket depth
Restoration
Mobility
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.
Case Studies 8
1. a) Chief Complaints: Patient complains of bad breath from her mouth
since last 6 months.
b) Other periodontal complaints:
Patient complains of bleeding gums in the morning, after mastication and during brushing.
Patient also complains of stains on her teeth and wants to get them cleaned
2. Systemic History: No relevant medical history 3. Family History: No relevant family history
4. Past dental experience: - First dental visit
5. Oral hygiene habits: Patient brushes her teeth using toothpowder and toothbrush once a day using scrub technique, since childhood. Patient doesn’t clean her tongue.
6. Tissue Abuse/Harmful habits: Patient occasionally uses misri on her teeth since last 10 years
7. Dietary enquiry: Adequate diet
8. General examination:
Normal gait
Afebrile
9. Extraoral examination:
Symmetry of face: Bilaterally symmetrical face
Lymph nodes: non tender
TMJ: normal
10. Intraoral examination:
a) General oral hygiene status: Fair
b) Examination of gingiva:
Color: Pale pink with pigmentation, except in mandibular anteriors, where it is pale pink
Contour: normal scalloping in all except in 31-33 and 41-43 where there is reduced scalloping
Consistency: Soft and edematous with rolled margins
Surface texture: stipplings absent
Size: normal
Position: at CEJ except in 31 and 41 where it is apical to CEJ
Bleeding: bleeding on probing generalized
Suppuration: absent
c) Width of attached gingiva (in mm):
1
1
2
3
3
3
3
3
3
2
3
3
3
1
7
6
5
4
3
2
1
1
2
3
4
5
6
7
1
1
2
2
2
2
2
1
2
2
2
1
1
1
d) Tension test: Negative
e) Other clinical features (if any):
f) Examination of teeth:
1.Teeth present: 11-17; 21-27; 31-37; 41-47.
2. Alignment: Malalignment of Lower anterior teeth.
3. Grades of mobility:
I
7
6
5
4
3
2
1
1
2
3
4
5
6
7
I
I
4. Loss of tooth structure: - Attrition in 31-33, 41-43, 11-12, 21-22
11. Proximal contacts: Tight contacts except in lower anterior teeth where there are overlapping teeth
12. Food impaction: In lower anterior region
13. Dental plaque: Generalized
14. Calculus: Supra and Subgingival calculus present
15. Material alba : Present
16. Occlusion: Presence of wear facets
17. Hypersensitivity: -
18. Discoloration: -
19. Pocket depth (in mm):
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
20. Total attachment loss (in mm):
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
11. Etiological factors:
Systemic: -
Local: Plaque, calculus, materia alba.
12. Investigation required: Blood hemogram including blood hemoglobin, Differential Leukocyte Count, Total Leukocyte Count, Bleeding time, Clotting time and Random blood sugar level.
13. Radiographic findings: Horizontal Bone loss upto junction of cervical and middle third of root in relation to 31, 32, 41, 42. Crestal bone loss of around 1 mm in 46, 47 interdental region
14. Provisional diagnosis:
Chronic generalized plaque induced gingivitis along with localized Periodontitis in 31, 32, 41, 42, 46, 47.
15. Prognosis:
Overall: Good
Individual: Good
Treatment plan:
Emergency treatment: -
Planned treatment:
ETIOTROPIC PHASE (Phase I therapy):
Diet counseling
Removal of local irritants (plaque and calculus)
Root planing
Correction of restorative and prosthetic irritational factors
Occlusal therapy
Provisional splinting in lower anterior teeth
EVALUATION OF RESPONSE TO PHASE I:
Gingival inflammation
Plaque and calculus
Pocket depth
Occlusion
Restoration
Mobility
SURGICAL PHASE (Phase II therapy):
If the pockets persist after 3 weeks of phase I therapy, flap surgery to be carried out lower anterior region, and lower left posterior region.
RESTORATIVE PHASE (Phase III therapy): _
MAINTENANCE PHASE (Phase IV therapy): Rechecking:
Gingival inflammation
Plaque and calculus
Pocket depth
Restoration
Mobility
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.
Case Studies 9
a) Chief Complaints: Patient wants to get her missing teeth replaced.
b) Other periodontal complaints: Patient complains of bleeding gums in the morning, since last 4-5 years. Gums bleed when patient gets up in the morning, and also when patient brushes her teeth. Patient also complains of mobility in lower anterior teeth since the past 1 year.
2. Systemic History: No relevant medical history 3. Family History: No relevant family history
4. Past dental experience: - Patient got a root canal done and few teeth extracted before 1 year
5. Oral hygiene habits: Patientuses toothpaste and brush to clean her teeth once in a day using horizontal scrub manner since childhood. Patient also cleans her tongue everyday.
6. Tissue Abuse/Harmful habits: No such habits present.
7. Dietary enquiry: Adequate diet
8. General examination:
Normal gait
Afebrile
9. Extraoral examination:
Symmetry of face: Bilaterally symmetrical face
Lymph nodes: non tender
TMJ: normal
10. Intraoral examination:
a) General oral hygiene status: Poor
b) Examination of gingiva:
Color: reddish pinkexcept in lower anteriors, where it is bluish pink
Contour: normal scalloping in all except in 31-33 and 41-43 where there is deep scalloping
Consistency: Soft and edematous with rolled margins
Surface texture: stipplings absent
Size: normal
Position: at CEJ except in 31 and 41 where it is apical to CEJ.
11. Proximal contacts: Tight contacts except lower anterior teeth where there are open contacts
12. Food impaction:
13. Dental plaque: Generalized
14. Calculus: Supra and Subgingival calculus present
15. Material alba: Present
16. Occlusion: Deep bite present.
17. Hypersensitivity: - In lower anterior region
18. Discoloration: -
19. Pocket depth (in mm):
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
20. Total attachment loss (in mm):
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
11. Etiological factors:
Systemic: -
Local: Plaque, calculus, materia alba.
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 of:
31, 32, 41, 42
45, 47, 48
13, 14
24, 25, 26
13. Radiographic findings: Crestal bone loss seen in interdental region between 47, 48. Bone loss upto junction of cervical and middle third of root in relation to 31, 32, 41, 42.
14. Provisional diagnosis: Chronic generalized plaque induced gingivitis with localized chronic periodontitis in 31, 32, 41, 42, 47, 48 region
15. Prognosis:
Overall: Good
Individual: Good
Treatment plan:
Emergency treatment: -
Planned treatment:
ETIOTROPIC PHASE (Phase I therapy):
Diet counseling
Removal of local irritants (plaque and calculus)
Root planing
Correction of restorative and prosthetic irritational factors
Occlusal therapy
Provisional splinting in lower anterior teeth
EVALUATION OF RESPONSE TO PHASE I:
Gingival inflammation
Plaque and calculus
Pocket depth
Occlusion
Restoration
Mobility
SURGICAL PHASE (Phase II therapy):
If the pockets persist after 3 weeks of phase I therapy, flap surgery carried out in lower anterior region and lower right posterior region.
RESTORATIVE PHASE (Phase III therapy): Replacement of missing teeth 15, 16, 46 along with crown on 14
MAINTENANCE PHASE (Phase IV therapy): Rechecking:
Gingival inflammation
Plaque and calculus
Pocket depth
Restoration
Mobility
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.
Case Studies 10
1. a) Chief Complaints: Patient wants to get his teeth cleaned. Patient complains that he has bleeding gums since last 1 year. Patient complains of bleeding from gums during brushing, mastication, and in the morning.
b) Other periodontal complaints: Patient also complains of bad breath in the morning, since the last 1 year.
2. Systemic History: No relevant medical history 3. Family History: No relevant family history
4. Past dental experience:Patient visited a dentist before 2 years for sensitivity of teeth.
5. Oral hygiene habits: Patientuses toothpaste and brush to clean his teeth once in a day using horizontal scrub manner since childhood. Patient also cleans his tongue everyday.
6. Tissue Abuse/Harmful habits: Patient smokes 10-15 cigarettes a day since last 20 years, and has a habit of chewing gutkha 5-6 times a day since last 10 years.
7. Dietary enquiry: Patient has a non vegetarian diet. Patient has a habit of intermittent snacks between meals
8. General examination:
Normal gait
Afebrile
9. Extraoral examination:
Symmetry of face: Bilaterally symmetrical face
Lymph nodes: non tender
TMJ: normal
10. Intraoral examination:
a) General oral hygiene status: Poor
b) Examination of gingiva:
Color: Reddish pinkwith pigmentation in the maxillary anteriors and bluish pink in the mandibular anteriors. Reddish pink in posteriors.
Contour: Normal scalloping in all except in 11-13 and 21-23 where there is deep scalloping
Consistency: Soft and edematous with rolled margins
Surface texture: stippling absent
Size: Normal exceptin 11-13 and 21-23 where it is enlarged in horizontal dimension.
Position: At CEJ except in 13 and 24 where it is 2 mm below CEJ
Bleeding: Bleeding on probing generalized
Suppuration: Absent
c) Width of attached gingiva (in mm): Adequate
d) Tension test: Negative
e) Other clinical features (if any): Nil
f) Examination of teeth:
1.Teeth present: 11-17; 21-24, 27; 31-37; 41-47.
2. Alignment: Malalignment of lower anterior teeth and deep bite
10. Furcation involvement: - Grade 1 on lingual aspect in 36
11. Proximal contacts: Open contacts in mandibular anterior region
12. Food impaction: In maxillary anterior region
13. Dental plaque: Generalized
14. Calculus: Supra and Subgingival calculus present
15. Material alba: Present
16. Occlusion: Absence of facets
17. Hypersensitivity: - Hypersensitivity to cold in lower anteriors.
18. Discoloration: - Intrinsic staining present in anteriors
19. Pocket depth (in mm):
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
20. Total attachment loss (in mm):
8
7
6
5
4
3
2
1
1
2
3
4
5
6
7
8
11. Etiological factors:
Systemic: - Smoking
Local: Plaque, calculus, materia alba.
12. Investigation required: Blood hemogram including blood hemoglobin, Differential Leukocyte Count, Total Leukocyte Count, Bleeding time, Clotting time and Random blood sugar level.
Full mouth intraoral periapical radiographs required
13. Radiographic findings:
Angular bone defect seen in 23-24 region upto the junction of the middle and apical third of the root of 24
Horizontal bone defect seen upto junction of middle and cervical third of the roots of 11,21,22,23, 31,32,41,42.
14. Provisional diagnosis:
Chronic generalized severe periodontitis
15. Prognosis:
Overall: Fair
Individual: Fair
Treatment plan:
Emergency treatment: - Nil
Planned treatment:
ETIOTROPIC PHASE (Phase I therapy):
Diet counseling
Removal of local irritants (plaque and calculus)
Root planing
Occlusal therapy
Excavation of caries and restoration
EVALUATION OF RESPONSE TO PHASE I:
Gingival inflammation
Plaque and calculus
Pocket depth
Occlusion
Restoration
Mobility
SURGICAL PHASE (Phase II therapy):
If the pockets persist after 3 weeks of phase I therapy, flap surgery to be carried out, along with bone grafting in maxillary canine and premolar regions. Flap surgery to be carried out if pockets persist in any remaining regions
RESTORATIVE PHASE (Phase III therapy): _
Replacement of 25,26 with fixed or removable partial prosthesis depending upon the response to treatment and plaque control of the patient.
MAINTENANCE PHASE (Phase IV therapy): Rechecking:
Gingival inflammation
Plaque and calculus
Pocket depth
Restoration
Mobility
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.
