2. Treatment Overview Statement
Patient chief complaint: “I’m missing several teeth and have decay in a lot of teeth. I just want
to get that cleared up so I will have a full set of teeth.”
I will address Patient S’s chief complaint through periodontal, restorative, orthodontic, and
prosthodontic treatment. Restoration and preservation of his dentition will provide a mutually
protected occlusion, restoring function and esthetics while addressing his chief complaint.
Following maxillary and mandibular orthodontic treatment, his maxillary arch will be restored
with crowns and two fixed dental prostheses (FDP). The mandibular arch will receive an
implant supported removable dental prosthesis (ISRDP) to facilitate chewing on his left side.
Patient S’s treatment will be completed in several phases.
Preparatory Phase
Patient S is a 34 year old high caries risk patient with generalized slight chronic periodontitis.
He has smoked 1 pack per day (ppd) for 16 years and is currently undergoing smoking
cessation. The preparatory phase of Patient S’s treatment begins with arresting the caries
process through application of the Anderson Medical Model. Teeth #‘s 3,4,5,6,7,8,9,10,14,20,
28,&31 will be restored with glass ionomer provisional restorations. Tooth #9 will be
endodontically retreated due to the presence of a radiolucent apical lesion, and deficient
radiographic obturation. Patient S’s oral hygiene is poor, and he will undergo initial non
surgical periodontal therapy with detailed oral hygiene instructions to treat his generalized
slight chronic periodontitis. Periodontal re-evaluation of initial periodontal therapy and
completion of the Medical Model will provide a treatment decision point. If there is non-
compliance, I will fabricate maxillary and mandibular treatment partial dentures and use direct
restorative materials to restore both arches. If Patient S demonstrates acceptable levels of oral
hygiene and diet compliance at a 3 months re-evaluation, we will continue with the preparatory
phase of treatment and initiate orthodontic treatment. An endosseous 1-stage implant will be
placed approximately 3 months after the initiation of orthodontic treatment. If required, this
implant will be used for orthodontic anchorage, and finally, to act as a supportive and retentive
element for a mandibular Kennedy Class III RDP.
Corrective Phase
Following successful completion of the preparatory phase, I will commence with restoring
Patient S’s dentition. Restoration of his maxillary arch will include PFM crowns fabricated for
teeth #’s 3,6,7,8,9,10 and a PFM FDP from teeth #‘s 11-14. His mandibular arch will be restored
using surveyed PFM crowns fabricated for teeth #‘s 21&28. A Locator abutment will provide
support and retention for a mandibular Kennedy Class III RDP to replace extracted teeth #’s
18,19,20,29,30. A maxillary bruxism splint will be fabricated for him to wear at night.
Maintenance Phase
Upon completion of the corrective phase, Patient S will be placed on a three month trial
maintenance program for one year followed by a 6 month recall after one year.!
All treatment will be completed using universal precautions and personal protective
equipment. All instruments will be autoclave sterilized. Other items and surfaces will be
disinfected with Dispatch for a minimum of two minutes contact time.
3. Patient: S
Patient Identification
xxxxxxxxx
Chief Complaint
“I’m missing several teeth and have decay in a lot of teeth. I just want to get that cleared up so I
will have a full set of teeth”
Treatment Expectations
“I think it would be easier to have dentures. Either a plate or implants and I like the way my
front teeth look. ”
Medical/Systemic Overview
General Appearance
Patient S appears to be a well-nourished male in apparent good health
Family Medical History
Father: 52 years old; smoker 1 ppd
Mother: 52 years old; smoker 1ppd
Siblings: 1 older brother; 36 years old
Children: 3 children (15,13,10) – No medical issues
Family Dental History
Father: Dentate
Mother: Dentate
Brother: Dentate
Children: Dentate
Social History
Marital Status: Married
Alcohol: 6 pack of beer/week
Tobacco: 1 ppd for 16 years. Quit for 3 years and started start smoking again. Has quit
smoking since 30 Aug 10. Patient referred to smoking cessation program.
Physical Fitness: Fit
Nutrition
Breakfast: Coffee – Black
4. Lunch: Sandwich/Chips
Dinner: Spaghetti, Pizza, BBQ
Snacks: Chips
Fluids: Water/Diet Coke
Past Medical History
Allergies: Penicillin (unconfirmed - allergic event was 20 yrs. ago), NK food or latex allergies
Hypertension: Patient was on antihypertensive medications prior to enlisting. He was
! instructed to stop HTN meds by recruiters in order to qualify to enlist.
Overall Health: Good
Current Medical Status
Allergies: Penicillin (unconfirmed - event was 20 yrs. ago), NK food or latex allergies
Medications
! Loratidine - PO 10 mg - seasonal allergies
Social: Non smoker
Hypertension: Patient’s BP is 153/84 (Stage 1 hypertension). Patient has been made aware of
his BP and feels that smoking cessation will assist in decreasing his blood pressure.
Physical Exam
Height: 76”
Pulse: 81 bpm
Weight: 230 lbs
BP: 153/84
Resp rate: 14
BMI: 28
Normal weight = 18.5–24.9
Overweight = 25–29.9
Past Dental History
Overview: Patient S has had intermittent dental care prior to Active Duty (2 yrs ago) and it was
mainly on an emergent basis. All procedures were well tolerated.
Oral Hygiene
Brushing: Electronic Sonicare Toothbrush once per day
Flossing: 3 times per week
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5. Oral Pathology
Extra Oral Exam
Lymphadenopathy: No tender or enlarged lymph nodes
Thyroid: No swelling or masses detected
Muscle Palpation: No tender muscles detected
TMJ Exam
Noises: None detected
Maximum Opening: 45 mm
Protrusive: 3 mm
Right Lateral Excursion: 10 mm
Left Lateral Excursion: 12 mm
Intra Oral Exam
Lips: WNL
Cheeks: WNL
Buccal Mucosa: WNL
Ridges/Gingiva: WNL
Palate: WNL
Tongue: WNL
Floor of the Mouth: WNL
Oral Cancer Screen: Negative
Restorative:
Caries Risk Assessment: High
≥ 2 Lesions in the past 3 years
Poor oral hygiene
Moderately high CHO diet (Monster soda BID during deployment)
Irregular dental visits
Carious Lesions:
#4 DO
#6 Bu
#7 MDLiBu
#8 MLi
#9 MLiBu
#10 DLi
#31 Bu Pit
5
6. Defective Restorations:
#3 MOBu Amal
#5 O Amal
#8 DLiBu Comp
#9 DLiBu
#10 MLi
#14 MOLi Amal
#21 O Amal
#28 DOLi Comp
Missing Teeth #’s:
3rd molars (1,16,17,32) & #’s
2,12,13,15,18,19,20,29,30
Endodontics
Symptomatic teeth: Nil
Endodontically treated teeth: #9
History:
The initial endodontic treatment of tooth #9 was completed at age 12
and retreated due to discoloration when the patient was 17 y.o. Tooth
#9 is currently asymptomatic.
Radiographic interpretation:
A periapical radiograph of tooth #9 shows a previously
endodontically treated #9 with a non metallic restorative material in
the access opening and in the mesial/distal of the tooth. A carious
lesion was present in mesial and distal of #9 and was restored with a
GI restorative material (Sep 10). The crestal bone appears to be intact
and the PDL space is continuous until the apex, where a radiolucent
lesion is faintly visible. Tooth #9 appears to be a single canal
obturated with a radiographically dense core material surrounded by
a less radiopaque material.
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7. Periodontics
Gingival Quality:
! Maxilla: Generalized erythematous marginal gingiva, blunted papilla with some
! stippling
! Mandible: Generalized knife-edged papillae, healthy coral pink color with stippling
! present
Oral Hygiene Status: Poor to Moderate oral hygiene
Plaque Assessment Scoring System (PASS) score: 15% Plaque free surfaces
Probing dePatienths ≥4mm: #10 DBu & MBu #11
Bleeding on Probing: Teeth #‘s 3,4,5,6,7,8,9,10,11,14
Calculus: Moderate calculus mandibular incisors
Recession: Miller Class I - Buccal surface of #’s 22, 27, 28
Keratinized Gingiva: : Generally 4-5 mm on both mandibular and maxillary arches
CLINICAL FINDINGS
TOOTH # PERCUSSION PA L PAT I O N PROBING COLD TEST MOBILITY
(MILLER)
3 Negative Negative ≤4mm Normal 0
4 Negative Negative ≤4mm Normal 0
5 Negative Negative ≤4mm Normal 0
6 Negative Negative ≤4mm Normal 0
7 Negative Negative ≤4mm Normal 0
8 Negative Negative ≤4mm Normal 0
9 (RCT’d) Negative Negative ≤4mm No response 0
10 Negative Negative 4mm Normal 0
11 Negative Negative 4mm Normal 0
14 Negative Negative ≤4mm Normal 0
21 Negative Negative ≤4mm Normal 0
22 Negative Negative ≤4mm Normal 0
23 Negative Negative ≤4mm Normal 0
24 Negative Negative ≤4mm Normal 0
25 Negative Negative ≤4mm Normal 0
26 Negative Negative ≤4mm Normal 0
27 Negative Negative ≤4mm Normal 0
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28 Negative Negative ≤4mm Normal 0
31 Negative Negative ≤4mm Normal 0
10. H O R I Z O N TA L R A D I O G R A P H I C B O N E
LOSS
10% 10% 10%
10% 15% 10%
} 5mm
20mm
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11. Orthodontics
Angle Classification:
" Molar - Left and Right- Unable to determine
! Canine - Left and Right - Class I
Skeletal: Class I skeletal ANB =3°
Overbite: 0% " " " Overjet: Tooth #8 - 1mm, Tooth #9 - 2mm
Midlines:
" Maxillary: Coincident with facial midline
! Mandibular: 2mm right deviation of maxillary midline
Wear Pattern: Moderate wear Mx/Md anterior teeth, Occlusal wear facets on Mx/Md
! posterior
Parafunctional Habits: Nocturnal bruxism
Analysis of Diagnostic Records
Alignment and Symmetry:
" Maxillary Arch: U-shaped arch, posterior right segment spacing, missing teeth #12/13
! Mandibular Arch: U-shaped arch, missing teeth #’s: 18,19,20,29,30; diastemas between
! ! anterior teeth, #21/28 distally tipped, #31 mesially tipped
! Bolton analysis: 3-3: -0.6 mm discrepancy in the maxillary arch
Facial Esthetics:
! Smile: Shows approximately 5mm max anterior tooth structure
! Profile: Convex profile, Slightly obtuse nasolabial angle
! Lip Competence: Competent
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12. Occlusion
Angle Classification:
" Molar - Left and Right- Unable to determine
! Canine - Left and Right - Class I
Overbite: 0% " " " Overjet: Tooth #8 - 1mm, Tooth #9 - 3mm
Wear Pattern: Moderate wear Mx/Md Anterior teeth, Occlusal wear facets on Mx/Md
! posterior
Parafunctional Habits: Nocturnal bruxism
Excursive Movements:
" Right lateral md movement:
! ! Working side: #31/3 and incisors
" Left lateral md movement:
" " Working side: Incisors
! ! Non working side interference: #31/3
! Protrusive movement: #31/3
Crossbite: Posterior right side & #6/27
SupraeruPatiention: Tooth #14
Prosthodontics
Non-restorable teeth: None
Missing teeth to be replaced: " Max Arch: #12,13" Md Arch: #18,19,20,29,30
Mutually protected Occlusion: No
Anterior Guidance: No
Residual Ridge defects: " Allen Cl A #12-13" Allen Cl C #20-17 and #29-30
Cross Bite: Posterior right side & #6/27
Short Clinical Crowns:
! Ant mx teeth #‘s 6-11
! Posterior teeth #’s: 14, 20, 28
Vertical Dimension of Occlusion (VDO): No loss of VDO
" VDO was evaluated with three different techniques:
! Freeway Space: 3mm (Points measured from tip of nose to chin at rest and at maximum
! ! ! ! intercuspation)
! Phonetics: (Letter F/S/60-66): WNL
! Corners of the mouth: Not turned downwards and no history of angular cheilitis
12
13. Esthetics (priority based on the patient’s chief complaint)
Edentulous space:
! Lack of dentition (left mx posterior) when the patient smiles
Anterior Mx Teeth
! Shape: Short anterior maxillary clinical crowns
! ! Tooth #8: 6mm (inciso-gingival)/8mm (mesio-distal)
! ! Tooth #9: 8mm (inciso-gingival)/8mm (mesio-distal)
! Shade: Previously endodontically treated tooth #9 has lower value relative to adjacent
! ! teeth
!
! !
19 Years Old
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14. Problem List by Discipline
Chief complaint:
“I’m missing several teeth and have decay in a lot of teeth. I just want to get that cleared up so I
will have a full set of teeth”
Medical/systemic: Uncontrolled Stage 1 Hypertension
Restorative:
" Carious Lesions:
! ! #4 DO! !
! ! #6 Bu
! ! #7 MDLiBu
! ! #8 MLi
! ! #9 MLiBu
! ! #10 DLi
! ! #31 Bu Pit
" Defective Restorations:
! ! #3 MOBu Amal
! ! #5 O Amal
! ! #8 DLiBu Comp
! ! #9 DLiBu
! ! #10 MLi
! ! #14 MOLi Amal
! ! #21 O Amal
! ! #28 DOLi Comp
Endodontics: Tooth #9 - Previously endodontically treated tooth with asymptomatic apical
! periodontitis
Periodontics: Generalized slight chronic periodontitis
Orthodontics: Supraerupted tooth #14, mandibular diastemas, midline discrepancy
Occlusion: No mutually protected occlusion, no anterior guidance
Prosthodontics: Several edentulous spaces, parafunctional habit (bruxism)
Esthetics: Left mx edentulous ridge; short clinical ant max crowns, discolored tooth #9, md
diastemas
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