1. LOGO RIYADH COLLEGE OF DENTISTRY AND
PHARMACY
Comprehensive Case
Presentation
Prepared By:
p y
Sultan Rkeeb al-Shammery
al-
Level
12
1

2. Age : 25
Gender : Male
Nationality : Yamani
Occupation : receptionist
Marital & Social Status : Single
2

3. In the ‫• ﺗﺼﺒﻐﺎت ﻓﻲ‬
‫ﻲ‬ ‫ﺒ‬
patient’s
i ’ ‫اﻷﺳﻨﺎن‬
own
words:
d ‫اﻷﻣﺎﻣﻴﺔ‬
•History of Chief Complaint
Long time ago
g g
3

4. Medical History
Within Normal •
Family Medical History
Within Normal •
Past Dental History
Just for check up •
p
4

5. No habits He use tooth
brush twice a
day
5

6. 6

7. I. Extra – Oral Examination
Swelling
Skin NAD
TMJ
7

8. II. Intra – Oral Examination
II.
NAD
8

9. III . Oral Hygiene
Gingival Index ► 1 mild inflammation
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
1 1 1
1 0 1
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
Plaque Index ► 1
18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
1 0 1
1 0 1
48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
9

10. PRE-TREATMENT PHOTOGRAPHS
10

11. Frontal view
11

12. Maxillary Occlusal view
12

13. Mandibular Occlusal view
13

14. Right lateral view
14

15. Left lateral view
15

16. 16

17. Panoramic
Pa o amic
17

18. Bitwing Radiograph
18

19. Diagnostic Casts
19

20. 20

21. 1 2 3
generalized
li d Carious teeth Extraction
sever enamel
fluorosis with
stains 16 , 17 , 18 , 28 , 38
affecting all of 27, 37 , 47 ,
the permanent
teeth 48
21

22. Caries
22

23. Caries
23

24. Diagnosis
Periodontium: Generalized mild gingivitis
G li d ild i i iti
24

25. 25

26. 26

27. Phase I
Ph Perio treatment
Condition:
Generalized mild gingivitis
Recommendation :
Polishing , Oral hygiene instructions
27

28. 28

29. Phase II Operative t
Op ti treatment
tm nt
Condition:
# 18 , O Caries
O. C ries
Recommendation :
Class I composite restoration
29

30. Condition:
# 17 , O Caries
O. C ries
Recommendation :
Class I composite restoration
30

31. Condition:
# 16 , Dist l , Palatal Caries
Distal P l t l C ries
Recommendation :
P.R.R
31

32. Condition:
# 27 , O. Caries
Recommendation :
Class I composite restoration
32

33. Condition:
# 37 , O. Caries
Recommendation :
P.R.R
33

34. Condition:
# 4 , O. Caries
48
Recommendation :
Class I composite restoration
34

35. Condition:
# 4 , O. Caries
47
Recommendation :
P.R.R
35

36. 36

37. Condition:
# 38 , impacted teeth
Recommendation :
Extraction
37

38. Phase III Surgical Treatment
Condition:
# 28 , traumatize and No opposing
after extraction tooth # 38
Recommendation :
Extraction
After discussing the Surgical
treatment plan with the patient ,
The patient said (No need to go
surgery at this time , Because No
g y
any symptoms or pain in this time
38

39. 39

40. Upper anterior teeth
U t i t th
Condition:
Sever dental fluorosis of
TFI = 6-9 with yellow/brown
6 9
discoloration, based on the 1978
dental flourosis classification scheme of
Thylstrup and Fejerskov
Recommendation options :
- Bleaching ??
- Veneer
40

41. 41

42. preparation ( 0.5 – 0.8 ) mm
midfacially , ( 0 3 – 0 5 )mm along
0.3 0.5
the gingival margin
42

43. p y p
Temporary composite restoration
43

44. After veneer cementation
44

45. 45

46. Lower anterior teeth
L t i t th
Condition:
Sever dental fluorosis of
TFI = 6-9 with yellow/brown
6 9
discoloration, based on the 1978
dental flourosis classification scheme of
Thylstrup and Fejerskov
Recommendation options :
- Bleaching or microabrasion
( coast?? Pt need ?? )
- Veneer
46

47. Microabrasion
Conservative treatment
Bleaching
Veneer
47

48. Microabrasion
Mi b i
( No any Effect )
48

49. Bleaching ( ZOOM2)
49

50. Bleaching ( ZOOM2)
eac g OO )
isolation
50

51. Bleaching ( ZOOM2)
eac g OO )
Whitening Gel
51

52. Bleaching ( ZOOM2)
eac g OO )
ZOOM light
g
( 45 – mint )
52

53. After Bleaching
53

54. After 1 month
54

55. Veneer
After 1 month , patient come back to evaluate the lower
anterior shade color . The CC In the patient s own words
patient’s
‫ﻟﻮن اﻷﺳﻨﺎن ﻣﺎ ﻋﺠﺒﻨﻲ‬
‫وارﻏﺐ ﻓﻲ ﻋﻤﻞ ﺗﺮآﻴﺒﺎت ﻟﻸﺳﻨﺎن اﻟﺴﻔﻠﻴﺔ‬
55

56. 56

57. 57

58. Temporary composite restoration
58

59. Return After veneer cementation
59

60. POST-TREATMENT PHOTOGRAPHS
60

61. Frontal view
61

62. Maxillary Occlusal view
62

63. Mandibular Occlusal view
63

64. Right lateral view
64

65. Left lateral view
65

66. 1 restore esthetic and function
2 improve his OHI
Treatment
T
Objectives
j
3 control caries
66

67. LOGO
67

68. office bleaching with 35% hydrogen
peroxide does not significantly affect the
color and luminosity of fluorotic teeth
Konsl 2007 , dental digest journal
Return
68

69. Conservative treatment options such as tooth whitening
p g
and microabrasion can dramatically improve severely
discoloured fluorosed teeth. This can provide a
satisfactory interim outcome or minimize the removal of
discoloured enamel and dentine prior to the provision of
veneers
Manton DJ , 2007 Australian dental journal
return
69

70. A chronic endemic form of hypoplasia of the dental
e a e
enamel caused by d drinking water with a high
g ate t g
fluorine content during the time of tooth
formation, and characterized by defective
, y
calcification that gives a white chalky
appearance to the enamel, which g
pp , graduallyy
undergoes brown discoloration.
Jablonski's Dictionary of Dentistry, 1992, p286
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70