Patient complained about poor function - “I have holes on the lower tooth at the back, I want fillings so I can chew” Patient also concerned about aesthetic appearance – “I want my front teeth, which were chipped, to be fixed”
History of main complaint:
Pain sensation, not continuous and especially when something cold is applied to the cavity. Patient noticed it for about one week previous to the appointment. About a year ago patient came in for an extraction and amalgam restorations.
Hereditary – Patients father diagnosed with Diabetes, Hypertension and Gout.
Patient – Patient has Asthma and Gout.
Medication – Gout : Voltaren
Asthma : Budaflam pump
Half a Disprin (every alternate day)
Medical history record dated and signed by the patient.
Patient deemed fit for treatment.
Extra-oral Exam :
External abnormalities – NAD (Nothing Abnormal Detected)
Palpable lymph nodes – No regional lymphadenopathy
Oral mucosa, Oropharynx- NAD
Temporomandibular Joint – NAD
Intra-oral Exam :
Subjective impression of the mouth :
Satisfactory oral hygiene, many amalgam restorations, some gingival recession visible on posteriors, minimal calculus and plaque. No periodontitis.
Diagnostic Procedures & Special Investigations :
Percussion and Palpation
Vitality Testing :
- using heated gutta percha and ethyl chloride
• Electric Pulp Tester
• “Dentine” Test
| | | | |21 – Class IV | |11 – Class IV |22 – Class IV | |18- Missing |25 – Amalgam Restoration | | |26 – Amalgam Restoration | | |27 – Missing | | |28 - Missing | | | | |45- Missing |34 – Palatal Lesion | |46 – Amalgam Restoration |35 – Missing | |48 - Missing |36 – Missing | | |37 – Crown | | |38 - Missing |
Treating the Patient
Diagnosis and Prognosis :
Patient primarily requires treatment of an aesthetic nature on anterior teeth, Vitality Testing has shown all carious / fractured teeth to be vital. Radiographs do not show any secondary caries underneath the existing amalgam restorations. Removable prosthesis required to replace missing molars in the mandible. Prognosis is good, depending on patient compliance and availability.
Treatment Options :
11, 21, 22 – Crowns / Composite Restorations / Porcelain veneer 25, 26, 46 – Replace amalgam filling / Polish
47 – amalgam / composite restoration
Treatment Plan :
Phase 1 – No emergency treatment...