Clinical Presentation & Findings
Discuss
1. Diagnosis & differential diagnosis
From OPG, radiographic bone loss
Greatest bone loss noted on central incisors of the maxilla
Posterior teeth show Grade II and III furcation involvement
Patient has mobility class II and has lost lower central incisors due to mobility
Grade C because smoking >10 cigarettes a day
Other differential Diagnosis: Molar incisor Stage III Grade C periodontitis, Generalised State III Grade C periodontitis, Generalised Stage IV Grade C periodontitis, periodontitis as a manifestation of systemic diseases (hematologic, genetic distord), other pathology (osseous sarcoidosis, alveolar bone actinomycosis, eosinophilic granuloma)
15 endo-periodontal lesion in periodontitis patient grade III?
36 endo-periodontal lesion in periodontitis patient grade II - III?
46 endo-peridontal lesion in periodontitis patient grade II - III
DDx - periodontal abscess, root fracture, dentoalveolar abscess
2. Identify risk factors
Patient is a smoker
OH can be improved. currently no use of interdental cleaning
Genetics
Anxiety
Overhanging (overcontoured) restorative margins
caries risk for endo lesions
3. Bone loss type and severity - general and tooth related
General:
Generalised bone loss with a combination of horizontal and vertical bone loss to the apical third (greatest loss) with furcation involvement.
Vertical bone loss associated with tooth 36, 37, 46, 47, 15, 11, 21 and 35
Tooth related
4. Prognosis for dentition
Periodontal prognosis: questionable
there looks to be about 50% attachment loss or more
Mobility is Grade I or II
but furcation involvement looks deep, and potentially could be poor access
there's no guarantee that risk factors (smoking, poor oral hygiene) can be controlled.
5. Prognosis per tooth
15, 35, 47 all hopeless with 80%+ attachment loss
36, 46 compromised
6. Treatment plan (please address all treatment needs) (teeth to be extracted, teeth to be RCT, etc.)
teeth to be extracted: 15, 35, 36, 46, 37
36 and 46 to be hemisected and endodontic treatment by specialist due to the patient's age and need to conserve more teeth
place bone graft to prevent bone resorption
Review every 3 months due to severe bone loss
7. Provide provision of restorative plan (fixed, removable, implant supported restorations)
once periodontal condition stabilises
Consider implants to replace missing back teeth
Consider removable restorations
Consider fixed dental prosthesis
8. Maintenance plan
Education/ Initial therapy I: supragingival scale and clean and prophylaxis, give OHI with use of interdental brushes, also smoking cessation
Wait two weeks
Initial therapy 2: sub-gingival scale and clean in pockets deeper than 5mm, so posterior teeth
Periodontal review: full charting.
If periodontal condition stabilises, review in 6 months.
If periodontal condition does not stabilise, review in 3 months, give OHI with use of interdental brushes, also smoking cessation.
Useful information
Comments