CASE 4410.8

It's been a long time since my last post, I've been with exams but we restarted classes on monday so today I wanted to talk about one of our cases at the clinic. My partner and I we had this case as a first visit. The patient is a 38 years old women.

How do we start the first visit? What we usually do is the questions to the patient. We need to know:

• Visit reason: she wanted a revision.
• Personal medical history: no interest
• Family history: her father had angina pectoris, myocardial infarction and stomach ulcers. Her mother also had a heart desease.
• Medication: occasional medication for headaches - ibuporfen.
• Periodontal status: severe probing with <6mm of widespread
• Bad habits: smoking of 2 packs (40 units aprox.)
• Last dentist visit: 4 years ago.
• Oral higiene: 2 times a day, very suspicious.
• Alergies: no interest.

After all the history we have to determine a presumptive  diagnosis. We took some XR how we could:

1. Bitewing of the Right side:

2. Bitewing of the Left side:

3. Periapical of the antero-supeior sector:

4. As we observe a bad general status we decide to take a Orthopantomography (OPG) 

Presumptive Diagnosis:

• Severe generalised calculus 
• Root fragments: 1.8, 1.5, 2.8, 3.6 and 4.6 (International)
• Cavities: 3.7 and 2.2
• Fracture: crown fracture on 4.5
• partial edentulism: 1.6, 2.6 and 3.5
• Anterio-superior crowns on 1.2, 1.1, 2.1 and 2.2 in bad status.
• 2.2 has to be evaluated with all the anterior sector because the crown seems to be fractures and is not restorable.
• Occasional radiographic founds: radiopacity on 4.8 (posible cementoma). 

Treatment plan:

1. Hygienic phase: remove all the calculus
2. Surgical phase: extracting root remnants
3. Restorative phase: 4.5 and 3.7.
4. Master of aesthetic and prosthetic phase: antero-superior sector (2.2 is the most important). 

Actuality: We did the hygienic phase and I remove the cavity on 3.7. Now we just need the patient's effort for all the other treatment. I'm on 3rd year so here is where is our work: first visit and diagnosis, higiene and small cavities. 

  

Surgical instruments I

It's been a long time since the last time I posted, but never is late. All of this instruments are used in oral surgery and we normally dispose them like this: 

 Here is our new lab: 

So after the good equipment: medical gown, gloves, mask and goggles we proceed to do the incision with a scalpel. We practice with the needle holder and the tweezers. 
   

    

                         

                        

Here on the left we can see my practice.

     

All the different kinds of sutures: for example here we have the continued suture (right up), intertwined suture (left down), single points and finally horizontal mattress suture.