Jan 31, 2012

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. 


  

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