Tooth Extraction

Patient:  X.V
Age: 50
Diagnostic:
     - Partial edentulism 
     - Periodontal disease  
     - Calculum supragingival and subgingival

Our patient has:

   - Superior arch: second right molar, both canines and lateral incisors all with big restorations. Plus a partial superior prosthesis supported by the fractured canine and the molar.

   - Lower arch: the patient has in relative good condition from the first right premolar to the second left premolar and no prosthesis.   

Treatment plan:

- First phase: hygienic phase. We proceeded to do a tartrectomy.

- Second phase: Surgical phase. We removed the superior left canine (2.3) that had a crown fracture. 

- Third phase: prosthodontic phase. Reemplace missing tooth. For now the patient don't want to do the lower prosthesis because she can't afford it. We are waiting if one day is ready. 

CASE 4563.2

Yesterday at the university clinic, a patient came for a cleaning. He said he had no apparently disease and that he also brushes his teeth once a day.

He has a severe gingivitis generalised. In the first visit this patient was bleeding all the time so the probing was very difficult. He has a lot of calculus under his gums that apparently we can not see only deduce because his gums are red, shining and big.

We tried to discover why, brushing his teeth once a day, he had this gingivitis. In one moment he said that he spent 2 years in prison and that's why he couldn't brush his teeth well. He lived under pressure.  

Here is the case before we started: 

Here is the end:

Now we need to visit him next time to see if his gums disminued with the cleaning and the products that we gave to him: 

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.