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KNOWLEDGEHUB
PeriodontalandRestorativeCaseTreatmentplanning-Dr.NeilWilsonTreatment-VictoriaRichards-Carter
Sharingknowledgeandstimulatingconversation
betweendentalprofessionals.
Thisgentleman,inhislatefortieswasreferredtothe
centrebyhisGDPfortreatmentofGeneralisedChronic
Periodontitis.
Lookthroughthecaseandjoinintheconversationsonline.
Periodontal&RestorativeCaseNeilWilson&VictoriaRichards-Carter
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www.centralenglandreferrals.co.uk©2017Periodontal&RestorativeCaseNeilWilson&VictoriaRichards-Carter
ThepatientwasreferredbyhisGDPforassistancewithtreatinghisperiodontaldisease.TheOPGradiographshowsgeneralisedsevereboneloss.
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www.centralenglandreferrals.co.uk©2017
Onexamination,thepatientwassufferingfromgeneralisedchronicperiodontitisandtoothsurfacelosslocalisedtotheanteriorteeth.Bothuppercentralincisorswere6mminlength.
BPE’srecordedwere4*/4/4*4*/4/4*
Largeamountsofsupraandsubgingivalcalculuswaspresent.ThepatienthadahistoryofseeingGDPforscalingandpolishingofhisteeth,buthadneverseenahygienist.
Theissuesofperiodontitisaswellastoothsurfacelosswerediscussedwiththepatient.
Periodontal&RestorativeCaseNeilWilson&VictoriaRichards-Carter
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Priortoundertakinganycomplexrestorativedentaltreatment,itwasexplainedtothepatientthatgingivalhealthneededtoimprovesignificantly.ItwasdecidedthatthepatientwastogothroughacourseofFullMouthDisinfectionunderthecoverofantibiotics,duetothechronicnatureoftheperiodontitis.Thenatureofthetreatmentwasexplainedtothepatient,along
withtheexpectedoutcomes.
Aninitialhygieneappointmentwasundertaken.Adetailedpocketchart(inc.recession,mobility&furcationcharting)identifieddeeppocketing,especiallyinmolarregions.Thebleedingscorewas36.1%.
ThroughoralhygienetechniquesweredemonstratedtothepatienttoimproveplaquecontrolpriortoFullMouthDisinfection.
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www.centralenglandreferrals.co.uk©2017Periodontal&RestorativeCaseNeilWilson&VictoriaRichards-Carter
Followingtheinitialhygieneappointment,thepatientunderwent2x90minappointmentswithin24hours.A7daycourseofantibiotics(amoxicillin500mg&Metronidazole200mg)werestartedatthefirstofthese
appointments.LAwasusedinordertocarryoutRSDatthe2x90minappointments.
Thepatientwasgivenchlorhexidenebasedproductstousefollowinghisappointments,theseincluded;mouthwash,gel&spray.
6weekslater,thepatientwasseenforareviewandstainremoval.At12weekspostFullMouthDisinfection,anewdetailedpocketchartwascarriedout,identifyingsignificant
reductioninpocketing.Bleedingscorewasnowat6.5%
Hygienerecallsweresetat3months.
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3monthslater,duetosignificanttoothsurfaceloss,adiagnosticwax-upwasmadeoftheupper3-3,inordertocreateaDahlrestoration.
A‘suckdown’wasproduced,andusedtoshowthepatientinhisownmouthhowhecouldlookaftertreatment.Thepatientwasadvisedthattherewouldbenoposteriortoothcontactanditmaybeanumberofmonthsbeforeteeth
couldcomebackintoocclusion.The6anteriorteethwerebuiltupincomposite–FiltekSupreme,shadeA2,thenpolished.
Thepatienthasre-visitedtheCentreforfurtherpolishingandareview.Posteriorteethhavebeguntocomebackintoocclusion.
Periodontal&RestorativeCaseNeilWilson&VictoriaRichards-Carter
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www.centralenglandreferrals.co.uk©2017
Thepatientwasadvisedthatthecompositerestorationscanstainandwearovertime,meaningtherewillbefurtherinvestmentintheirbuildups.However,thetreatmentcarriedouthasbeenveryconservativeastoothstructurehas
notbeendamaged.Thiswasaveryrecentcase,butthepatientwasextremelyhappywiththeresult.Wewillcontinuetoreviewthe
patientandhelphimtomaintainhisperiodontalhealth.
Periodontal&RestorativeCaseNeilWilson&VictoriaRichards-Carter
Click here to refer to CESRC or: Call 0121 478 3770 Email [email protected]
Typesofpatienttobereferred:
Advancedrestorative
Complexdentalimplantwork
ProsthodonticsReferra ls to Ne i l Wi l son
www.centralenglandreferrals.co.uk©2017Periodontal&RestorativeCaseNeilWilson&VictoriaRichards-Carter
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