L E B A N E S E U N I V E R S I T Y- S C H O O L O F D E N T I S T RY

D U B 1 - D R E

S T E P H A N I E M O U AWA D

0 9 - 0 3 - 2 0 11

Problem Based Learning:

Clinical case

Case presentation

Mr. I.

Age: 75

Sex: Male

Localized hypersensitivity

Cervical lesions

Chronic periodontal disease

Occlusal overload

Diastemas

Localized hypersensitivity

Possible causes:

Pulp exposure and potential pulpal

pathology

Exposed root

Enamel loss with exposed dentin

1- Defining the problems

#14

Cervical lesions on premolars and molars

Tensile stresses causing

abfraction,

Associated with other local

chemical and biomechanical

factors, causing erosion and

abrasion

Increased stress (tooth # 14:

opposing crown)

Severe chronic periodontal disease with gingival recession

RECESSION

SEVERE BONE LOSS

Poor oral and dental

hygiene

Occlusion problems

and bad parafunctional

habits

Occlusal overload

Incisal WEAR

Malocclusion

Parafunctional habits (bruxism)

Important upper and lower anterior Diastemas

•Periodontal disease

•Occlusal overload

•Inter-arch tooth size

discrepancies

2- Elaboration of a treatment planning

A- Medical History

The patient is asked to declare any medical

condition (present and past)

B- Sequencing of treatment

1- Chief complaint

2- Preventive measures (motivation to oral care)

3- Interdisciplinary discussion (periodontist/ orthodontist)

4- Discussion of treatment options with patient (take

consent to proceed)

5- Treatment procedure

Indirect pulp

capping

1- CHIEF COMPLAINT: Tooth # 14

RCT

2- Preventive measures

3-Interdisciplinary discussion

Occlusion adjustment

Root scaling

Orthodontic treatment (?)

Option 1

Direct composite Veneers

4- Discussing the options with the patient

ClV composite Cl V comp/

Endo+ Crown

Crown replacement

Post. teeth Tooth #14 Tooth #44

Option 2

Orthodontic

Cl V composite/ crown Cl V composite

Cl I Incisal

14

13 11 23

16

15

45

46 44 41 31

Cl V composite Crown replacement Cl IV composite

PS

If Orthodontic movement creates large

posterior space, then consider RPD

with dento-mucosal support

Option 3

Cl V composite/ crown

Cl V composite

Cl I Incisal

14

13 11 23

16

15

45

46 44 41 31

Cl V composite Crown replacement Cl IV composite

Option 4

splinting

Stabilization of loose teeth and occlusion

Types:

- Fixed: Wire & composite splints, Ribbond

- Removable appliances: Hawley, Clear tray

Wire & composite

technique

Ribbond

unfilled bonding adhesive

filled composite

flowable composite

Removable

appliances

?

+ night guard??

Treatment Aesthetics Preservation Resistance Cost Time

*Direct Veneers(C) * ClV post *Crown 44 And or Crown 14 *Splinting

+

(large gaps = large teeth)

- - ok short

Review

Treatment Aesthetics Preservation Resistance Cost Time

*Orthodontic *ClV, ClIV, ClI(C) *Crown 44 And or Crown 14 *Splinting and retention

+++

+++ +++ High Long

Treatment Aesthetics Preservation Resistance Cost Time

*Full mouth restorations with crowns *Splinting

+ (long crowns)

-- ++ High Ok

Treatment Aesthetics Preservation Resistance Cost Time

*Keep the diastemas *ClV, ClIV, ClI(C) *Crown 44 And or Crown 14 *Splinting

- +++ +++ Low short

+

Age

+

Motivation

+

Patient Preferences

Option #4Keep the diastemas, treat all other lesions

Option # 1Direct composite Veneers

5- Proceeding with the treatment

Maintenance and recall

Check the state of the splints/effect of night guard

Check for gum health and bone support

checkups every 6 months for overall treatment control

Thank you