Comprehensive Care Treatment Plan Presentation | Dr. Alfred Khallouf
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Transcript of Comprehensive Care Treatment Plan Presentation | Dr. Alfred Khallouf
![Page 1: Comprehensive Care Treatment Plan Presentation | Dr. Alfred Khallouf](https://reader031.fdocuments.us/reader031/viewer/2022021919/587820e91a28aba12d8b67d7/html5/thumbnails/1.jpg)
Welcome to the AEGD-2
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Comprehensive Care Treatment Plan Presented by
Captain Alfred G. Khallouf AEGD-2 Resident
Class of 2005
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Introducing Our Patient
63 years old Male African-American Attitude-Positive Patient type- Philosophical
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Historical Notes
Retired from USAF in 1984 as a MSgt Married with 6 kids and 8 grandchildren and 2 great-grandchildren States that he is in good health and somewhat active Lived in San Antonio area since 1982
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Subjective Findings
Chief Complaint: “I have a bunch of problems I want to fix.” Denies any history of smoking Sporadic dental tx. at a civilian dentist. Other major concern is missing crown from tooth # 7
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Medical History AF Form 696
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Medical / Systemic
History of back surgery to replace 2 cervical disks. Undergoing Physical Therapy at WHMC Seen at WHMC for Arthritis and high B.P. which is controlled by medication B.P. average: 138 / 88 Reports no known drug allergies
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Medication
Aspirin 350mg daily Celecoxib 200 mg twice daily Effexor 75 mg once daily Indocin 50 mg daily
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Med use, regimen, effects and concerns
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Oral Pathology
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Oral Pathology
Sinus Tract present adjacent to # 30, asymptomatic Subgingival Caries extending into pulp Class II Furcation involvement Dx. Pulpal Necrosis w/ Chronic Apical Periodontitis
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Oral Pathology
5x2x3mm pedunculated pink lesion with fingerlike projections in the floor of the mouth Patient unaware of asymptomatic lesion Differential Diagnosis ● Squamous Papilloma ● Verruca Vulgaris ● Condyloma Acuminatum
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Restorative Findings
Caries risk: High Numerous Carious teeth and defective restorations: #s 3-MODFL; 5-O; 6-F; 7- missing crown; 8-MI; 9MID; 10-L; 11-F ;12-MOD; 13-O; 14-MODL; 15-MO; 30-MODFL; 31-MODFL; 32-O Cervical abrasion/abfraction lesions: Generalized
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Anterior Dentition View
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Maxilla
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Max Right Sextant
1- Missing 2- Missing
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Max Right Sextant
3- Defective MODL Amalgam restoration
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Max Right Sextant
4- No treatment 5- Defective Occlusal Amalgam restoration
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Max Anterior Sextant6- Class V abrasion on Facial 7- Prior RCT completed greater than 10 years ago
with a missing crown
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Max Anterior Sextant8- Class IV chip, MI 9- Class IV chip, FIDL with a lingual amalgam
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Max Anterior Sextant10- Defective lingual amalgam 11- Class V abrasion on facial
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Max Left Sextant12- Defective MOD amalgam 13- Defective Occlusal amalgam
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Max Left Sextant14- Defective MODL Amalgam restoration and
Supraerupted
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Max Left Sextant15 Defective MO Amalgam Restoration and Supraerupted 16- missing
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Anterior Dentition View
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Mandible
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Mand Left Sextant
17 – missing 18 – missing 19 – missing
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Mand Left Sextant
20 – 2 small pit occlusal amalgams 21 – missing 22 – No Treatment
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Mand Anterior Sextant
23 – no treatment 24 – no treatment 25 – no treatment 26 – no treatment 27 – no treatment
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Mand Right Sextant28- Existing Gold crown over 42 years 29- Existing MODL Amalgam with 2 pins
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Mand Right Sextant30- Defective MODFL Amalgam restoration
with a pin and associated periapical pathology and sinus tract and furcation involvement
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Mand Right Sextant
31- Defective MODFL Amalgam restoration with 2 pins
32- Existing occlusal Amalgam restoration and also is supraerupted and not in occlusion
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Endodontic Findings
3- defective restoration ● Asymptomatic ● No positive findings to palpation, percussion ● Endo Ice and EPT response WNL ● Recurrent Caries ● Periradicular Dx: Normal ● Pulpal Dx: Normal
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Endodontic Findings
7- crown missing since June 2003 ● Obturation radiographically and clinically
acceptable ● No contamination noted ● Asymptomatic- No positive responses ● Gutta Percha short about 2 mm ● May require retreatment for adequate post
length ● Periradicular Dx: Normal ● Pulpal Dx: Pulpless
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Endodontic Findings
14 and 15 ● Supraerupted ● Asymptomatic ● Re-establish Occlusion ● Calcified Canals beginning
to form ● Periradicular Dx: Normal ● Pulpal Dx: Normal
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Endodontic Findings29- Asymptomatic ● No positive findings to palpation, percussion ● Endo Ice and EPT response WNL ● Abutment tooth for a 3-unit FPD ● Periradicular Dx: Normal ● Pulpal Dx: Normal
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Endodontic Findings30- asymptomatic ● Sinus Tract present with sensitivity to palpation ● Subgingival Caries extending into pulp ● Class II Furcation involvement ● Periradicular Dx: Chronic Apical Periodontitis ● Pulpal Dx: Pulpal Necrosis ● Nonrestorable: to be extracted
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Endodontic Findings
31- Defective restoration ● Recurrent decay ● No positive findings to palpation, percussion ● Asymptomatic ● Endo Ice and EPT response WNL ● Abutment tooth for a 3-unit FPD ● Periradicular Dx: Normal ● Pulpal Dx: Normal
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AF form 935 Periodontal Charting
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Periodontics
Modified O’Leary 42% PD: 1-6mm BOP: 15 of 25 teeth Mobility: Cl I #30 Diagnosis: ● Localized Chronic Moderate Periodontitis: #11-15,
31. ● Localized Chronic Severe Periodontitis: #3, 30, 32 ● Generalized Gingivitis
Etiology: 1) Plaque 2) Calculus
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Periodontics: Prognosis
Short term: ● Overall: Fair ● Individual: #30 and 32- Hopeless
Long term: ● Overall: Fair ● Individual: Questionable # 3 and 15
Perio Maintenance: Every 3-4 months
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OrthodonticsMand Ant. crowding about 3 - 4mm Midline discrepancy: mand 2 - 3mm to the left Pt. states he is not interested in Orthodontic Tx.
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OcclusionAngle class I molar on right side Class I premolar on left side Loss of VDO due to missing # 17, 18, 19 and 21 Supraerupted # 14, 15, 32 TMJ: Asymptomatic
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Oral Surgery
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Oral Surgery30- nonrestorable 32-malposed and not in function or occlusion Lesion in F.O.M.
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Prosthodontics
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Prosthodontics
Missing teeth: #1, 2, 16, 17, 18, 19, 21 Single crowns: #3, 7, 14, 15, 3-unit Fixed Partial Denture: #’s 20 – 22, 29 - 31 Mandibular Removable Partial Denture replacing missing teeth #’s 18 & 19
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Treatment Plan by Phase
I. Emergency Care ● Extract # 30 & 32 ● Biopsy lesion in F.of M.
II. Medical / Systemic ● Consult with Physician for Contraindications ● High Caries Protocol and Dietary Counseling
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Treatment Plan by Phase
III. Diagnostic / Initial Therapy ● Medical Model and Caries Control ● OHI- Brushing & Flossing ● Extract Hopeless teeth ● Endo- Retreat RCT # 7prn and other RCT prn ● Sc/RP- site specific # 3,11-15, 28-32 ● Operative/Restorative
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Treatment Plan by Phase
1 & 2: No Treatment – not to be replaced 3: Possible RCT with Full Gold Crown & Crown
lengthening prn 4: No Treatment 5: Replace with Occlusal amalgam 6: Replace with Glass Ionomer or composite 7: Retreat RCT prn for post length, Cast Post & Core and
PFM crown 8: Replace with Composite 9: Replace with Composite 10: Replace with lingual composite
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Treatment Plan by Phase
11: Replace with Glass Ionomer or composite 12: Replace with MOD amalgam with enameloplasty
to adjust occlusion prn Class V abrasion, replace with Glass Ionomer or composite
13: Replace with occlusal amalgam 14: Intentional RCT prn to allow for crown (Full Gold)
due to supraeruption and re-establish occlusion 15: Intentional RCT prn to allow for crown (Full Gold)
due to supraeruption and to re-establish occlusion 16: No Treatment
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Treatment Plan by Phase
17: No Treatment 18: Replace with Denture tooth from RPD 19: Replace with Denture tooth from RPD 20: Abutment tooth for a 3-unit FPD &
Wrought wire clasp and distal rest 21: Replace with pontic from 3-unit FPD 22: Abutment tooth for a 3- unit FPD &
Cingulum Rest for RPD 23: No Treatment 23: No Treatment 24: No Treatment 25: No Treatment
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Treatment Plan by Phase
26: No Treatment 27: No Treatment 28: Mesial Rest for RPD 29: Abutment tooth for a 3- unit FPD with a mesial rest for
an RPD & possible RCT prn 30: Extract and replace with Pontic from 3-unit FPD 31: Abutment tooth for a 3- unit FPD & Cast ½ round clasp
from distal and distal rest with possible RCT prn 32: Extract and not to be replaced
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Treatment Plan by Phase
IV. Re-Evaluation ● Check O.H. and Pt. Compliance ● Re-chart 935 ● Assess Key Teeth # 20, 22, 29 & 31
V. Corrective Surgical ● Ridge Augmentation prn ● Orthodontics: which pt. does not desire ● Prosthodontics
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Treatment Plan by Phase
Single Crowns ● #3, 14 and 15- Full Gold Crown ● #7- Porclein Fused to metal 3-unit Fixed Partial Denture ● #20 – 22: Pier Abutment Survey Crowns ● #29 – 31: Pier Abutment Survey Crowns
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Treatment Plan by Phase
Mandibular Partial Denture ● Kennedy classification II, modification I ● Major Connector: Lingual Plate ● Clasp Assembly # 20 and 31
● #20: Wrought wire clasp and distal rest ● #22: Cingulum Rest (indirect retainer) ● #28: Mesial rest ● #29: Mesial rest ● #31: Cast ½ round clasp from distal and distal rest ● Denture Teeth replacing # 18 and 19
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Treatment Plan by Phase
Nightguard / Occlusal Guard
VI. Maintenance ● Re-evaluation ● Perio Recall every 3-4 months
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Alternative TX. Plan #1
Maxilla ● Extract teeth # 14 and 15 Mandible ● Do NOT fabricate an RPD ● Keep the pt. in only 2nd premolar occlusion
on the left side
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Alternative TX. Plan #2
Maxilla ● Extract teeth #3, 14 and 15 ● Fabricate RPD replacing teeth # 3, 14 & 15 Mandible ● Single unit Survey crowns for teeth #29, 31 ● Fabricate an RPD to replace teeth # 18, 19
and 30
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Alternative TX. Plan #3
Extract # 30 and fabricate a bilateral distal extention removable partial denture if we are not able to save # 30.
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They say 2 heads are better than one
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What I feel like now