EFFECT OF RESTORATION ON PERIODONTAL HEALTH

HISTORY Name Address Education Occupation

Age

Gender FM / M

CHIEF COMPLAINT:

PAIN Yes \ No Site Localized Generalized Onset Sudden After stimuli Always Character Deep & Dull Sharp Throbbing Radiation Yes / No Aggravated by Relieved by

Duration 10-15 sec > 1 min < 1 min

FOOD IMPACTION Yes / No HOW REMOVED? Wood stick Dental Floss Any other mean BRUSHING Yes / No Frequency / day Type

EXCLUSION CRITERIA Smoking Any Systemic Problem Pregnancy Any Long term Drug Hx Stress EXAMINATION SOFT TISSUE Bleeding Swelling Recession Abscess

Yes Yes Yes Yes Yes

/ / / / /

No No No No No

Yes Yes Yes Yes

/ / / /

No No No No

 RESTORATION Tooth #

Duration of Restoration Cavity Design II III V Restorative Material Amalgam GIC Composite Resin Crown/Bridge Abutment If Crown /Bridge Supra gingival Equi gingival Sub gingival Probing Depth Up to 2mm 2-5mm 5-7mm >7mm Clinical Attachment Loss = Pocket depth distance from gingival margin to CEJ Pocket depth + distance from gingival margin to CEJ

RADIOGRAPHIC EXAMINATION Bone Loss Yes / No Overhang Margin Yes / No Periapical Radiolucency Yes / No

 GINGIVAL RESTORATION INDEX GRI = 0 (No dental restoration in the gingival area or margin of dental restoration closer than 1mm to gingival margin) GRI = 1 (Supragingival margin of dental restoration extending less than 1mm below gingival margin) GRI = 2 (Sub gingival margin of dental restoration extending more than 1mm below gingival margin) GRI = 3 (Grossly insufficient marginal fit of dental restoration in supra &/or subgingival location) PLAQUE INDEX

17 47

16 46

15 45

14 44

13 43

12 42

11 41

21 31

22 32

23 33

24 34

25 35

26 36

27 37

GINGIVAL INDEX

17 47

16 46

15 45

14 44

13 43

12 42

11 41

21 31

22 32

23 33

24 34

25 35

26 36

27 37