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Slide#:
1. AAP title slide
2. Personal profile:
The patient was referred to OHSU Department of Periodontology for a comprehensive
periodontal examination by her general dentist on Oct 16, 2006. The patient is a 53 year
old Caucasian female who resides in SE Portland, OR. She works as a self employed
graphic artist. The patient was asymptomatic at her initial visit and her chief complaint
was, I want to save my teeth from falling out.
3. Medical and Social History:
Vital signs were recorded on Oct. 16, 2006 and were WNL. The patient considers herself
to be in good health. The patient sees a medical doctor twice a year for routine checkups. The patient has been diagnosed with hypercholesterolemia and depression at the
time of the comprehensive periodontal examination. Patient reports no history of
inheritable diseases and both parents have healthy dentitions. The patient states she
socially smoked cigarette tobacco and socially imbibes alcohol. During the course of
treatment, with encouragement, the patient quit smoking. Patient denies recreational use
of drugs. Patient shows great motivation in achieving oral health and retaining teeth.
4. Medications:
She reports ingesting prescription medications of Fluoxetine-20mg/day for depression
and Atorvastatin-20mg/ day for high cholesterol.
The patient states she is allergic to penicillin.
5. Extra/Intraoral History and Findings:
Clinical extraoral history and findings, intraoral history and findings including
periodontal examination, occlusal analysis, and radiographic findings were documented.
Please refer to your case report summary.
6. Pre-Treatment Chart:
CAL, BOP, probing depths, presence of plaque, gingival recession, furcation
involvement, tooth mobilities, and other clinical findings are illustrated. Please refer to
the pre-treatment case report record for further details.
7. Disclaimer:
None of the photographs in this presentation have been altered with the exception of
cropping out background images and re-orientation of the photographs so that they
appear as if the viewer is looking directly into the patients mouth. The exception being
the maxillary/mandibular anterior lingual teeth, which are projected as if you are sitting
on the patients tongue.
8. Anterior View:
Questionable
Short Term
All teeth except teeth those
below
2, 3, 14, 15, 22, 23, 29, 31
Unfavorable
24, 25
24, 25
Favorable
Four Phases:
1. Phase I Treatment: Non-Surgical
2. Phase II Treatment: Surgical
3. Phase III Treatment: Restorative
4. Phase IV Treatment: Maintenance
Overall Goal:
1. To establish a dentition and periodontium which the patient and the
provider can maintain in health, comfort, function, and aesthetically
acceptable long term.
Goals would be accomplished through:
1. Elimination or control of primary factors and risk factors
2. OHI reinforcement
3. Ensuring patient compliance
27. Phase I Treatment:
Complete PARQ (informed consent for treatment)
Oral Hygiene instruction
Four quadrants scaling and root planing
Re-evaluation in 4 weeks
Smoking cessation program
Fluoride treatment
Occlusal Adjustment on tooth #14 if indicated
28. Phase II Treatment: Surgical
Osseous surgery in Maxillary Right and Left Posterior Sextants
Regenerative Surgery Mandibular Right Posterior Sextant
Open Flap Debridement Mandibular Anterior Sextant
29. Treatment Plan-Phase III
Restorations-#3, 14, 15
Occlusal adjustment if indicated-#14
Fabrication of an occlusal night guard
30. Treatment Plan-Phase IV
3- month maintenance intervals
31. Stage II Surgery: Guided Tissue Regeneration Surgery Mandibular Right Sextant
Written informed consent signed and received
32. Pre Surgical Presentation-buccal
Pre-surgical vital signs: BP -115/82, Pulse - 63
Patient premedicated at the time of surgery with 800mg ibuprofen and rinsed with 0.12%
chlorhexidine for 1 minute
Local anesthesia achieved with 2% Lidocaine HCL with 1:100,000 epinephrine (0.018
mg/carpule x 1 )
Papillary and marginal gingiva appears slightly edematous, rolled, and slightly boggy,
with smooth texture
Papillary gingival contours appear pointed to slightly blunted
33. Pre Surgical Presentation lingual
Papillary and marginal gingiva appears slightly edematous, rolled, slightly boggy, with
smooth texture around #30 and 31
Papillary gingival contours appear pointed
34. Buccal Incisions
Intrasulcular incisions to the alveolar crest was made from the distal line angle of tooth
#27 to the distal facial line angel of #31.