Case Approach

Individualised care

Focus on prognosis & longevity of natural dentition

Back up plans?

Rem/Fixed Pros

Full Mouth rehabs

Ex. Endo on a lower 6 in a 12 y.o = not a great idea if cannot be avoided as the has to last a lifetime

Do we need to involve the family in decisions?

What are the patients attitudes and expectations

Systematic Approach to photos

1.Periphery

2.Perio& OH

3.Toothwear

4.Teeth/restorations

5.Caries& other

Start w/ the frame
Don't just start with the issues
Describe what you see efficiently

Identification of dental disease

Caries

Periodontitis

Toothwear

Oral Cancer

Provide sensible differential diagnosis

Conservative, 'reversible management' intially

Primary Care
Secondary Care
Stabilisation & Review
Maintence and Monitoring
Rehabilitaion

Clinical_Ser_003_crop

"This is a intraoral clinical photograph of the patients mouth in quadrant 4"

"Image is bordered on the RHS by the tounge and LHS by the lip/buccal sulcus, there appears to be adequate salivary flow present"

"Periodontal health is in !? health, gingival biotype is !?"
" The extent of tooth wear is!? "
" Tooth 48 to 44 are present - all restored... 44/45 have MOD composite resin restorations that appear to have some occl staining, 46 a full coverage white restoration, and 47/48 occl amalgam restorations that appear to have developed some creep or coronal leakage

radiograph

Outside --> Inwards

  • surrounding bone (assoc. structures, densiity ect..)
  • perio (bone levels)
  • caries (P lesions)
  • Tooth wear (hard tissue loss)
  • Oral Cancer/Path (radioopacities/lucencies)

crown

root

periapical area

"This is a periapical radiograph of teeth in quadrant 4. We can see tooth 45 to 48. 48 is not completely visible in this radiograph. The bone is of normal density. Generalised horizontal bone loss present, Suggestive of hx of but there is veritcal bone loss associated with the interproximal of 47 suggestive of active/progressive periodontal disease.

22

The crown and apicies of 45-47 are clearly visible.
Unable to comment on the tooth wear.
The crowns are heavily restored with very radio-opaque materials possibly amalgam. 47 has two roots and two visible canals. There appears to be blunting of the pulpal horns and wideing of the PDL space and possibly a PARL at the apicies.

  1. Assess the periphery and corners of the image
  1. Examine the outer cortices of the mandible
  1. Examine the cortices of the maxilla
  1. Examine the zygomatic bones and arches
  1. Assess the internal density of the maxillary sinuses
  1. Assess the structures of the nasal cavity and the palates
  1. Examine bone the pattern of the maxilla and mandible

This includes:

  • orbits
  • articular processes of the temporal bone
  • cerivical spine
  • styloid processes
  • pharynx
  • hyoid bone

Trace in a circle:

  • anteior/posterior rami
  • coronoid processes
  • condyles/condylar necks
  • inferior border
  • continiyuity of cortices
  • Posterior/Medial walls
  • Floor of Max sinuses
  • Zygomatic processes/ pterygomaxillary fissure

Extend posteriorly from the zygomatic processes of the maxilla to the temporal bones.

  • Compare LHS to RHS
  • Opacification (inflammatio or diease)
  • nasal floor/hard palate and conchae extending horizontally along both sides
  • nasal septum
  • assess the density and pattern of the trabeculae for abnormalities
  • assess size, position, cortication and symmetry of the: IAN canal, mandb foramina, mental foramen

Future Care ie Prosthodontic Rehab?