Periodontal Case Study

Reina Ligeralde
DEH 23
5.30.08
Patient Profile and Chief Complaint
Name: Abby Fraction
Age: 27
Ethnicity: Asian
Occupation: graduate student
Chief complaint: teeth cleaning
Medical History
Childhood vaccinations in 1981
Completed hepatitis B vaccination series in 1997
Menstruates regularly, every 30 days
Paternal grandfather had liver cancer and type II diabetes mellitus
Practices birth control: Ortho Tri-Cyclen Lo
Takes a multivitamin daily
BP: 110/65, P: 73, R: 16
ASA II
Dental History
Four 3
rd
molars extracted 3/00
Porcelain crown on 7 in 2006
Last dental exam and teeth cleaning: 9/07
Last dental x-rays: FMX at RCC 4/08
Clinical Findings
E & I
Periodontal Exam
Calculus
Radiographic Exam
ADA and AAP Classification
E & I
Bilateral 3 mm X 2 mm nevi on auricles
Bilateral palpable submandibular nodes
Left side of TMJ clicking
Bilateral mandibular tori
Torus palatinus
Bilateral linea alba
Erythemic papilla on the anterior portion of the dorsal surface of the
tongue
Periodontal Exam
Free gingiva
generalized coral pink with localized cyanotic gingiva between 6 and 7 due to P crown
on 7, generalized scalloped, generalized firm, generalized smooth
Attached gingiva
generalized coral pink, generalized firmly bound down to underlying bone, generalized
stippled
Adequate salivary flow
Skeletal classification: mesognathic
Angles classification: class I bilateral molar relation with crowding in the
mandibular anteriors
Maximum opening: 44 mm
Periodontal Exam (continued)
MBI: 0%, BOP: 8.3%
Probing depths range
1-3 mms with localized 4 mms 30D & 31M
Recession
2 mm 2B, 3B; 1 mm 4B, 5B; 1 mm 10F, 11F; 2 mm 12B; 1 mm 14B; 1 mm 15L, 14L; 1
mm 3L; 2 mm 2L; 3 mm 31B, 30B; 1 mm 29B, 28B; 3 mm 27F; 3 mm 22F, 21B, 20B,
19B, 18B; 1 mm lingual surfaces of 18, 22, 24-26, 28-31
Clinical Attachment Loss
2 mm 2B; 1 mm 3B; 1 mm 12B; 1 mm 15L; 1 mm 3L; 2 mm 2L; 3 mm 31B, 30B; 1 mm
29B, 28B; 2 mm 27F; 2 mm 22F, 21B, 20B; 3 mm 19B, 18B; 1 mm 18L, 31L
Mobility: + on 5, 7-10, 20-27
Fremitus: + on 8-10, 12
Furcation: none noted
Periodontal Exam and Calculus
Abfraction: 2-4, 11-12, 18-20

Attrition: 22-27

RCC calculus code: light
Radiographic Exam
1, 16, 17, 32 extracted
Restorations
7 has a P crown, 8 & 9 have facial composites, margins intact
Tooth findings
Possible decay: none noted
No radiolucencies around the apices of teeth noted
No internal or external root resorption noted
No dilacerations noted
Atypical tooth findings: 24-26 attrition

Radiographic Exam (continued)
Critique of angulation
Because the vertical angulation is off in the PAs, I would use the BWX for the periodontal
interpretation.
Trabecular pattern
Consistent throughout
Lamina dura
Present and consistent throughout, becoming fuzzy
Alveolar crest
Blunted in the posterior teeth and sharp in the anterior teeth, greater than 1.5-2 mm
apical to the CEJ, 1 mm bone loss at 3M, 12M, 13M, 15M, 20M, 21M, 28M, 29M, 30M
PDL space
3D, 4M, 5D, 6MD, 14M, 18M, 19D, 20D, 21D, 24M, 26D


Radiographic Exam (continued)
Furcation - interradicular radiolucency
19 noted
Calculus
7M noted
General osseous interpretation
No radiopaque or radiolucent lesions noted
Critique of Radiographs
Vertical angulation
Can see the occlusal plane in all the posterior PAs
Maxillary right posterior PAs and maxillary left molar PA need to increase angle
of PID
Maxillary left premolar PA and mandibular posterior PAs need to decrease angle
of PID
The maxillary premolar PAs should have been placed more parallel to the arch.
Horizontal angulation
The following films should have been adjusted to see interproximally.
Slightly: mandibular right molar PA and mandibular left posterior PAs
Severely: premolar BWXs, anterior PAs, maxillary right posterior PAs, maxillary
left premolar PA, and mandibular right premolar PA
ADA and AAP Classification
ADA II
AAP: generalized slight chronic periodontitis due to mechanical
forces modified by plaque and calculus
Dental Health Education
Oral plaque therapy
aids
Appt
1
Appt 2 Appt 3 Type/Age
nt
Method taught
Disclosing 5.1.08 GUM
Toothbrushing 5.1.08 soft Bass: twice/day
Floss 5.15.08 Glide C-shape:
once/day
Pockets/
Probing
4.24.08
Nightguard 5.15.08 daily
Rationale for Case Selection
Medical history/systemic health
Birth control
Systemic & oral risk factors
Grinding, mechanical forces
Dental hygiene diagnosis
Perio: uncontrolled
Caries: controlled
OHI: adequate
Influencing cultural & social factors: young with stress as a graduate student

Rationale for Case Selection
(continued)
Oral health education/strategies
Soft brush with Bass method
Floss
ACT mouth rinse with fluoride
Nightguard
Reevaluations
19 buccal due to decay
Abfraction areas: 2-4, 11-12, 18-20



Rationale for Case Selection (continued)
Referrals
19 buccal due to decay
Abfraction areas: 2-4, 11-12, 18-20 for possible restorations
Nightguard
Recall: interval: 4 months
Rationale: check referrals and bone levels

Goals
Maintain good oral
homecare and bone levels
Maintain MBI & BOP to
less than 10%
Reduce PI each
appointment
Treatment (Tx) Plan & Implementation
Treatment Plan Sequence Start Date Finish
Date
Appt 1
X-ray check 4.24.08 4.24.08
FMX 4.24.08 4.24.08
Assessments 4.24.08 4.24.08
DDS Exam 4.24.08 4.24.08
Appt 2
2nd check-in 5.1.08 5.1.08
PI, OHI 5.1.08 5.1.08
LR scale 5.1.08 5.1.08
Tx Plan & Implementation (continued)
Treatment Plan Sequence Start Date Finish
Date
Appt 3
UR, LL, UL scale 5.15.08 5.15.08
Selective polish 5.15.08 5.15.08
Fluoride 5.15.08 5.15.08
4-month recare
Pictures
Facial
Pictures
Maxillary arch lingually
Pictures
Mandibular arch lingually
Pictures
Abfraction on 11-12 & 18-20
Questions?