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Perio Project

Perio Project. Carly Memsic & Kay Shepherd. Personal History. Name : Antonio Rodriguez  Date of Birth:     2/11/1960          Age: 50  Sex: Male Race : Hispanic , only speaks Spanish Occupation : Construction

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Perio Project

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  1. Perio Project CarlyMemsic & Kay Shepherd

  2. Personal History • Name: Antonio Rodriguez •  Date of Birth:     2/11/1960         Age: 50 •  Sex: Male • Race: Hispanic, only speaks Spanish • Occupation: Construction •  Marital status: Married with 4 children

  3. Medical History Review • Patient denies any systemic illness, past or present. • No medications • Baseline vitals: BP: 122/88 P: 78 R: 16. • Modifying factors: Smoker

  4. Dental History Review • Last dental visit: 3 years prior in Mexico • Extensive history of decay. • Chief complaint: Needs a teeth cleaning.

  5. Treatment Plan

  6. Radiographs

  7. Radiographs

  8. Radiographs

  9. Radiographs

  10. Radiographs

  11. Radiographs

  12. Radiographic Evaluation • Crown to Root Ratio: Generalized 1:2, posterior sextants and maxilary anterior sextant. Generalized 1:1 in mandibular anterior sextant. Localized 1:1 on teeth #'s 20 and 28. • Poor crestal bone denisty • Disturbances in trebeculation in edentulous areas around #18 and #32 • Furcation involvement • Generalized 2-3 mm horizontal bone loss • Poorly defined lamina dura. • Localized widening of the PDL on the distal of tooth # 29. • No periapical pathology.

  13. Pre-Treatment Status

  14. Periodontal Evaluation • Pocket depths:  generalized 4-5mm pockets with localized • 3 and 6mm pockets. • Calculus: • Medium-heavy, tenacious subgingivalcalculus concentrated interproximally. • Moderate supragingival calculus. • Mobility: Generalized + mobility on all  maxillary incisors. • +1 mobility on #10A, 10B, 25 and 26. • Furcations: Class I: 2B, 14B, 14ML, 15B, 15DL 18B, 18L, • 32B, and 32L. Class II: 2ML and 14DL • Clinical Attachment Loss: Generalized 4-5, localized 6- 7 mm

  15. Gingival Description • Marginal and attached gingival • (1) Marginal:Erythmatic with localized cyanosis. • Attached: Coral with slight physiologic pigmentation. • (2) Marginal: Blunted. • (3) Marginal: Edematous, spongy. • Attached: Slightly spongy. • (4) Marginal: Shiny Attached: Slightly stippled. • MBI: 74% • Alveolar Mucosa: Generalized pink with slight physiologic pigmentation.

  16. Plaque Index • 91%

  17. Clinical Evaluation • Perpetuating factors: • Crowding in the maxillary anterior segment makes effective plaque removal at home difficult and exacerbates inflammation. • The lack of proximal contact for his mandibular molars undermines their periodontal integrity. • Etiology: Plaque accumulation. • Diagnosis: Generalized moderate chronic periodontitis with localized severe chronic periodontitis modified by smoking. • Prognosis: Fair to Poor

  18. Goal and Objectives • Goal: To arrest the progression of periodontal disease • Objectives: • Increased motivation/ value of oral care • Smoking Cessation • Improved oral hygiene techniques and frequency • Caries prevention • Complete removal of calculus • Management of oral bacteria • Gain in attachment levels • Decreased Inflammation

  19. Oral Hygiene Evaluation • Assessment of the patient’s skill level -  • Patient exhibits fair-poor skill level. • uncontrolled, rapid horizontal brushing strokes. • neglects proper adaptation and angulationof bristles along gingival margin and has difficulty brushing posterior teeth. • does not spend at least 2 minutes • rarely flosses • does not brush his tongue.

  20. Oral Hygiene Evaluation • Patient’s awareness of periodontal disease: • Patient is unaware • not concerned with the bleeding • aware of the risk that smoking has on overall health, but did not understand the negative influence of smoking on the oral cavity.

  21. Oral Hygiene Objectives • Improved brushing technique – Electronic toothbrush • Increased duration of brushing • Frequent use of interdental aids • Caries prevention - CAMBRA • Smoking cessation • Tongue cleaning

  22. Indices • Gingival Index (GI) - used to measure the degree of inflammation This index is reversible Gingival index pre treatment: 2.2 • Periodontal Disease Index (PDI) - used to measure the degree of disease, with greater emphasis placed on advanced disease. This index is not reversible. Periodontal index pre treatment: 5.9

  23. Dental Hygiene Treatment

  24. Post-Treatment Status • PROBINGS: • Pre treatment: generalized 4-5mm pockets with localized 3 and 6mm pockets. • Post treatment: generalized 3-4mm pockets with localized 5mm pockets. Post treatment the patient gained a generalized tissue resolution of 1-2mm. • GINGIVAL DESCRIPTION: • 1.    Pre treatment: Generalized edema and redness. • 2.    Post treatment: Localized edema and redness with generalized coral tissue. • 3 Month Recare

  25. Post- Treatment Status - INDICES Marginal Bleeding Index: • Pre-treatment:74% • Post-treatment: 3% • 71% Improvement Plaque Index: • Pre-treatment: 91% • Post-treatment: 80% • 11% Improvement Gingival Index: • Pre-treatment: 2.2 • Post-treatment: 0.6 • Improvement of 1.6 Periodontal Disease Index: • Pre-treatment: 5.9 • Post-treatment: 5.9 • This index is irreversible

  26. PHOTOS • Pre-treatment Post-treatment

  27. PHOTOS • Pre-treatment Post-treatment

  28. PHOTOS • Pre-treatment Post-treatment

  29. PHOTOS • Pre-treatment Post-treatment

  30. PHOTOS • Pre-treatment Post-treatment

  31. PHOTOS • Pre-treatment Post-treatment

  32. PHOTOS Post-treatment • Pre-treatment

  33. Summary • Patient developed an awareness and interest in proper oral health. • Patient was compliant and receptive. • Patient now has the OH tools and education for proper maintenance and management of periodontal disease. • Prognosis will be determined by his compliance and smoking habit. • Patient has a limitation with access to care, but referral to a periodontist and orthodontist would improve prognosis. • Patient may benefit from local statin therapy. • Our goals and objectives were met.

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