Clinical Case: Miss Acherona Scratch

Miss Scratch has presented complaining of a tooth that is tender to bite on

Study the case information and photographs by running your mouse over the picture bar on the right. Then answer the questions below.

Diagnoses
Aetiology
Treatment Plan
Endodontics
Periodontology
Diagnoses

Q1
In broad terms, what diagnoses have you made for Miss Scratch? Your answer should include:
• Chronic Marginal Gingivitis (esp UL1)
• Apical periodontitis UR4
• Minimal tooth wear (mainly LR3)
• UR8 Over-erupted
• LR8 Un-erupted and impacted

Remember - diagnoses are generally simple statements - do not confuse them with aetiology.




Q3
Why has UR4 become non-vital? • From pulpal infection. This may have been due to caries, or exposure of the pulp to infection when the tooth was restored.



Q6
Despite a cavity dressing, UR4 is still tender. What immediate treatment would you do to relieve pain? • Under rubber dam. the dressing should be removed, and pulp remnants extirpated from the chamber and canals as far as the curve.
• If there is time, a coronal flare should be created.
• The canals should be liberally irrigated with Sodium Hypochlorite during this, then dressed.
• A temporary restoration should then be placed, providing a good coronal seal.



Q7
What would you use to dress the root canals? • Non-setting Calcium Hydroxide paste (e.g.Hypocal)



Q8
What materials could you use for a temporary restoration? • Polycarboxylate Cement (e.g.PolyF) or Zinc Phosphate Cement are dressings of choice, as they are hard-wearing.
• Zinc Oxide-Eugenol (e.g. Kalzinol) will probably fail as this is a 2-surface cavity.
• Glass Ionomer Cement (e.g. Chemfill) can be used, but it can be difficult to accurately remove later as it is tooth-coloured.



Q9
After discussion, the patient insists that an attempt to save UR4 is made. How would you manage the endodontic treatment? • This is a difficult case, and warrants referral to a specialist.



Q11
What is the relevance of the occlusion in this case, regarding UL1? • Periodontal disease can be accelerated by occlusal trauma, e.g. if the crown on UL1 had premature contacts (interferences) in intercuspal position or excursions.



Q12
What other considerations of crown design and fit may be relevant from a perio viewpoint? • Poor marginal fit (ledges etc)
• Poor contour (re food shedding)



Q13
The patient scored 2 in all sextants in the BPE. What does this mean? • Coloured area of probe remains completely visible in the sextant's deepest pocket.
• Supra or sub-gingival calculus, or other plaque retention factors, are detected.



Q14
What treatment is (generally) needed for a sextant that scores 2 in the BPE? • OHI
• Removal of calculus
• Correction of plaque retentive margins on restorations.

That concludes this clinical case. We hope you have found it useful.

Thanks for using the programme

Giles Perryer
Educational aims of this juce

 This Clinical Case involves a 35 year old woman who has attended you with a tender tooth.
   You will examine the patient and the radiographs, and devise a treatment plan.
 You will be asked questions about aspects of her dental conditions and care, and given model answers.
 Excellent practice for professional examinations involving real "unseen" patients!

This page contains verifiable CE / CPD




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