Enhanced Verifiable CPD from the
University of Birmingham

Virtual Patient
Keyser Sose


Intro Before you start, use the Magscope (above) to look around the mouth and examine the teeth. You can magnify and drag the image.

Get a feel for what is going on, and what the main problems might be.

Then go through the programme using the back-next buttons, and see if you have thought about the same things as we have...


This section has 6 questions on this patient's periodontal condition.
To remind yourself of the patient's history, click the HISTORY button under the main picture. Click again to return to the magscope.
Now answer the question below...

Describe this patient's oral hygiene.


2 Describe the marginal gingival features that lead to the diagnosis of gingivitis.


3 Study the interproximal area Lower left 5 and 6. Has there been any significant bone loss?


4 Tooth positional irregularities can often make one suspect bone loss where there is none.
Which of the upper 5 distal and upper 6 mesial have significant bone loss?


5 How do you explain the absence of periodontal disease (attachment loss) in a 55 year old patient who smokes, has very poor oral hygiene, and extensive marginal gingivitis?


6 How will you manage his periodontium?


This section looks at the reasons for the failure of the post crown UR2. The cast post had fractured, and (after being radiographed) the root was extracted.

Upper Right 2
This is a view of the extracted 2 root. Why did the post fracture?


8 Upper Right 2
Apart from the porosity, this post crown was badly designed, and may well have failed in the future anyway. We will now look at the design features necessary for a successful post crown.
What are the "rules" regarding provision of a ferrule effect? Does this preparation follow the rules?


9 Upper Right 2
A post should never be less than a certain length. This post was 7.5mm long. Did this post meet this "rule"?


10 Upper Right 2
A Post should be (at least) as long as the crown it will support. Did this post meet this "rule"?


11 Upper Right 2
Ideally, at least 5mm of root filling should be left undisturbed after a post prep, and there is 5mm here.
What is the very minimum that can be left, and why?


12 Upper Right 2
The root filling should be sealed off at the base of the post prep, e.g. with Glass Ionomer, to prevent re-infection of the apical canal if the post should ever come loose. Has this root filling been sealed?


13 Upper Right 2
You have now identified a number of faults with the post design. Outline how you would have prepared this post crown to avoid these faults (assume you are making a custom cast post).
• How much root filling will you leave?
• How thick will the Glass Ionomer seal be?
• How deep will the post hole be?
N.B. It takes a bit of thought and measurement to come up with an acceptable design.


This section looks at the options for replacing UR2. We will start by examining the patient's dynamic occlusion, particularly the relationship between the right canines.
This picture shows the mandible in right excursion (not intercuspal position).

Lower Right 3
The LR3 crown was fitted 3 years ago. It has a rough surface where it has been adjusted occlusally. What has been the consequence of fitting it? (Have a look at the upper canine here.)


15 Canine Guidance
Is it necessary to restore canine guidance? Why, or why not?


16 UR2 Replacement Options
Broadly, what are the options regarding UR2?


17 UR2 Replacement Options
The patient is insistent on having UR2 replaced, so "do nothing" is not appropriate.
His oral hygiene will need to be improved, but is unlikely to ever be "good".
What is the most appropriate replacement option? Why?


18 UR1
Why do you think UR1 was crowned? (Check out UL1 for comparison)


19 UR1
What do you make of the radiolucency UR1 tip? (The tooth is vital.)


20 Bridging the UR2
There are two obvious abutments for a 2-unit cantilever bridge: UR1 or UR3.
What would you consider in making the choice?


21 Study Casts
Why should we mount study casts (with facebow transfer) onto a semi-adjustable articulator ?


22 Treatment Plan
Outline the steps in your provisional treatment plan. Split it into short-term and long-term.


23 Summary
We hope you have enjoyed working with this "Virtual Patient".
You may not agree with the way we would manage this patient, but if not, we hope it has got you thinking about alternative approaches.
Thanks for using the programme.

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