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ارائه تشخیص و طرح درمان -واحد درمان جامع -غزاله دریاکناری Name: F. E. Gender: Female Age: 33 Current state: Single, living with parents, no jobs Address: Afsarie, Tehran • Patient visits a dentist due to severe pain in the right side of lower jaw. • Lower right molar teeth are both suffering from caries. • Tooth # 31 is then restored and # 30 is prepared for endodontic treatment. • Further efforts of the GP to treat tooth # 30 fails and the patient is referred to Tehran University, Faculty of dentistry. • No present or previous history of systemic/acute illnesses. • No drug is taken by the patient at present. • Patient was hospitalized in summer 1391 for “gallbladder laparoscopy”. The procedure was done with no complications and patient is in a steady condition at the moment. • No other significant information. • All is normal. • Slight facial asymmetry. • Right TMJ click on opening (translation phase). • Slight deviation of the jaw to the left, while opening the mouth. • Soft tissues: Normal, slight inflammation of gingiva where there is plaque present. • Normal saliva flow. • Class I molar relation on both sides. • Bilateral posterior cross bite. • Anterior open bite. Slight inflammation of gingiva, and grade I bleeding on probing Amalgam fillings: # 31, 29, 17, 18, 19, 20 Decays: # 31, 17 Amalgam fillings: # 2, 5, 14, 15 Composite fillings: # 3, 7, 8, 9, 10 Prosthetics: # 4, 12, 13 =Panoramic view= No pathologies and no imbedded teeth Root canal treatments: # 4, 12, 13 Post & cores: # 4, 12, 13 Overhang lucency Carious lesions on both teeth Bone defect Defects under crown Tooth # 4 has a distal pocket with carious lesions under the crown Root canal therapy of the teeth with irreversible pulpitis/necrosis of the pulp o After sensitivity tests, tooth # 31 was also diagnosed with irreversible pulpitis. So teeth # 31, 30 are treatment priorities due to patient’s pain. All active caries should be restored with temporary restorations. o Teeth # 14, 21 should be restored. Tooth # 17 has a class I restoration and distal caries plus a distal pseudo pocket. There is no counter tooth and the lesion is difficult to reach for restoration treatment, so it is suggested that the tooth is extracted. Supra and sub gingival scaling and root planning should be done. Prognosis of tooth #4 should be determined after the removal of the defective crown and underlying caries. Patient’s oral hygiene should be assessed and redirected to a better self oral care. Follow ups are needed. Fixed prosthodontics restoration for teeth with surface loss/root canal treated. o Teeth # 31, 30, 14 are best restored with single full coverage crowns due to severe tooth surface loss. Final restoration of tooth # 21 with composite. Final esthetic treatments with patients agreement o Incisor teeth of upper jaw are previously filled with composite, no reoccurrence of caries is detected in clinical examination but the fillings are not esthetically suitable. No orthodontic treatment is indicated considering patient’s age and current status. She is happy with the way things are.