Periodontology assignment

Treatment Planning Assignment Spring 2014 T730D Advanced Periodontal Surgery Module Directions: Patient Case photographs, radiographs and periodontal charting are found in the “Treatment Planning Assignment Spring 2014” folder in SP14 IN DENT T730D Advanced Periodontal Surgery Resources in OnCourse. Using complete sentences, please answer the twelve questions (total, 100 Points) related to the findings in the Patient Case. Answers must also demonstrate clarity, organization and correct mechanics (spelling, punctuation, grammar, capitalization). Please provide evidence and rationale for questions and treatment decisions. Any and all materials used must have the references/resources cited. the textbook is not considered an appropriate reference. As you develop the treatment plan for this case, please review material from all the Periodontics Modules (T641, T720, T730). Some suggested resources for information include: AAP Clinical and Scientific Papers http://www(dot)perio(dot)org/resources-products/posppr2.html Greenstein G. Periodontal response to mechanical non-surgical therapy: a review. J Periodontol 1992; 63: 118-30. Kwok V, Caton JG. Commentary: Prognosis Revisited: A System for Assigning Periodontal Prognosis. J Periodontol 2007; 78(11): 2063-71. Lindhe J, Socransky SS, et al. “Critical probing depths” in periodontal therapy. J Clin Periodontol 1982; 9:323-36 Below are abbreviations and description to assist you with reading the periodontal chart: no later than 12:00 PM (noon) on Friday, April 11, 2014. PD: Probe Depth GM: Gingival Margin Location/Recession CAL: Clinical Attachment Level Furcation: ᴧ Grade I Δ Grade II  Grade III  Mobility  Bleeding (red dot)  Plaque (yellow dot) 03/2014 Patient Case: Age: 54 y.o. Race: Caucasian Gender: Male Height: 70” Weight: 218 lbs. BP: 124/83 mmHg CC: Patient presented for periodontal treatment per recommendation of general dentist. Medical History and Findings: Medical conditions: Diabetes mellitus type II; Hyperlipidemia; Gastric ulcers; Esophageal reflux; Shortness of breath with exertion; Head injury on Right resulting in paralysis of cranial nerve VII Patient stated monitoring his sugar levels at home where he reports levels in the 120s-130s. His HbA1c over the last 2 years have ranged from 6.0 to 6.5 %. Patient reported a hearing aid and eyeglasses. Current Medications: glipizide 10 mg q.d.; simvastatin 40 mg q.d.; gemfibrozil 600 mg b.i.d.; aspirin 81 mg q.d.; raberprazole 20 mg q.d.; acetaminophen 500 mg q 8h prn; loratidine 10 mg q.d. No known drug allergies. No know adverse drug reactions. Social History: 84 pack-year history and refused to discontinue smoking No alcohol use in 21 years Dental History: Patient reported the mandibular anterior teeth have occasionally felt loose Reported never receiving dental treatment until adulthood and infrequent care Extractions: Third molars were extracted as a young adult #14 and #18 were extracted 6-7 years ago-the patient cannot recall the reason Oral Hygiene: Patient reported brushing once a day and rinsing with Scope mouthwash once a day Family History: Patient reported a history of coronary artery disease in his father and an irregular heartbeat in his mother. Patient reported both his mother and father have full dentures. Page 3 of 4 03/2014 Initial Examination: Extra-Oral Findings: Lower lip demonstrated an indistinct vermilion border. Lymph nodes were not palpable. Intra-Oral Findings: The patient’s tongue was fissured. A 6 mm x 8 mm white lesion was present on the left soft palate. The buccal mucosa and floor of mouth were unremarkable. Angle’s Class I molar relationship on the right and Class III molar relationship on the left Canine guidance was present on the right side and group function on the left side Maximum incisal opening was 53 mm. Deviation of the mandible to the right was evident with opening. O’Leary Plaque Control Record score: 74% See Initial Periodontal Chart Questions 1 Gingival Description (Initial) (8 points) Describe the clinical presentation and condition of the patient’s gingiva. Questions 2 Radiographic Findings (8 points) Discuss your radiographic interpretation as it relates to the patient’s periodontal condition. Questions 3 Risk Assessment: (4 points) a. Any risk factors? b. Any risk determinants? c. Any risk indicators? d. Any risk predictors? Questions 4 Diagnosis (4 points) Questions 5 Etiology, Pre-disposing and Contributing factors (8 points) Discuss and describe the pathogenesis or significance of each. Questions 6 Prognosis- Discuss your rationale for categorizing the teeth. a. Overall: (4 points) b. According to McGuire and Nunn, list the teeth with the following prognosis: (4 points) i. Good ii. Fair iii. Poor iv. Questionable v. Hopeless c. According to Kwok and Caton, list the teeth with the following prognosis: (4 points) i. Favorable ii. Questionable iii. Unfavorable iv. Hopeless Questions 7 Initial Therapy and/or Non-surgical Phase (10 points) Describe in detail your recommended course of treatment. Provide rationale and supporting evidence for your recommendations. Page 4 of 4 03/2014 Re-evaluation Examination: The patient returned for reevaluation approximately 6 weeks after completion of initial therapy. See Re-evaluation Periodontal Chart O’Leary Plaque Control Record score: 50% Patient reported brushing twice a day, flossing once a day and using Scope mouthwash daily. Active Therapy performed: Oral surgery: Biopsy Left soft palate Endodontics: Treatment of #7 Periodontal Surgical Phase was initiated once the patient demonstrated effective oral hygiene evident by an O’Leary Plaque Control Record score of 12%. Questions 8 Gingival Description (Re-evaluation) (10 points) Describe the clinical presentation and condition of the patient’s gingiva. Comment on patient’s response to Initial Therapy. Questions 9 Surgical Treatment Plan/Periodontal Surgical Phase (10 points) Describe in detail your recommended course of treatment for this patient. Provide rationale and supporting evidence for your recommendations. Questions 10 If the patient discontinued smoking, describe how his Periodontal Surgical treatment plan would be different. (10 points) Describe in detail your recommended course of treatment. Provide rationale and supporting evidence for your recommendations. Question 11 Surgical Procedure (10 points) Describe one of the surgical procedures recommended in Question 9 or 10. Include the goal for the procedure, incision design, steps taken, instruments/materials used and post-operative care. Questions 12 Maintenance Phase (6 points) Periodontal therapy never ends. Provide the treatment plan for the next stages of therapy