013 – A Case study on Severe Periodontal Disease

A 40 years old Chinese lady complaint of her mobile upper central incisors, requested to save the teeth. Clinical examined found that her both upper central incisors are suffered from severe periodontal disease (known as advance stage of chronic adult periodontitis), almost half of the supporting alveolar bone loss, the teeth were mobile and protruding. Her overall oral hygiene was poor, a lots of calculus (tartar) deposited especially on the lower teeth. This is due to seldom visit to dentist because of dental phobia.

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She was informed that both incisors have to be extracted because of the severe periodontal disease, and she need to show her willingness to improve her oral hygiene before any permanent prosthesis to be done to replace the extracted central incisors.

Periodontal treatment was carry out to save her remaining teeth.

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Both the upper right & left central incisors are loose, protruding and bleeding tendency of the surrounding gum. The upper gum showed sign of inflammation, swelling, redness and bleeding. The lower teeth was covered by calculus.
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Because of the severe Chronic Adult Periodontitis (Gum & supporting tissue disease), the upper right central incisor was been “push out” when she bite the teeth together. The tooth was loose and almost lost of all the supporting bone.

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Both the upper central incisors were extracted. Take note of the calculus deposited on the root surface, it extended to the root tip. It means the teeth lost of all it alveolar bone.

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The others upper teeth also periodontal compromised, denture become not a good solution to replace the extracted teeth. I decided to temporary bonded the extracted teeth with resin splint. The root of the teeth were amputated, clean and disinfected. Then cemented a stainless steel wire with resin cement. The appearance of the “provisional Splint”. The teeth firmly splinted with resin composite.

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The teeth were reposition into the extraction socket, and then splinted to the adjacent teeth with resin composite.

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The occlusal view of the temporary splinted teeth.

 

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The palatal view of the temporary splinted teeth. Patient was schedule for the cleaning of the lower teeth on the second visit.

 

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The outcome of the temporary splinted teeth on the second visit after 2 weeks. Please to inform that she improved on her oral hygiene habit, take note on the healthy gum of the upper teeth.

 

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Review after 1 month of the temporary splinted teeth. The soft tissue healed nicely surrounding the amputated root and the gum look healthy, no more swelling, redness and bleeding.
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Review after 6 months, good oral hygiene maintained. Patient was informed to use interdental brush to keep away the interdental space (black triangle space) from plaque. Implant supported crown as permanent replacement solution if she can maintain her oral hygiene for another 6 months.
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Palatal view after 6 month to show the soft tissue healing around the amputated teeth.

Prepared by Dr Goon Yong Por.