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Diagnosis &treatment planning in conservative dentistry dr arsalan
The document discusses diagnosis and treatment planning in conservative dentistry. It covers patient assessment, risk assessment, clinical examination of teeth and restorations, radiographic examination, adjunctive diagnostic aids, occlusion examination, periodontal examination, and considerations for treatment planning such as sequencing of treatment and interdisciplinary coordination. The goal of examination and diagnosis is to identify problems and risks to develop an appropriate treatment plan.
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Diagnosis &treatment planning in conservative dentistry dr arsalan
- 2. Diagnosis &Treatment Planning inConservative Dentistry Presented By Dr.M Arsalan Zubair M.D.S resident Dow Dental College Dow University Of Health Sciences
- 5. Patient Assessment • ChiefComplaint Symptoms • Medical History Communicable Disease, Allergies or Medications, Cardiac abnormalities, Physiologic changes associated with aging • Dental History
- 6. • Magnification • Photographyin Operative dentistry
- 8. • Advantages: Easyto use We can document current esthetic condition of patient Notice changes in existing pits and fissures Photographs of treatment of deep carious lesion aid in future diagnosis of tooth For digital documentation it is easier and cost effective.
- 10. • Preparation OfClinical Examinations Clean, dry, Well illuminated mouth that’s why initial scaling, flossing, tooth brushing is required Proper examination instruments Cotton rolls should be placed Floss is good for determining over hanging, improper contours and open contacts Starting from the upper right quadrant with posterior tooth and then moving to maxillary and mandibular arches
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- 13. • Categorization accordingto the above factors
- 15. • Identify earlylesion • Visual changes • Tactile sensation • But explorers are discouraged Why??? Clinical Examination of Caries
- 16. • Good forroot surface caries • Radiographs are also good • Primary Occlusal grooves and Fossa are less prone • Occlusal fissures and pits are more prone
- 17. • Chalkiness orsoftening or cavitations of tooth structure • Brown gray discoloration radiating peripherally from pit and fissure • Carious pits Causes Developmental defects Erosion or Abrasion Occurrence Occlusal two-third of Facial and lingual surface of tooth May be on the palatal side of Maxillary tooth
- 18. ICDAS(International caries Detection andAssessment system)
- 19. • Histological depth 1=90% in outer enamel & 10% into dentin 2=50% inner enamel & 50% into outer one third dentin 3=77% dentin 4=88% dentin 5=100% dentin 6=100% dentin into one third of inner dentin
- 21. • Proximal surfacecaries Diagnosed Radio graphically Visually by separating contact Fiber optic transillumination • Brown Spots Remineralized lesion less prone to caries rather more resistant to caries. • Proximal Surface Caries in anterior teeth Diagnosed Radio graphically Visually Fiber optic transillumination Probing or explorer
- 22. • Cervical Caries White spot early enamel lesion Dry and wet is distinguishing test Diagnosed tacitly • Root surface Caries Root exposure, dietary changes, Systemic disease, Xerostomia Lesion at C.E.J Soft and spread laterally around C.E.J Active lesion is soft and cavitated Best diagnosed by vertical bite wing radiographs • New Methods For Diagnosing caries DIAGNOdent Spectra Camera Carie ScanPro
- 23. • DIAGNOdent device •Major disadvantage is false positive test
- 24. • Spectra Camera •High energy violet or blue light on tooth surface • It stimulate porphyrins metabolites which make carious lesion red while enamel appear green • It has scale 0-5
- 25. • Carie ScanPRO Caries detection by alternating current impedance spectroscopy(ACIST) Detects early carious lesion Provide color and numerical scale for severity of caries
- 26. Clinical examination OfAmalgam Restorations • Amalgam blues • Proximal overhangs • Marginal Ditching • Voids • Fracture lines • Lines indicating the interface b/w abutted restorations • Improper anatomic contours • Marginal ridge incompatibility • Improper proximal contacts • Recurrent Caries • Improper occlusal contacts
- 28. Clinical Examination OfTooth colored Restorations • Proximal Over hangs • Marginal ditching • Recurrent caries • Improper contour • Marginal Ditching • Voids
- 29. Clinical Examination of Dentalimplants and Implant Supported Restorations • In molars it is difficult to replace three roots with one implant • Vertical loss of bone support prior to implant placement makes vertical space making crown implant ratio difficult • Peri-implantitis • Occlusion is difficult to maintain due to lack of cushioning • Restoration should confined in the middle with no deflections
- 30. Clinical examination ofAdditional Defects • Non hereditary hypo calcified areas of enamel • Chemical erosion • Idiopathic Erosion • Abrasion • Attrition • Fracture • Craze line • Dental anomalies…
- 31. Radiographic Examination ofTeeth and Restorations • Indications of Radiographs • Proximal caries, overhang, poorly contoured restorations • Pulpal abnormalities • Periapical changes in peridontium • Impacted tooth or congenital abnormality • False positive and negative diagnosis
- 32. Guide lines forPrescribing Dental Radiographs For Dentate Adults New Patients
- 33. • Recall Patient •Clinically caries present or High risk • No Clinically Caries or No Risk Factors • Periodontal disease
- 34. Adjunctive Aids indiagnosis of teeth and Restorations • Percussion • Palpation • Vitality Test Hot test Cold test Electric pulp tester Test Cavity • Study Cast
- 35. Examination Of Occlusion •Signs of enamel cracks, occlusal trauma • Potential effect of restoration on occlusion • Class of occlusion • Over jet • Over bite • Midline shifts • Position of malposed teeth, super erupted, spacing • Dynamic occlusion should be evaluated • Relation should also be assessed in centric relation • Canine guidance or group function exist • Presence and amount of anterior guidance • Non working side contacts • Abnormal wear should be checked • Plunger cusp
- 36. Review Of Peridontium ClinicalExamination • Gingival color,shape,texture • Depth of sulcus • Instrument used for measuring depth • Six locations • Normal sulcus depth • Involvement of furcation • Gingival recession • Mobility • Plaque presence • Proper contoured restorations
- 37. Radiographic Examination • Bitewingare good for assessing bone level • What is Biologic width? • Normal value? • What will happen if restoration encroach biologic width? • What method is done to avoid these condition?
- 40. Treatment Planning • GeneralConsideration • Sequencing • Interdisciplinary Consideration Endodontic Periodontics Orthodontics Oral Surgery Fixed and Removable prosthodontics • Indications for Operative Treatment • Preventive treatment • Restoration of incipient lesion
- 41. • Treatment OfAbrasion, Erosion and Attrition • Root surface Sensitivity • Repairing of Restoration • Replacement of Restorations • Indication of Amalgam Restoration • Indication of Direct Composites • Indication of Indirect tooth Color restoration • Geriatric Patient
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- 44. Inter-disciplinary Consideration in Operativetreatment • Pulpal or periapical Pathology • Endodontic ally treated tooth show no evidence of healing, • Inadequate fill • Fill exposed to oral fluids • Precede operative treatment • Poor periodontal prognosis=no extensive restoration • Good health = Before or after • Surgical procedure indicated= before permanent restorations • Biological width: Crown lengthening ( 6 week after surgery)
- 45. • Extrusion • Realignment •Impacted, Unerupted • Grossly carious tooth should be extracted especially 2nd molars whose has to receive cast restoration are damaged due to removal of 3rd molars • Core buildup can be done from amalgam or composite • Preparation for receiving clasp, rests in removable prosthesis
- 46. Treatment Of Abrasion,Erosion, Abfraction and Attrition Considered for restoration only • Area is affected by caries • Defect is sufficiently deep compromise structural integrity of tooth • Intolerable sensitivity • Defect continue to peridontal problem • Area is to be involved in design of partial denture • Involving the pulp • Actively progressing • Desire for esthetic improvement
- 47. Treatment of rootsurface caries • Arrested lesion not need to be restored until for aesthetic purposes • Active lesion can be restored by tooth color restorations Treatment of root surface sensitivity • Fluoride varnishes • Oxalate solutions • Resin based adhesives • Desensitizing tooth paste contain Potassium nitrate • Restorative treatment
- 48. Replacement of Existingrestoration Non tooth color restoration • Marginal void • Gingival overhang • Marginal ridge discrepancy • Over contouring of facial and lingual surface • Poor proximal Contact • Recurrent Caries • Ditching deeper than 0.5mm Tooth color restoration • Improper contour that cannot be repaired • Large voids • Deep marginal staining • Recurrent caries • Unacceptable aesthetics