Marjola Davidhi
Dental technician: Olsi Koti
ANAMNESIS: Patient 28 years old,12 years smoking(extremely smoking).No sistemic deseases.
CLINICAL SITUATION: When the patient came in the clinic he had no pain complaining, but esthetics problems due to extensive caries,hialolithosis,agressive gingivitis and functional problems during masticatory process,jaws anatomy deformation due to the early lose of teeth structure.Existend contact in occlusion between maxillary and mandibulary frontal incisors teeth and between teeth 17 and 48.No luxation of the teeth(good attachement with the bone)
AIM OF THE TREATEMENT: Patient had only 2 months and 1 week in disposition for making everything: extractions, dental therapy, infections treatements, composite post core build up, and metal porcelain prosthodontics reconstructions of all the mouth.Esthetic and functional rehabilitation of the mouth and facial esthetic improvement.
TREATMENT PLAN: Paradontal rehabilitation. Antibiotic-therapy.Daily mouth bio rince a lot of time a day for rehabilitation of swallow ,red , inflamed gingiva.
Extraction of teeth 19+18+28+radix 38+radix 37Also 15+25 extracted cause of infections, short treatement time and too much deep caries destruction(no time for orthodontic extrusion).
Cause of too much smoking(high levels of nicotin maybe)total deep anesthesia it was in every treatement session impossible.For these reasons, I didn’t treated 48.Next time that he will have the possibility to come in the clinic again, it will be the target of treatment. The aim of saving 48 is to save the bone level in the region of 47 (possible implant restoration in the future if the treatment of 46 will fail…)
RCT of all the remained teeth.Manual canal treatement cause of very tight root canals.
Composite, Fabricated Post core build-up restoration for all the teeth except 41,32 cause of very narrow, tight nerv canals and I wanted to be mini-invasive to save the teeth structure. Teeth 41 and 32 composite restorations.
Than all the teeth reconstructed with cr-co ceramic crowns from tooth 46 till 35+ one depended element to complete the jaw from6-6 minimum .On teeth 46 cause of infection and short time in disposition and unknown prognosis of 46(high risk,because of purulent abcess),I didn’t planed a depended element in this region. Also from 17-27 crom cobalt ceramic bridges separated between them with 3 or 4 elements each of them.All Verti Prep. We could be oriented for the DVO Occlusion length because of existend contact between maxillary and mandibulary frontal incisors teeth and between teeth 17 and 48. We increased a bit DVO for creating space for posterior teeth..Patient choosed no provisory crowns (economic conditions)Provisor cementation 1 week and control.Ceramic used from laboratory:VITA VMK MASTER.
CONCLUSION:Doubtful bone prognosis for the future.Reduced bone strength noticed during the extractions.Momentaly these teeth have a normal mouvement.Maybe no actual paradontosis and actual changes in Rontgen, but if the patient goes on with smoking, no hygiene and not a healthy eating regime,it exist the risk of probably luxationes in the future.Also the remained tooth structure was not so strong to hear convinced the cri -cri sound after caries removal.Because of smoking, the remained dentin is still decolored, but not 100 procent hard.Every teeth has prefabricated post core ,but I didnt made an extra enlargement of radix oriffices for other kind of posts to save as strong as possible the structure of teeth.And Glass posts, I found them very fragile for this case.The treatement of infections was done very intensiv and I was sure it will go on everything ok with them. Doubtful the prognosis of 46.Insisting for a final OPG from the patient….Documentation post treatment done with little roentgen fotos for more detailed information. After 9 months of follow up, absolutely no complaining from the patient.Facial esthetic improved,masticator function improved,the quality of the life of the patient is improved.So I belive that if the patients goes on with the same life style, and regime as before, there is something to be afraid.However There is also the hand of God:)
PS.ALL THE ENDODONTIC THERAPY IS MANUALY TREATEMENT because of very very narrow, tight canals.No 3D graphy cause of limited economy possibility from the patient,short time treatement ,I ask you really apologise for no professional dental photos because of short time in disposition.I choosed Cr-co porcelan restaurationes also for the frontal teeth because of the few remaining tooth structure and the economic choose of the patient and a little time to make bleaching of the remaining tooth structure from nicotin.In the beginning of treatement, I had no intention of detailed documentation of the case,So all the photos are photo from my handy.Thank you.I made it with love passion:)Enjoy it!!!
Rontrgen during manual RCT.Tooth 48 hidroxid Calcium intracanal dressing and periapical .Tooth 45 and 44 after RCT and composite post core restaurationes.The aim of this foto it was to control if ca 2+ it is periapical applied because of long and very tight canals.More importand than what you put in the canal, is the good cleaning of the canal.
Tooth 17 after RCT.4 canals manual treated.Cause of very tight and loncanals, gutapercha points couldnt arrive the end of the radix,but more important than what you put in the canal, is the good mechanic and chimic cleaning of the canal.After 4 sessions of manual canal treatemend and 1 session root filing and 1 session coronal filing.Intermediate sessions ca 2+.( months follow up, patient absolutely no pain.
Tooth 22 control of periapical calcium hidroxide dressing.Very narrow canals of 24.Radix 25 not yet extracted.Manual mechanical canal treatement.
Tooth 12 during hidroxid calcium dressing sessions.All the teeth RCT manualy treated due to very narrow canals.Roentgen control.
