Notes 2.0

Phone consultation completed
PCO:
Advised F2F
Pt has/does not have covid symptoms
Appt booked
Explained that currently no capacity to see pt under NHS during contracted hours therefore
pvt appointment offered out of hours. Quoted £40
co: nil
mh: updated and checked
shown appliance to pt
temp removed
tried in, pt happy with fit
restoration fitted with GIC,
excess cement removed
flossed and bite checked,
OHI,
pt has seen it prior to cementation and is happy with it
pt took the statement from lab
options:
1. nhs b3 metal
2. pvt porcelain 600
3. pvt gold 750 (40%)
pt opted for option 1 for cost
co: nil
procedures such as L.A, prep, Temporisation and a second fit app disc prior to start of trt.
Pat is also informed of importance of OH maintenance such as floss and interdental
brushing. Importance of regular ex and professional cleaning either by dentist or hyg disc as
well. Also informed the restoration may req to be remade due to fractures or decay and
even RCT or re RCT or extraction may be required due to complications of various natures,
which we can not be liable for and also inf that the restoration may fracture come out due
to retention or fracture of the tooth which we can not be liable for. if any of these those
happen then we have to take a decision when necessary
LA 2.2ml lidocaine hydrochroride 2% adrenaline 1:80 000
warned of nerve damage, and adv not to eat before the anaestetic worn off risk of nerve
damage and haematoma leading to permanent or temp numbness of relevant area inc
cheek nerves teeth lip
existing rest removed
Prep with any nec retention locks and parallel groves.
imps with triple tray putty wash,
disinfected with Perform ID
tellio temp placed
pt is informed that temp is fragile, smoking and spicy food such as curry will change its
colour.
pt is inf that we try to match the colour but there might be some shade differences which
will be beyond our control as has to be accepted as it is.
sent to: Veus Lab
shade:
POIG
Duraphat varnish 50mg/ml F- applied

Cotton wool isolation
After care instructions given
OHI given - Brush + Dental floss + m/w
Diet adv
etch<bond<flow comp A2
bite checked
pt pleased
options for fill:

1. nhs b2 amalgam
2. pvt comp 100
pt opted for option 1 for cost
SK please do amalgam fill and use LA 2% lidocaine 1:80k adrenaline
treatment options perio:

1. NHS b2 perio
2. pvt with hyg 45/session
Pt opted for option 2 due to prev good exp with hygienist
hyg please carry out RSD as relevent and use LA if needed 2% lidocaine 1:80k adrenaline
options:
1. nhs b2 rct
2. nhs b2 xla
3. pvt ref for rct at kent endo
if has rct will req. cuspal cov, nhs b3 metal, pvt porcelain 600 or pvt gold (40%) 750
pt opted for option 1 with nhs b3 metal crown for cost
co: nil
pmh: checked and updated

sh: non smoker, drinks < 14 units / week
dh: non anxious, regular attender
eo: TMJ L&R, clicking, crepitus, trismus, LN - submandibular, submental, cervical chain, pre
and post auricular, occipatal - NAD
io: ST checked - lip, labial mucosa, vestibule, hard palate, soft palate,BM, tongue,
commissures, lat tongue borders, FOM, ant and post pillar, ventral of tongue, gingiva - NAD,
generalised BOP, no pockets > 3mm, no clinical sign of caries,
TW - none noted
occlusion - functional
ohi: good
rads: (L) + (R) BWs taken for caries screening and bone levels assessment. See report.
diag: Generalised Gingivitis

Generalised Periodontitis Stage Grade, currently unstable, RFs -
prog:
risk assessment:
caries - low
perio - low
oral cancer - low
tw - low
recall set at 6/12 as per risk assessment
OHI given - pt advised to brush at gingival margin and floss daily, brush 2x daily, spit don't
rinse, recommended use of TEPE brushes
Diet advice given - pt advised to minimalise frequency of sugars to meals only
Treatment plan -
co: nil
tx:
warned pt that tooth may require RCT & restoring or an XLA in the future if symptomatic. pt
aware and understands.
2% lidocaine 1:80,000 adrenaline 2.2ml IDB risk of nerve damage and haematoma leading to
permanent or temp numbness of relevant area inc cheek nerves teeth lip
caries accessed with fast handpiece
caries removed with slow handpiece
caries free cavity
hard scrathy dentine overlying the pulp infomred pt
matrix band and wedge placed
amalgam placed
occlusion checked
flossed used through contact point to check
POIG - teeth may be initally sensitive, do not bite hard for 24hrs, eat on other side
POLAIG
Ohi given - pt advised to brush at gingival margin and floss daily, brush 2x daily, spit don't
co: nil
tx: secondary imps w/ special trays and bite registration
upper and lower secondary imps taken w/ alginate in special trays
upper wax rim adjusted until happy w/ occlusal height, labial and buccal support
pt. shown in mirror pt happy with soft tissue support.
lower wax rim adjusted until happy w/ occlusal height, adjusted labial and buccal support.
heels trimmed off both upper and lower rims.
centre lines and canine marked on.
shade chosen w/ pt - B2, pt shown shade in mirror and happy with choice.
pt closed into ICP and reference marks added into softened wax
emergency appt, not CU, pt aware

co: LLQ, pt says broke tooth a few days ago, no pain experienced but sharp bit of broken
tooth is rubbing against the tongue and causing irritation
sh: non-smoker, < 14 units/week of alcohol
eo: no facial asymmetry
TMJ NAD
lymph nodes NAD
io: ST - checked. LL6 large MOD amalgam present with mesio-lingual and disto-lingual
portions broken away completely, no buccal swelling or tenderness associated with LL6,
lingual ulceration on tongue not yet present from sharp tooth
SIs: percussion test, LL6 negative
rads: nil taken
dx: LL6 broken tooth with complete lingual fracture
prog: LL6 - guarded
Treatment today -
moisture control achieved with high speed and cotton roll

tooth restored w/ GIC Ketac
vaseline applied whilst setting
occlusion checked
POIG
Advised pt that this restoration is temporary and advised definitive restoration for LL6.
Explained to pt that LL6 has lost integrity due to the mesio-lingual facture and requires
cuspal coverage/integrity. Treatment plan options regarding LL6 presented to pt as seen
below -
LL6
1) Leave w/ risk of worsening/pain/infection/swelling
2) Restore w/ crown to provide cuspal coverage
pt opted for option 2
Advised pt to book exam appt.

(R) BW taken for caries screening and bone levels assessment
Acceptable
Good bone levels
No abnormal rads
(L) BW taken for caries screening and bone levels assessment

Acceptable
Good bone levels
No abnormals rads
pt attended appt w/
co: nil
pmh: updated and checked

sh: attends school
dh: regular attender
eo: TMJ L&R, clicking, crepitus, trismus, LN - submandibular, submental, cervical chain, pre
and post auricular, occipatal - NAD
io: ST checked - lip, labial mucosa, vestibule, hard palate, soft palate,BM, tongue,
commissures, lat tongue borders, FOM, ant and post pillar, ventral of tongue, gingiva - NAD,
no sign of NAI, no plaque/calc present, mixed dentition
tw: none noted

ohi: good
rads: nil taken as no justification
diag: no path detected
prog: nil
risk assessment:
caries - low
perio - low
tw - low
recall 6/12 as per risk assessment
Fluoride Varnish applied

POIG
OHI given - pt advised to brush 2x daily, spit don't rinse

Diet advice given - pt advised to limit sugars to meals only and to drink acidic juices/fizzy
drinks through a straw
tx: ULE mesial

no LA required
showed pt slow handpiece
caries excavated with slow handpiece
caries free cavity
moisture control achieved with high speed and cotton rolls
matrix band placed w/ wooden wedge in place
occlusion checked
POIG
warned mum and pt of possible necrosis or further caries in the tooth in the future that may
lead to pain and or swelling. warned mum and pt that ULE may require pulpotomy or XLA in
the future if tooth becomes symptomatic. advised mum to monitor and supervise pt's OH
and control patients diet as best as possible.
patient and parent happy with today
co: nil
tx: UR2 MIP
warned pt that tooth may require RCT & restoring or an XLA in the future if symptomatic. pt
aware and understands.
2% lidocaine 1:80,000 adrenaline 2.2ml IDB risk of nerve damage and haematoma leading to
permanent or temp numbness of relevant area inc cheek nerves teeth lip
caries free cavity
hard scrathy dentine left, informed pt
matrix band and wedge placed
etch < bond < comp
comp A3.5 placed
occlusion checked
flossed used through contact point to check
restoration polished and finished
POIG - teeth may be initally sensitive, do not bite hard for 24hrs
POLAIG
co: sore when wearing denture LLQ, pt pointed, wants new denture slightly adjusted
tx: lower partial denture ease
advised pt that can ease denture in sore area however, may affect fit, pt accepts risk and
would like it eased
eased with straight handpiece
pt happy now
co: nil
tx: partial denture fit
denture fitted
good fit
bite checked
good appearance
pt shown in mirror and happy with appearance and bite
shown how to place and remove
pt confirmed that they can do it
denture hygiene and care advice and instructions given.
warned pt not to wear denture while sleeping

co:
TMJ NAD
lymph nodes NAD
io: ST - checked. slow healing extraction socket present with debris and pus inside, halitosis
present
SIs:
rads:
dx: actue alveolar osteitis of socket
prog: fair
Treatment today -
extraction socket irrigated w/ saline

Alvogyl packed lightly into socket
Advised pt to not touch the alvogyl with tongue or finger and that it will dissolve on its own
prescribed Metronidazole 400mg, TDS, 7/7, script written
warned pt not to take abx w/ alcohol, pt aware and understands.
Advised pt to book exam

co:
TMJ NAD
lymph nodes NAD
io: ST - checked
SIs: percussion test -
rads:
dx:
prog:
Treatment today -
co: nil
tx: UR4 DB
warned pt that decay is large and restoration is close to nerve. warned pt that if tooth
becomes symptomatic then RCT or XLA will be required in the future. pt is aware and
understands.
2% articaine 1:100,000 adrenaline 2.2ml administered via buccal infiltration risk of nerve
damage and haematoma leading to permanent or temp numbness of relevant area inc
cheek nerves teeth lip
anaesthesia achieved
existing rest. removed w/ fast handpiece
caries free cavity
matrix band placed w/ wooden wedge in place
occlusion checked
POIG
POLAIG

co: LLQ, pt says her crown fell out last night, brought crown in with her, says this is the first
time it has fallen out and would like crown to be recemented
TMJ NAD
lymph nodes NAD
io: ST - checked. LL5 retained root present, ferrule present also between 1mm-2mm, post
core & crown fits back into LL5,
SIs: nil
rads: nil
dx: LL5 post & crown debonded
prog: LL5 - very guarded due to risk of continued debond and failure
Treatment today -
tried in, pt happy with fit

crown recemented w/ Ketac
excess cement removed
flossed and bite checked
pt pleased
Warned pt that if LL5 crown debonds again it will require replacement due to the crown
failing. Warned pt that LL5 may become unrestorable in the future and require XLA. pt
aware of risks and everything discussed today regarding LL5.
Advised pt to book exam.
tx:
warned pt that tooth may require RCT & restoring with crown or an XLA in the future if it
becomes symptomatic. pt aware and understands.
vaseline applied to surface of LR6, flowable composite placed and light cured, occlusal
stamp removed
caries free cavity
etch < bond < comp
comp A2 placed via incremental layering
PTFE tape placed and occlusal stamp placed to mould comp to shape of tooth for final layer
occlusion checked
restoration polished and finished
POIG - teeth may be initally sensitive, do not bite hard for 24hrs
POLAIG
1) Leave w/ risk of worsening/pain/infection/swelling
2)
tx: RSD
warned pt prior of risk of recession, black triangles and post op sensitvitiy and pt happy to
proceed
reinforced OHI wi/ pt, discussed appropriate TEPE sizes and use of angled Bass technique,
recommended colgate, oral b or sensodyne toothpaste that contains correct amount of
fluoride
advised to brush at gingival margin and floss daily, brush 2x daily, spit don't rinse,
Diet advice also given - pt advised to minimalise frequency of sugars to meals only
RSD relevant sites with USS
calculus removed both supragingival and subgingival
POIG including post op sensitivity and increased length of teeth after gums heal
Warned pt that periodontal disease results in eventual tooth loss if disease is not stabilised.
pt aware of risks.
Advised pt on smoking cessation and explained the link between smoking and periodontal
disease thoroughly. Advised pt on hygiene tx every 3 months for upkeep and stabilisation of
gum disease.
pt aware and understands everything discussed in today's appt.
co: nil experienced

tx: post and core
4% articaine 1:100,000 adrenaline 2.2ml buccal and lingual infiltrations administered risk of
nerve damage and haematoma leading to permanent or temp numbness of relevant area
inc cheek nerves teeth lip
dentine pins and exisiting restoration removed
caries removed w/ slow handpiece
GP accessed and fibre post non-cutting bur used to remove GP down to 10mm with 4mm of
GP left remaining in apical third
yellow fibre post placed
post cemented with Relyx and core built up with composite
preparation with any necessary retention locks and parallel groves
lower imps taken in lower stock tray with putty wash
upper imps of pt's denture taken in upper stock tray and alginate
putty wash bite taken
clip temp placed
informed pt that temp is fragile, smoking and spicy food such as curry will change its colour
informed pt that we try to match the colour but there might be some shade differences
which will be beyond our control as has to be accepted as it is.
sent to: Veus Lab
shade:
POIG
POLAIG
informed pt that they may get soreness and or swelling for the next 2-3 days
informed pt that any emergencies to call the practice
pt happy
co: nil
tx: RCT
explained risk of rct including:
perforation of walls, separation of file, pain, infection, abscess, risk of failure, loss of tooth.
procedures such as L.A, use of instruments and temporization, failure risks and poss of file
fracture and consequent prog. disc prior to start of tx, risk of failure leading to loss of tooth
pt accepts risks and consents and written consent form signed
2.2ml 2% lidocaine 1:80,000 adrenaline buccal and palatal infiltration administered
fast handpiece used to access caries
rubber dam placed
pulp accessed
single canal located
canal accessed and extirpated w/ size 15 file
canal copiously irrigated w/ 3% sodium hypochlorite - Paracan
apex locator used to determine working length. WL -
PA taken to confirm working length
QA1
ledermix placed w/ paper points
cotton pledget placed - informed pt
restored with GIC for interim
rubber dam removed
POIG
POLAIG - advised pt not to eat after the anesthetic worn off
co: nil
tx: RCT
explained risk of rct including:
perforation of walls, separation of file, pain, infection, abscess, risk of failure, loss of tooth.
fracture and consequent prog. disc prior to start of tx, risk of failure leading to loss of tooth
pt accepts risks and consents and written consent form signed
2.2ml 2% lidocaine 1:80,000 adrenaline buccal and palatal infiltration administered
RCT restarted
GIC and cotton pledget removed
single canal relocated
WL confirmed as previous - 28mm
opened to size 15
WaveOne rotary instrumentation commenced
red file chosen as Master Apical File
canal irrigated copiously with 3% Paracan - sodium hypochlorite
MAC tried in
PA taken. QA1.
canal dried extensively with with paper points
canal filled w/ red GP and T.Seal.
composite restoration placed to seal GP entry
etch < bond < comp
comp A3.5 placed
occlusion checked
post obturation PA taken
QA1
good length and density of GP
POIG
POLAIG
fluoride
gum disease.
co: URQ, pt says he has been experiencing sensitivity in this region for a week or so when
eating/drinking cold or warm things

TMJ NAD
lymph nodes NAD
io: ST - checked. no buccal swelling or tenderness present, no lost fillings in URQ, ginigval
recession of the UR6 is present and the recession is of > 2mm with root surface exposed, no
colour change of any teeth in URQ present
SIs: percussion test - all teeth negative

3in1 - UR6 root exposed surface is very sensitive +++
rads: nil as no justification
dx: root exposure of the UR6 due to gingival recession
prog: root exposure sensitivity - guarded
Treatment today -
Reassured pt that no teeth in URQ have changed colour.

Showed pt gingival recession of UR6 in the mirror and also used 3in1 to show that the
sensitivity he is experiencing is coming from this area. Explained to pt that sensitivtiy is
caused by air/food/drinks hitting the exposed root surface. Recommended Colgate Sensitive
toothpaste to pt and gave pt sample and also recommended Sensodyne toothpaste to help
alleviate symptoms of sensitivity. Advised pt to avoid eating certain foods/drinks that trigger
the sensitivity and to also smear the sensitivity toothpaste around the UR6 region when/as
required. pt aware and understands everything discussed in today's appt regarding his
sensitivity.
Advised pt to book 6/12 exam.
pt attended w/ mum
co: nil
tx: LRD SS crown
mum consents to procedure of fitting pre-formed SS metal crown on LRD prior to start of tx
verbal consent gained and FP17 form signed
Explained the procedure thoroughly to mum and pt. Information leaflet for SS crown given
to mum.
Explained the clinical evidence of SS crowns. Explained that SS crowns are used for the
restoration of carious primary molars where more than two surfaces are affected, or where
one or two surface carious lesions are extensive. Explained crowns are usually 1mm high in
children's occlusion and this is okay as the child's bite will compensate and adjust to this.
no LA required
mesio-distal length of LRD measured
pre-formed SS metal crown size LRD 6 chosen
fast handpiece used to remove bulbosities and distal contact
crown tried onto tooth and snapped on
crown removed
crimpers used to crimp distal portion of crown
GIC luting cement placed into crown
tooth dried and crown placed on from palatal to buccal
firm pressure used to seat crown
excess cement removed w/ hand scaler
cotton wool roll placed and pt made to bite down hard to ensure tight fit
gingival blanching observed
bite checked, measured pre-mature occlusion of 1mm
floss used through contact point
POIG
Explained to mum that pt will feel the crown is 'tight' and it may be uncomfortable for a few
days but this should ease eventually, advised analgesia if required. Explained that pt's bite
will adjust to the crown. Explained that if pt can't tolerate the discomfort after over a week
then occlusion may be adjusted further.
warned mum of possible necrosis of the tooth in the future that may lead to pain and or
swelling and possible XLA of LRD in the future. mum and pt understand.
advised parent to monitor and supervise OH and control patients diet as best as possible.
rinse
mum understands everything discussed today.
patient and parent happy with today.
UL1 assessed and trauma investigations carried out

eo: no facial swelling present
no lip laceration present
io: UL1 MIP enamel fracture, sharp broken incisal edge, no exposed pulp, no grey
discolouration of UL1, no mobility of UL1, no visible trauma/damage sustained to other
upper anterior teeth, UL1 is vital and responsive to endofrost and sensitive ++ to 3in1.
SIs: percussion test, UL1 TTP negative, all other anterior teeth negative
rads: PA UL1 taken to assess periapical tissues following trauma
dx: concussion of UL1, enamel fracture of UL1, tooth currently shows signs of vitality
prog: guarded due to UL1 now having a history of trauma
Treatment today -
IADT tauma guidelines followed

MIP build up of UL1 w/ composite restoration
Advised soft diet for pt for 2/52 and to use posterior teeth to chew mainly
Advised mum to monitor tooth for signs of discolouration and buccal swelling. Warned mum
and pt that if the tooth starts to show signs of losing vitality then RCT may be indicated at
that point. Warned mum and pt that tooth may require RCT or XLA in the future. mum and
pt understand.
R/V appt in 2 weeks
pt attended appt w/
co: nil
tx today: review of UL1 following trauma
TMJ NAD
lymph nodes NAD
io: ST - checked. no colour change or no grey discolouration of UL1, no mobility of UL1, UL1
not TTP, no visible trauma/damage sustained to other upper anterior teeth, UL1 is vital and
responsive to endofrost and sensitive ++ to 3in1
Advised mum and pt that UL1 is currently vital but explained to them that the long term
prognosis of the tooth is guarded due to UL1 now having a history of trauma.
Once again advised mum to continuously monitor tooth for signs of discolouration or pain
or swelling that may occur in the future. Warned mum and pt that if the tooth starts to
show signs of losing vitality then RCT may be indicated at that point. Also warned mum and
pt that tooth may require XLA in the future. mum and pt aware and understand everything
discussed today.
co: nil
tx: wax try in
upper and lower wax rims tried in
bite checked
pt shown in mirror
pt happy with appearance, shade and bite
pt happy to go to finish
sent to lab for finish

co: LLQ, pt pointing to wisdom tooth, pt says he has had throbbing aching pain for past
week, hasn't been able to sleep properly, LHS of face feels tender and it hurts to open
mouth wide
TMJ NAD
lymph nodes NAD
io: ST - checked. LL8 partially erupted, buccal gingiva around LL8 extruding pus when
palpated, gum around LL8 red inflamed and tender
SIs: nil
rads: nil taken as no justification
dx: pericoronitis due to partially erupted LL8
prog: LL8 - guarded due to risk of recurrent episodes of pericoronitis
Treatment today -
prescribed Metronidazole 400mg, TDS, 7/7, script written

warned pt not to take abx w/ alcohol, pt aware and understands.
Advised pt that LLQ pain is due to pericoronitis caused by PE LL8. Advised pt that pus is
present around LL8 and rec. abx to treat current episode.
Advised pt to keep LLQ as clean as possible due to build up of debris under flap of gum over
LL8 causing inflammation. Rec. use of single tufted brush.
Advised pt that according to NICE guidelines, more than 2 episodes of pericoronitis indicates
removal of LL8 and advised pt on XLA LL8 if pericoronitis occurs again. pt aware of
everything discussed in today's appt.
Advised pt to book exam.
co: nil
verbal consent obtained and written consent obtained, pt signed wirtten consent form
discussed replacement options including leave gap / denture / implant. pt. opted to leave
gap - warned pt that implant placement can be more expensive following XLA if bone
grafting needed
pt aware of risk and accepts
explained benefits of procedure:
benefits including removal of source of infection and future pain/swelling.
explained risks of procedure:
bleeding, bruising, post op infection, damage to adjacent structures inc bone, nerves
(leading to numb feeling in certain areas), blood vessels and teeth. risk of MOS which may
entail: cutting of gum and/or bone and placing of stitches, may be risk of part of root
remaining in situ and possibly needed referral to elsewhere
tx: XLA LL7
LA: 2.2ml 2% lidocaine, 1:80,000 adrenaline administered via IDB and intraligamentary
injections
anaesthesia achieved
explained risks of nerve damage and haematoma leading to permanent or temp numbness
of relevant area inc cheek nerves teeth, lip
XLA LL7 with luxator and forceps
apices in tact
got pt to bite down on gauze and haemostasis achieved
POIG written and verbal given to pt in form of discussion and leaflets
POLAIG
RP.
co: nil
upper and lower fixed braces fit

optragate placed
teeth cleaned
etch 45 secs
bond placed
light cure
brackets placed upper and lower 7-7
0.16 wire ni ti ligated upper

0.14 wire ni ti ligated lower
begin IPR NV
bitegaurds: not needed
POIG written and verbal and wax

review 4 weeks
Scan reviewed with patient: showed anterior, maxilla and mandibular images. Showed with
and without IPR/Superimposition/Attatchments.
We have reviewed the clincheck together and it shows:
1. IPR (enamel stripping/shaping) = no Explained IPR and the purpose of it.

2. Attachments (white filling dots stuck onto the teeth for the whole treatment time) = yes
Explained what attachments and the purpose of it.
3.Aligner number = 14 therefore approx 28 weeks.
Covered all of consent sheets: difficult tooth movements, thin gingival biotype causing
recession, root treated teeth with apical pathology, short roots, gums not being predictable,
black triangles forming and need of bonding post Invisalign, need of further aligners, may
take longer than 20 weeks for full treatment.
After that time refinements are possibly needed, meaning more rx/aligners and more time.
Explained the importance of wearing a retainer after.

Consent form signed
Pt happy to proceed
Finance discussed with the patient ½ to be paid now (£) and the remainder to be split into
equal instalments
Smile Consultation
MH- Reviewed & Updated
C/O: Unhappy with position of teeth.. " __".
HPC:
Previous cosmetic/orthodontic treatment:
If yes, retainer worn:
Teeth changing in appearance:
Sought any other consultations prior to this:
Any event coming up that would like treatment complete by:
How long noticed for? What is it you don’t like?
Explained importance of good OH and stabile teeth (no active caries or periodontal dx) prior
to carrying out any cosmetic procedure. Advised pt should have had a recent examination
and a good level of OH prior to embarking on any cosmetic treatment.
Pt understands and accepts this.
Advised C/U if has not been carried out at Novel Dental.
Options briefly highlighted regarding malalignment.

1. Comprehensive orthodontics ~ 18 months, £4000+ Thorough system, can refer to local
specialist orthodontist.
2. STO (including Invisalign, 6MS, Inman Aligner) ~<12 months, Focused on anterior teeth,
those that show in the smile line. Price dependent on number of arches treated
Explained importance of retainers in 1 &2. Lifelong commitment, usually 6/12 full time wear
(except of eating and cleaning) and every night thereafter for as long as wants teeth to
remain straight.
3.Restorative options (crowns, veneers) May produce fast results also can change colour of
teeth, however has a finite longevity and can be destructive to tooth tissue.
4.No treatment, is always an option
Pros and cons explained of each option. Including but not limited to longevity, prognosis,
aesthetics, procedure, bonding, time, cost and maintenance.
Pt uninterested in 1,3 and 4. Would like more information regarding Invisalign.

Shown book and examples of cases completed. Retainers fixed and removable explained,
benefits and risks of system.
Pt to decide and book if interested. Advised only once these are taken and a more
comprehensive examination is carried out, can options be explored further.
Pt happy and understands.
Clinical Photographs taken & impressions sent for clincheck
Topical anaesthetic applied to the gingivae

Optragate dam and then etch scotch and comp A attachments placed
First liners placed
Pt able to place and remove aligners
disc maintenance of trays eg remove prior to eating / disc staining of trays.
IPR completed between:
Reccomended analgesics for 2 days from now then to re-evaluate, they may need 1-3 days
of paracetamol on each change over day
Advised to change trays weekly and the day of change will be Fridays
Trays given week 1 to 4
Given patient Orthodontic chewies in order to acclimatise to retainers
prescribed amoxicilin 500mg TDS for 7/7 21 capusles due to buccal swelling and risk of
spreading infection.
C/O - nil
MH - no change.
Tx:
imps for whitening trays
- Both upper and lower imps taken using alginate in stock trays – pt. tolerated well.
- Sent to Boutique for bleaching trays.
N/V fit and photos.
ES
Whitening review app.
C/O - nil.
Tx -
Pt. consented to having photos taken of post-op shade.
Gave pt. boutique whitening gels 6 hygrodgen peroxide day gels x 4 (owed to pt. from last
time).
Post op shade - A2.
Pt. happy with whitening tx. have advised if top ups needed can buy syringes 20 each.
ES
Whitening tray fit
Tx -
Pt. consented to having photos taken of pre-op shade.
Upper and lower whitening trays - checked fit, pt. able to get them in and out, no
adjustments needed.
Gave pt. boutique whitening gels 16% carbamide peroxide x 8 gels - demonstrated to pt.
how to place gels into trays, discussed method and advised on use of sensitive tp as needed
- sample given today.
Current shade -
Advised pt. to use gels every night for 2/52 and will review shade at next app.
Discussed avoiding coffee, red wine, smoking and anything that may stain the teeth during
whitening - pt. understands this would effect results.
Warned of post op sensitivity and how to manage this.
MH - No change.
C/O - No complaints.
Tx – Restoration -
- Warned pt. deep rest risk of flare up and need for RCT / XLA.
- Buccal inftiltration given / ID block - - lidocaine 2%, 1:80,000 adrenaline, BN - B15717AA,
Exp - 2018 02 - dose 2.2mL / Articaine 4%, 1:100,000 adrenaline, BN – B15471AA, Exp –
2017 06.
- Anaesthesia achieved.
- Cavity adjusted with fast hand piece.
- All caries removed with large rosehead.
- Tooth acid etched 40% orthophosphoric acid, 20s, washed and dried.
- Moisture control achieved with high speed suction and cotton rolls.
- Prime and bond applied, lightly dried, light cured 20s.
- Tooth restored with composite shade A3.5 - light cured 20s per incremental layer.
- Shaped and polished, occlusion checked with articulating paper and adjusted accordingly.
- Pt. happy with appearance and bite.
- POIG with regards to LA and post op sensitivity.
co: nil
mh: no change
buccal inf given as sensitivie - buccal inf lidocaine 2%, 1:80,000 adrenaline, BN 22829AA,
2020 06, 2.2mL.
Anaesthesia achieved.
temp removed
tried in, pt happy with fit - showed pt. in mirror prior to cementation.
Nil adjustment needed.
restoration fitted with rely X ultimate.
Porcelain etch on crown 1min, washed and dried, scotch bond applied 20s, air dried.
Prep - acid etch 37% orthophosphoric acid 20s, washed and dried, scotch bond applied 20s,
rely x ultimat cement applied into crown, contacts flossed and excess removed.
LC 20 / surface.
flossed and bite checked,
OHI,
NHS band 3 metal, pv 650 gold, pv 550 porcelain
ES
C/O - nil.
MH - No change.
Tx - UL6 crown prep.
- PA taken - see report.
- Made pt aware root filling UL6 appears to have separated files in the MB and possibly in
the DB canal as well, GP then filled to these points. Made pt. aware this is not ideal,
however tooth is asymptomatic and no obvious periapical rads around the tooth, root filling
was done around 4 years ago and pt. reports no problems since.
- Advised pt. on the following options:
1) Ref to endodontic specialist for re-rct.
2) Replace crown UL6 with 650 emax - pt aware risk of flare up, advised crown needs to be
replaced due to mesial overhang which has caused caries.
3) XLA and discuss replament options - implant, denture or leave gap.
Pt opted 2 - aware risk of flare and poss need for re-rct / XLA in the future which we will not
be liable for.
procedures such as L.A, prep, Temporisation and a second fit app disc prior to start of trt.
Pat is also informed of importance of OH maintenance such as floss and interdental
brushing. Importance of regular ex and professional cleaning either by dentist or hyg disc as
well. Also informed the restoration may req to be remade due to fractures or decay and
even RCT or re RCT or extraction may be required due to complications of various natures,
which we can not be liable for and also inf that the restoration may fracture come out due
to retention or fracture of the tooth which we can not be liable for. if any of these those
happen then we have to take a decision when necessary
- Buccal inf given UL6- lidocaine 2%, 1:80,000 adrenaline, BN -22829AA, 2020 06, 2.2mL.
- Lower alginate taken.
- Existing crown removed, caries felt under comp core.
- Comp core removed and all caries underneath cleared.
- Rubbed dam and clamp applied.
- Etch, bond, lc 20s.
- Comp core built up in incremental layers #A2 - lc 20s per layer.
- Tooth prepped - 2mm occlusally and 1-1.5mm all the way around.
- Two step impression technique - Upper imp with silicone putty, removed, light bodied
silicone around tooth and in tray with putty and spacer removed.
- Happy with imp.
- Bite reg recorded.
#A1 chosen - showed pt. in mirror - happy with choice.
- Telio temp made, occlusion checked, warned temp can sometimes come off - advised to
place temp back over tooth should this happen, also discussed returning should temp be
lost or broken.
- POIG.
C/O - nil
MH - no change
Tx -
Discussed with pt crown procedure - L.A, prep, Temporisation and a second fit app
discussed prior to start of tc.
- Informed pt. of importance of OH maintenance such as floss and interdental brushing +
regular dental exams.
- Warned pt. of risks involved with crown prep: Rest may require to be remade in the future
due to fractures or decay, warned risk of future need for RCT or re-RCT or XLA. Advised we
can not be liable for any of the above and also informed that the restoration may fracture/
come out due to retention or fracture of the tooth which we cannot be liable for.
- Pt. accepts all of the above - happy to proceed with tx.
- Buccal infiltration given - lidocaine hydrochroride 2%, adrenaline 1:80 000, BN 21799AA,
exp 2020 02, dose 2.2mL.
- Articaine 4%, 1:100,000 adrenaline, B22038AA, 2019 09
- Existing rest removed, all caries removed with large rosehead.
- Composite core built in incremental layers #A2, cavity etched 37% orthophosphoric acid
30s, washed and dried, bond applied, lc 30s, comp applied in incremental layers, 30s lc /
layer.
- Shoulder bur used to prep margin 1-1.5mm around the whole tooth, 2mm taken occlusally,
sharp edges removed.
-Aristo temp placed.
- Pt. is informed that temp is fragile, smoking and spicy food such as curry will change its
colour.
- Pt is inf that we try to match the colour but there might be some shade differences which
sent to: Veus Lab
shade: metal
POIG
Tx:
imps
- Both upper and lower imps taken using alginate in stock trays – pt. tolerated well.
- Sent to SDH for s. trays + bite.
MH - No change.
Tx – Secondary imps + bite.
- Both upper and lower secondary imps taken using alginate in special trays – pt. tolerated
well.
- Upper wax rim adjusted until happy with occlusal height, labial and buccal support, pt.
shown in mirror – happy with soft tissue support.
- Lower rim – adjusted occlusal height, adjusted labial and buccal support.
- Heels trimmed off both upper and lower rims.
- Centre lines and canine marked on.
- Shade – chosen, pt. shown shade in mirror, happy with choice.
- Pt. closed into ICP and reference marks added into softened wax.
MH - No change.
Tx - Wax try-in.
- Both upper and lower wax rims tried in - pt. happy with appearance, shade and bite.
- Shown in mirror - happy to go to finish.
MH – No change.
Tx - Denture fit
- Denture fit - pt. shown in mirror, happy with bite fit and appearance.
- Denture fixative and brush given + denture hygiene and care advice given.
1) B3 acrylic denture.
2) 750 Valplast pvt
3) 950 CoCr pvt.
Urgent app only - pt aware not full check up, aware chargable as no open cot
co - pt getting pain from XLA site LL4
has been smoking since XLA.
mh - see form
eo - nad
io - LL4 suppuration seen from area, tender to palpate.
diag - dry socket LL4
prog - fair
options today - advised to avoid smoking and continue HSWMR
placed alvogyl in socket and prescribed metro 400 TDS for 7/7 21 capsules.
- Discussed with pt. will place medication in canal and temporary dressing on tooth - advised
pt. on post op pain and risk of swelling following extirpation.
Tx –
- Warned pt. temp tx. needs to return for RCT / XLA.
- Discussed risk of perforation, file separating and tooth being deemed unrestorable post
caries removal and need for XLA - pt. accepts happy to proceed.
- Pt understands, happy to proceed
- Buccal inftiltration given / Articaine 4%, 1:100,000 adrenaline, BN – B15471AA, Exp – 2017
06.
- ID block - lidocaine 2%, 1:80,000 adrenaline, BN - B21264AA, Exp - 2019 10 - dose 2.2mL
- Access drilled with fast hp.
- Bulk of caries removed with large rosehead.
- Odontopaste placed in pulp chamber.
- Tooth restored with GIC, occlusion checked.
- POIG with regards to LA and post op sensitivity + risk of post op flare up and swelling and
need for re-dress. Warned temp rest - avoid hard + sticky foods.
prescribed 5000ppm f- tp x 3.
TBI given.
1) Restore NHS band 2 amalgam

2) Restore pv comp 100
pt opted option
Fissure sealants
Tx – LL6 + LR6 - advised will place fissure sealants to help prevent caries developing
occlusally in the the lower permanent molars due to the deep fissures and plaque retentive
nature of these teeth.
- Teeth acid etched 40% orthophosphoric acid, 15s, washed and dried.
- Fissure sealed with Aristoflow - light cured 30s .
- POIG with regards to different occlusion, advised will settle in the next few days.
MH - no change.
C/O - no complaints.
Tx – Restoration LL35
- Buccal inf given - lidocaine 2%, 1:80,000 adrenaline, BN B23258AA, 2020 10, 2.2mL.
- Moisture control achieved with high speed and cotton rolls.
- Band placed around tooth and restored with ketac, occlusion checked ,vaseline applied
whilst setting.
- POIG.
MH - no change.
C/O - no complaints.
Tx – Restoration -.
- Excavator used to remove all caries infected dentine.
- Moisture control achieved with high speed and cotton rolls.
- Tooth restored with ketac.
- Checked pt. happy with bite and feel.
- Frankl scale ++ - pt. tolerated tx. very well.
prescribed metronidazole 400mg TDS for 7/7 - POIG advised no alcohol for 9/7 due to
pericoronittis and risk of spreading infection
Tx:
imps
- lower imp taken using alginate in stock tray – pt. tolerated well.
- Sent to APR for night guard.
Urgent app only - pt aware not full check up, aware chargable as no open cot
co - has lump at the back on the gum,not sure if wisdom tooth, felt lump underneath neck
and getting pain from gum right at the back
mh - see form
eo - ln palapable in sm region RHS.
io - LR8 surrounding operculum v. erythematous and inflamed, tender to press.
pa taken see report
diag - pericoronittis LR8
prog -fair
options today - prescribed metronidazole 400mg TDS for 7/7 - POIG advised no alcohol for
9/7 due to pericoronittis and risk of spreading infection
future options - advised >2 episodes consider XLA
discussed should swelling affect breathing / swallowing need to go to a and e.
pt made aware needs to book full check up ASAP
MH – No change.
C/O – No complaints.
I/O -
Tx – Perio App.
- Reinforced tbi - discussed appropriate tepe sizes for pt, and angled tb technique,
recommended e. tb.
- DPC carried out and put in paper notes.
- Scaling and RSD of pockets >4mm carried out with USS.
- POIG with regards to post op sensitivity.
MH – No change.
C/O – No complaints.
I/O -
Tx – Perio App.
- Reinforced tbi - discussed appropriate tepe sizes for pt, and angled tb technique,
recommended oral b e. tb.
- Discussed with pt. will not carry out DPC and full RSD until OH improved - will do prolonged
gross scale today and bring back in 3/12 to reasssess periodontal status and do RSD as
necessary.
- Warned pt. prior - risk of recession, black triangles and post op sensitvitiy - pt. happy to
proceed.
- Prolonged supragingival and slightly subgingival scaling carried out with USS - pt. tolerated
well.
1) NHS band 1 s&p

2) pv hygienist 40/session
all r&b explained (gum recession post op soreness)
pt opted pv hygiene for cosmetic cleaning to remove staining
1) NHS band 2 perio tx

2) Pv hygienist 40/session
all r&b explained (gum recession post op soreness)
pt opted pv hygiene
Perio options:
1) b2 perio
2) ref to hyg 3/12 recall 40 / app
3) ref to pvt perio specialist
pt opted 2 due to previous good experience, advised on importance of perio maintenance
advised will do 6ppc at next visit to assess repsponse to tx.
ES
Prescription for LA during RSD.
Lidocaine 2%, 1:80,000 adrenaline / Articaine 4%, 1:100,000 adrenaline, as needed.
MH - No change.
Tx – Primary impressions.
- Upper and lower primary imps taken using alginate in medium sized stock trays.
- Pt. tolerated well.
- Sent to lab to have upper and lower special trays + wire-reinforced wax rims.
MH - No change.
Tx – Restoration UR6 PRR
- Caries removed fast hand piece - minimal in enamel.
- Tooth acid etched 40% orthophosphoric acid, 15s, washed and dried.
- Prime and bond applied, lightly dried, light cured 30s.
- Tooth restored with flowable comp - PRR also applied to fissures - light cured 30s per
incremental layer.
MH - No change.
I/O –
- Explained to pt. risks and benefits of tx - removal of pain and source of infection, risk of
perforation, file fracture, bleach burns, endo failure and future need for XLA.
- Pt. signed consent form - happy to proceed.
Tx - RCT
- PA for estimated WL taken - see report.
- Buccal inf given - lidocaine 2%, 1:80,000 adrenaline, BN - BAA, exp - , dose - 2.2mL.
- Access cavity drilled with fast handpiece.
- Canals located.
- Moisture control - Rubber dam applied with clamp, widgets and oraseal.
- EWL =
- #10 and #15 taken to EWL.
- Irrigated with NaOCL 30s.
- Apex locator used to get WL.
- 0 reading =
- Actual WL =
- Irrigated with NaOCl.

- #25 Wave 1 gold file taken to actual WL.
- Irrigated with NaOCl, dried canal with paper points.
- #25 GP point placed to WL.
- WL rad taken - see report.
- Happy GP points going to length.
- Odontopaste placed in canals and tooth temporised with cavit.
- POIG with regards to post op pain and LA.
- Pt. told to come back should temp fall out.
MH - No change.
I/O –
- Explained to pt. risks and benefits of tx - removal of pain and source of infection, risk of
perforation, file fracture, bleach burns, endo failure and future need for XLA.
- Pt. happy to proceed.
- Warned pt. v. deep decay large cavity risk of tooth fracturing if not covered by crown -
advised will complete RCT today and will require indirect restoration.
Tx - RCT UR5.
- PA for estimated WL taken - see report.
- Buccal inf given - lidocaine 2%, 1:80,000 adrenaline, BN - B20998AA, exp -2019 10, dose -
2.2mL.
- Access cavity drilled with fast handpiece.
- Canals located - B + P.
- Moisture control - Rubber dam applied with clamp.
- EWL =
- #10 and #15 taken to EWL.
- Irrigated with NaOCL 30s.
- Apex locator used to get WL.
- 0 reading = B = 22.5mm, P = 20.5
- Actual WL = B = 22mm, P = 20mm
- Irrigated with NaOCl.

- #25 Wave 1 gold file taken to actual WL.
- Irrigated with NaOCl, dried canal with paper points.
- #25 GP point placed to WL in both canals.
- WL rad taken - see report.
- Happy GP points going to length.
- Cemented GP points to lenth with sealapex.
- Removed excess with heated excavator.
- Band placed around tooth and restored with amalgam - packed and burnished.
OR
- Removed any overhangs from cavity, removed 2mm occlusally.
- Imp taken with light bodied in prep and heavy bodied - triple tray technique used.
- Sent to vuse.
- Temporised with cavit.
- POIG with regards to post op pain and LA.
consent gained
warned post op sensitivity, black triangles, teeth feel different with tongue
ultrasonic scaler used to remove calculus deposits in all q's with uss - pt. tolerated well.
Tooth wear - signs of erosion of occlusal surfaces of posterior teeth - occlusal pitting seen,
and palatal wear of upper anteriors - discussed possible causes - intrinsic and extrinsic
sources of acid, advised to go to GP if aware of reflux / eating disorder + discussed reducing
sources of acid in diet.
MH - No change.
- Pt. has eaten today.
Tx - XLA -
- Consent forms signed for XLA -
- Discussed replacement options - leave gap / denture / implant - pt. opted leave gap -
warned implant placement can be more expensive following XLA if bone grafting needed -
pt. accepted.
- Went through risks and benefits verbally:
- Benefits removal of source of infection and future pain / swelling.
- Risks - pain, bleeding, bruising, swelling, infection (dry socket), damage to adjacent /
opposite teeth, fracture of roots leading to surgical removal, OAC (communication between
maxillary sinus and oral cavity), fracture of tuberosity / mandible and nerve damage, failure
to complete XLA and needing to ref on to iMOS.
- Pt. happy they understood - signed consent form and added to paper notes.
- Buccal and palatal infiltrations given around- lidocaine 2%, 1:80,000 adrenaline, BN -
B17035AA, Exp - 2018 05, dose -.
/ Articaine 4%, 1:100,000 adrenaline, BN – B15471AA, Exp – 2017 06, dose -
- Luxator applied both B and P around -.

- Forceps applied and tooth extracted apices intact.
- Pt. bit down on gauze.
- Haemostasis not achieved - placed haemostat in socket.
- Interupted suture placed using vicry rapide 4-0.
- Haemostasis achieved.
- POIG with regards to XLA, post op pain and bleeding, socket after care - leaflets and gauze
given.
MH - No change.
Tx - XLA UL2 + immediate denture.
- Consent forms signed for XLA -
- Discussed replacement options - leave gap / denture / implant - pt. opted immediate
denture - warned implant placement can be more expensive following XLA if bone grafting
needed - pt. accepted.
- Warned pt. with immediate denture, risk of denture being ill-fitting as lab have to judge
where the mucosa will sit underneath, advised will require reline / remake in 3-6/12 - Pt.
accepts this.

opposite teeth, fracture of roots leading to surgical removal .
- Pt. happy they understood.
- Buccal and palatal infiltrations given around UL2- lidocaine 2%, 1:80,000 adrenaline, BN -
B22036AA, Exp - 2020 03, dose - 2.2mL.

given.
RCT + Crown (if deemed restorable) or XLA - either here or ref for XLA under sedation (as pt.
anxious) - pt. opted. XLA here - discussed replacement options - leave gap, denture (may be
poorly tolerated with only one gap to replace), bridge (destructive as adjacent teeth sound)
or implant (pt understands that following XLA implant may be more expensive in the future
should bone grafting be required following bony healing).
MH - No change.
Tx - XLA ULC - see ortho letter.
opposite teeth, fracture of roots leading to surgical removal, damage to permanent
successor, failure to complete XLA and needing to ref on to iMOS.
- Pt. happy they understood - signed consent form and added to paper notes.
- Buccal and palatal infiltrations given around- lidocaine 2%, 1:80,000 adrenaline, BN -
B17035AA, Exp - 2018 05, dose -.
/ Articaine 4%, 1:100,000 adrenaline, BN – B15471AA, Exp – 2017 06, dose -
- Luxator applied both B and P around -.

- Haemostasis not achieved - placed haemostat in socket.
- Interupted suture placed using vicry rapide 4-0.
given.
co: nil
temp removed
tried in
pt happy with fit
showed pt in mirror prior to cementation
pt happy with shade and appearance of crown
bite checked w/ articulating paper
occlusal surface of crown adjusted
porcelain etch on crown 1 min and washed off and dried. scotch bond applied 20s and air
dried
tooth etched for 20s, washed and dried, scotch bond applied 20s,
Rely X universal cement applied into crown
crown seated and fitted onto tooth
contacts flossed and excess cement removed
LC 20 per surface
OHI,
pt seen for dental implant surgery

pmh rvd
tx plan and procedure and post op sequelae rvd
pt happy to proceed
consent
2pc lignospan with adre 1 in 80 000 B17888AA 06/2018 local infiltration
pt reports palpitations and local anaesthetic changed to citanest 3pc with octapressin 6040
03/19
oral rinse with corsodyl mw
bmpf raised retraction suture used
site prepared to receive bicon dental implant
LL6 4.5 by 6mm, LR5 4.5 by 8mm UL5 4.5 by6 mm
closure 3/0 vicryl suture
hemostasis
POIG
rv in 7days and OPG radiograph
script amox 125mg/5ml oral suspension, 7/7, TDS, confirmed no allergy to penicillin
co: nil
upper and lower imps taken in alginate using stock trays
disinfected in Perform ID
sent to lab for bite blocks
co: nil
bite blocks adjusted until conforms to occlusion
bite reg in wax
disinfected with perform ID
shade selected with pt A3
co: nil
denture try in tried in
good fit
good bite
good retention
pt happy with fit and appearance
warned no adjustments other than easing can be made once processed to completion
pt understands and consents to process to completion
co: nil
denture fitted
good fit
bite checked
good appearance
pt pleased
shown how to place and remove
pt confirmed that they can do it
denture care instructions given
warned not to wear while sleeping
co: sore when wearing denture LLQ, pt pointed, wants slightly adjusted
adv pt that can ease denture in sore area however, may affect fit, pt accepts risk and would
like it eased
eased with handpiece
pt happy now
upper and lower imps taken in alginate using stock trays

soft wax bite taken
shade A3 selected with pt
sent to lab for immediate denture straight to fit
emergency appt NOT check up pt aware

co: broken tooth LL, very sens, broke 5 days ago whilst eating dinner
eo: nad
io: ST checked-nad, LL broken tooth ML aspect, sens 3in1++, large amalgam present
diag: broken tooth
prog: good
GIC placed
warned provisional fill to protect integrety of tooth
POIG
adv needs defintive restoration
Emergency appointment
pt made aware appointment chargable unless exempt or have open course of treatment.
co: pain from socket where xla was, can sleep but deep throbbing pain, bad taste, bad smell,
few days now
eo: submandib lymphad+++
io: ST-checked, LL7 socket full of debris, bad odor
irrigated with corsodyl
packed lightly with alvogyl
adv will dissolve on its on
try not to touch
script: Metronidazole 400 mg TDS for 7 days
to prevent spread of infection
Verbal instructions given
adv no alcohol
pt is aware this is not exam appointment and needs to make seperate appointment for this.
co: crown fell off LL5, pt poitned, brought crown with her, no pain, not sure how it fell out
io: ST checked LL5 post hole present, post core crown fits well back in, first time fallen off,
happy to have recemented
recemented with Ketac
bite checked
excess removed
can floss
pt pleased
O.H ok
OHI and dietry adv given
co: pain from LL8, pt pointed, swollen, has disturbed sleep last 4 days
eo: submandib lymphad++
io: ST checked, LL8 PE, operculum present, very sore to touch, halitosis, red and inflamed
diag: pericoronitis
NICE guidelines explaiend about 2 bouts or pericoronitis for xla, explained use of single
tufted brush
irrigated with corsodyl
script: Metronidazole 400 mg TDS for 7 days
Verbal instructions given
adv no alcohol
O.H ok
OHI and dietry adv given
erythromycin 2x250mg, po 7/7, 56 tablets, qds given
Rx
duraphat toothpaste 5000ppm
6 boxes bd daily
for high caries rate
script: metro 400mg TDS 7/7 written, warning re: alcohol

to prevent spread of infection
lower alginate imp taken in stock tray

req. soft sides and hard biting surface
adv to wear whilst sleeping for forseable future
also explained normally people grind teeth due to stress so must find a way to manage
stress
co: nil
nightguard fitted
good fit
shown pt how to place and remove
cleaning adv given
advised 8 week review
POIG
co: nil
procedures such as L.A,Prep, Temporisation and a second fit app disc prior to start of trt. Pat
is also informed of importance of OH maintenance such as floss and interdental brushing.
Importance of regular ex and professional cleaning either by dentist or hyg disc as well. Also
informed the restoration may req to be remade due to fractures or decay and even RCT or
re RCTor extraction may be required du to complications of various natures, which we can
not be liable for and also inf that the restoration may fracture come out due to retention or
fracture of the tooth which we can not be liable for. if any of these those happen then we
have to take a decision when necessary
post hole drill prepared with GG23 and up to size red in order, post 12mm placed
rad taken to assess post, sliughtly short, made post to 15mm, retaken rad, much better
length
cemented with paracore and core built up
pro temp temp placed
pat is informed that temp is fragile ,smoking and spicy food such as curry will change its
colour.
pat is inf that we try to match the colour but there might be some shade differences which
sent to: Veus Lab
shade: A2
tca fit
Post op instructions given
inf pat may get soreness and or swelling for the next 2-3 days
if any emergencies to call the practice
pat happy
co: nil
RCT started due to pa lesion and pat request
fracure and consequent progn. disc prior to start of trt.
LA 2.2 ml Lignospan Special (lidocaine hydrochloride 2% and adrenaline 1:80,000) BN:
B11984AA exp 11/16 bucal inf
warned nerve damage, and adv not to eat after the anesthetic worn off
crown risks discussed: procedures such as L.A,Prep, Temporisation and a second fit app disc
prior to start of trt. Pat is also informed of importance of OH maintenance such as floss and
interdental brushing. Importance of regular ex and professional cleaning either by dentist or
hyg disc as well. Also informed the restoration may req to be remade due to fractures or
decay and even RCT or re RCTor extraction may be required du to complications of various
natures, which we can not be liable for and also inf that the restoration may fracture come
out due to retention or fracture of the tooth which we can not be liable for. if any of these
those happen then we have to take a decision when necessary
pvt rct, TFA system used as per instructions

Chamber prep, canals filed, rinsed w hypo chloride,
apex locator WL: 21
MAF: TFA SM red
canal dryed with paper points
filled with GP
MAF rad taken: Qa1 good length and density
final pa radiograph taken to check obturation:grade1: good length and density
shown to pat
post hole drill prepared with GG23 and up to size red in order, post 13mm placed
cemented with paracore and core built up
pro temp temp placed
pat is informed that temp is fragile ,smoking and spicy food such as curry will change its
colour.
pat is inf that we try to match the colour but there might be some shade differences which
sent to: Veus Lab
shade: A3.5
tca fit
Post op instructions given
inf pat may get soreness and or swelling for the next 2-3 days
if any emergencies to call the practice
pat happy
co: nil
trays fit well
shown pt how to place and remove
demo given
8 tubes of bleach given
shade reconfirmed as C4
pt understands
r/v 4/52
co: nil
current shade D3, photo taken with pt's consent
risks discussed for whitening inc. the fact fills will not change colour and so therefore may
need to change these after if in aesthetic zone
pt understands
also warned about sens and burnt gums
pt understands
upper and lower imps in alginate taken in stock trays
sent to Boutique
consent form discussed and signed
tca for fit
co - all ok since LV. feel stable and settled since LV. agreed to move to next stages if all ok. fit
implant abutmetn healing stage.
eo--nad.
io- lrq clsoed over and healing well. no signs of infect redenss, swelling. palpated around
goo. nad. agreed exposire and implant healing abutment attachemtn. agreed.
LR6 LA delviered buccal infil 1 x 2.2ml lignocain. buccal and lingual infil.
crestal incision made, envelope flap. implant cover screw acessd. evident good healing.
good integration. healing abutment attached. good stabliity. poig ++.
suture used to clsoe 3 x vicrl 3.0 suture placed. bleeding ok, good wound closurte. poig ++.
optimal maintenance no hard food 1/52 no bridhing over this region at least 1/52 rinses can
be done. poig ++.
tenderness/sens expected. allow to settle at least 2 weks. soft tissue healing. exposre and
imps at NV. agreed. POIG.
tca 2/52
IMPLANT FIT
Implant abutment and crown fit appointment.
All has been ok since LV. no pain, no discomfort. Temporary has settled well.
EO- NAD
IO- NAD - implants and soft tissue healing well. Temporaries all settled well.
advised today plan to remove temp and fit permanent restorations. agreed.
Temp Crowns /Temp Abutment removed.
Good soft tissue healing. implant stable.
**CEMENT RETAINED**
Abutment tried into position. good fit, and stability. torque tightened as per manufacture
instructions upto 25nm
Tryin of crown. good fit, and good margins. pt shows in mirror. pt happy with appearance
and fit.
good shade balance. Agreed to cement.
Abutments cleaned, fit with temp-bond to position (advised to allow to mimic PDL
movement, and limit stress on implant). No soft tissue blanching
held to position. excess cement removed from margins. bite checked - good. no
interference, no issues in guidance, no non-working interference.
POIG ++. pt advised post op care. must maintain optimal OH. implants can fail for similar
perio reasons to teeth. pt advised about risk of de-bonds, and fracturer. to be careful in bite.
**SCREW RETAINED**
Crown and Abutment tried into position. good fit, and stability. torque tightened as per
manufacture instructions. (upto 25nm)
Good fit, and good margins. pt shown in mirror. pt happy with appearance and fit. No soft
tissue blanching
good shade balance. Agreed to fit.
bite checked - good. no interference, no issues in guidance, no non-working interference.
POIG ++. pt advised post op care. must maintain optimal OH. implants can fail for similar
perio reasons to teeth. pt advised about risk of de-bonds, and fractures. to be careful in
bite.
Agreeed allow to settle into bite, soft diet ++, can feel strange, tender initial. If any issues
not sure about then TCA sooner for checking.
Advised pt out contact, phone and email, to contact back as soon as possible.
agreed KUO ++ Pt very happy with result. POIG reinforced.

tca 3/12 ex/rv + regular 3/12 hyg. Must maintain this schedule as per agreed consent. If
problems occur and pt fails to attend as agreed, then risk will be out of scope of any
coverage/guarantees etc.
IMPLANT CONSULTATION
SECTION1 – Initial Patient Info

CO:
HPC:
Patient’s Requests: (Fixed/ Removable Implant Restorative/ Cosmetic)
SECTION2 - History
Previous Medical History:
Psychological:
Social History:
Smoking Cigs/day:
Alcohol Units/week:
Other Special Considerations (budget, time, distance, travel, etc., particular wishes)
SECTION3 - Examination
PART A
Extra-Oral Examination
Facial Form: Square / Tapering / Ovoid
Facial Height: Long / Medium / Short
Profile: Prognathic / Ortho / Retro
Facial Asymmetry: Yes / No
Skeletal Class: I / II / III
Lipline: @ Rest High / Medium / Low
@Maximum Smile High / Medium / Low
Lips: Full / Average / Collapsed
Muscle Tenderness: Extra-oral / Intra-oral
Lymph Glands: Normal / Enlarged
TMJ Function: @ Left Pain / Crepitus / Click
@ Right Pain / Crepitus / Click
Mouth Opening: Restricted/Unrestricted
Maximum Opening: (mm)
Lateral Movements @Right (mm)
@ Left (mm)
Deviation: @ Opening (mm)
@ Closed (mm)
Path of Opening and Closure Notes:
PART B – Soft Tissues
Upper Lip-
Lower Lip-
Super Labial Frenum -
Inferior Labial Frenum -
Lingual Frenum –
Tongue
Fauces
Uvula
Soft Palate
Hard Palate
Glossopalatine arch –
Pharyngopalatin arch -
Palatine tonsil -
Ginigvae –
Salivary Duct orifices – sublingual, Submandibular
PART C
1. UPPER
Sulci: Deep / Moderate / Shallow
Attached Gingiva: @ General Adequate / Inadequate
@ Implant Site
@ Thick Fibrous / Thin Scalloped (Siebert and Lindhe 1989)
Muscle Attachments: Close / Remote
Ridge Conformation and sinus implications @ Height: Good / Moderate / Poor
@ Width: Good / Moderate / Poor
Details:
Graft Needed Yes / No / Possible
Palatal Vault High / Average / Low
1. LOWER
Sulci: Deep / Moderate / Shallow
Attached Gingiva: @ General Adequate / Inadequate
@ Implant Site
@ Thick Fibrous / Thin Scalloped (Siebert and Lindhe 1989)
Muscle Attachments: Close / Remote
Ridge Conformation and sinus implications @ Height: Good / Moderate / Poor
@ Width: Good / Moderate / Poor
Details:
Graft Needed Yes / No / Possible
Palatal Vault High / Average / Low
PART D – Periodontal
BPE:
General Oral Hygiene Poor / Fair / Good / Excellent
Pockets:
Calculus:
Plaque:
BOP:
Periodontal Disease Yes / No
PART E - Dentition
Teeth Present: See charting
Teeth Missing:
Extent of Restoration None / Slight / Moderate / Extensive
Condition of Dentition Poor / Fair / Good
Observations:
PART F - Prostheitc
Dentures: None
Upper: Full/Partial Base / Acrylic / Metal
Lower: Full/Partial Base / Acrylic / Metal
Bridge Work: None
Upper: PFM , Metal, Zirconia, Emax,
Lower: PFM , Metal, Zirconia, Emax,
PART G – Occlusion Static
Static Incisor Relation: 1 / 2 Div I / 2 Div II / 3
Open Bite Yes / No Extent:
Cross Bite Yes / No Where:
Initial Assessment Stable Yes / No
Describe: Arch Form, Crowding etc.
PART H – Occlusion Dynamic (Premature Contacts)
Protrusion: Anterior or Posterior Guidance
Left Side Disclusion: @ WS Canine Guide / Group Function
@ NWS Contacts
Right Side Disclusion: @ WS Canine Guide / Group Function
@ NWS Contacts
Tooth-Wear: Physiological / Pathological (See Charting)
Bruxism Yes / No
Accessibility Good / Reasonable / Difficult
PART I – Aesthetics
Smile Mid-Line Shift Yes / No Describe:
Discoloured Teeth Mottling / Staining
Missing Teeth Effect OBS
PART J - Special Tests
Electric Pulp Test
Cold
Hot
Percussion
PART K - X-Rays
PAs / Panoral / Lateral Ceph / CBCT / MRI Scan:
Lower jaw Upper jaw
Indications
X-RAYS Reports:
PART L Other Diagnositcs
Photos Yes / No
Study Casts Yes / No
Diagnostic Preview Yes/No
Temps Shade
Computer planning and guide eg SMOP Yes / No
LAB\
OBS
SECTION 4 – Treatment Planning
SECTIONS 5 – Other Treatment Considerations
Treatment Considerations /Advice /Warnings/Notes
As well as the benefits of implant treatment, which we have discussed, also discussed risks
associated with this treatment including but not limited to the following:
- Implant failure. Generally there is a risk of failure of approximately 1% to 5% depending on
specific circumstances. Usually an implant can be replaced should it fail either at the same
time or at a later stage. Occasionally additional procedures may be required and this may
extend the treatment time.
- There is a risk of accidental damage to adjacent anatomical structures, such as the
adjacent teeth, sinus if/when working in the upper jaw and the lower jaw nerves that
supplies the sensation of the lower lip although with accurate planning with a ct scan this is
reduced
- Damage to lower jaw nerve can result in permanent or temporary dysaesthesia (altered
sensation) and in rare cases numbness although with accurate planning this is reduced in
this case.
After surgery, pain, swelling, limited opening, bruising, tenderness or discomfort to varying
degrees. careful management with analgesics. antibiotic and a mild steroid to assist with
healing prior/post to surgery.
It is imperative to follow our advice and not put any excessive pressure on the healing
abutments during the healing period, which could result in failure. You must maintain a soft
diet for the first 3 to 4 months.
There is a low risk of the failure of an implant after the first years of function as long as your
health, both general and around the implants is maintained and no excessive forces are
exerted. Excessive forces may result in fracture of component parts or loosening of screws.
Pt made aware that implants and teeth are subject to wear and tear as time goes on and
depending on the amount of wear the need to replace the bridge/crown may arise.
There is also the risk of gum recession around implants exposing the silver/grey of the metal
and though this may not affect their survival it can require treatment for aesthetic reasons
Referral Needs Ortho / Perio / Endo / Oral Surgery / Med / Other 1 2 3 4 5 6 7 8 9 10
IMPLANT CONSULTATION OVERVIEW
Pt Referred by:
Pt would like to know more about Dental Implants and if possible to have dental implants as
treatment option.
Co –
HPC –
MH –
EO –
IO –
Overview of patients situation:
Options Discussed
1. Do nothing
2. Implant -fixed option not an NHS option. Requires surgery and sometimes a wait of
between 6 months in between treatment.
Requires patient to not smoke, and follow meticulous cleaning regime.
Permanently fixed in pt bone, requires minor oral surgery usually under local anaesthetic.
Takes 3-6 months maybe more for implant stabilization before the tooth can be placed and
may require temporary crown(s)/bridge(s) or denture(s) in the meantime. If looked after
average prognosis 10-15 years but can be longer. No damage or dependence on adjacent
teeth. Implant not immune to gum disease and peri/implantitis/mucostis can develop
around tooth. If this occurs problematic tooth needs to be removed asap as infection can
undermine the health of the bone meaning a graft may be required.-increasing cost.
Smoking and uncontrolled diabetes lower success rates, a period of no smoking before
implant for 1 month and ideally quit after. If continue smoking no guarantees are provided.
Discussed all outline advs and disadvs of this tx.
3. Bridge will require cutting, strategic re-shaping of adjacent teeth and they may need root
canal in the future, may also get sensitivity from treatment but is a fixed option
This may be attached on one side and or both loss of vitality roughly 20%after 5 years may
also can worsen any pre-existing periodontal condition usual life span 15 years if looked
after.
Maryland Bridge: advised can often need re cementing but little or no destructing of
supporting teeth
4. Denture – takes at least 4 visits and need to get used to a removable plate can take some
time. May need to come back for adjustments if immediate denture then needs a reline
after 8-9 months.
NHS and private options and costs discussed pt opted for:
If space is left: adjacent teeth may tilt opposing may over erupt into space there could be
long term costs of fixing occlusal interferences. Not everyone experiences tilting and over
eruption and some people cope fine without replacement very individual
Advised main aim of consultation today is to plan if implants are possible.
Discussion with pt about estimate costs, timescales and process/procedure, and
maintenance of dental implants understood. Agreed with pt if would like to proceed then
next step is detailed planning and assessment, and agreed CBCT scan will be required to
assess bone height, width, approximate density, adjacent anatomical structures .
Patient would like this and agreed CT scan to begin. agreed pt to visit imaging centre for
this. agreed. agreed CT scan and full v and planning. aged. pt aware est costs Tx
Plan/Options ageed tca after scan for rv. Patient happy
Advised CBCT costs £115 per arch, to be paid directly to CBCT centre. Pt tca after CBCT for
full assessment. Agreed.
CO - nil
all ok since LV.

agreed next stage tx today implant abutment imps. agreed.
Implant healing abutment screw removed. excellent healing. soft tissues good. implant well
integrated from torque assesemtn of healing abut,ent.
implant impression transfer coping placed. open tray. imp taken in putty and wash.
oppoing putty and wash. bite registration.
sent to veus lab for articulation and fabrication of implant abutment (custom) and crown.
healing abutment replaced. poig ++
tca crown fitting. poig ++

Implant review.
co - all has settled well since fitting appointment. Pt started with softer diet, and now feels
can chew comfortably in the area.
Pt states is maintaining good OH. Finds it difficult with new devices (tepe, super floss etc) as
recomended, however getting adapted to the regime. Not using all the time, but aware that
should be doing this.
Pt very happy with result and outcome of treatment.
EO - Nad
IO- Implant restoration stable. Good soft tissue integration. OH good. improvement areas
noted. pt shown in mirror.
Occlusion good, checked with articulating paper, no premature, unbalanced contacts in ICP
Lateral or protrusive movements.
Agreed KUO soft tissue. recession risk possible. Reinforced OHI. agreed KUO ++
To come back sooner if any issues or concerns.
post op pics taken for reference.
Review with me in 1 year to check and xrays as required.
Agreed regular checkup and Oral Hygiene Maintenance. Recommend to see hygienist 3/12
as per tx plan advice. agreed with pt.
Implant surgery:
CONSENT : Consent returned signed, Pt has had the opportunity to read through and ask
questions. Pt has no questions or queries. Happy to proceed based on the outline plan. No
other queries.
MH : Checked NAD. No Changes
PREOP MEDS: Patient has taken ibuprofen 400mg 1 hr before appointment, good food
before hand, 3g amoxicillin sachet taken, 2mg x 3 Dexamethasone tablets taken
SETUP: Asepsis carried out: drapes/gowns ref: Hygitech Kit. Pt hat, goggles, gown sheet,
PREOP PREPS: 2mins chlorhexidine m/wash. Chlorhexidene Gluonate wash around mouth
extraorally with sterile gauze. Streilie toothbrush to brush teeth +soft tissues intraorally +
Extraorally with gauze with Iodine
ANAESTHESIA: LA given: 1 x 2.2ml Lidocaine Special lidocaine hydrochloride 2% and

adrenaline (epinephrine) injection 1:80,000 solution for injection BN:B20989AA Expiry
date:08/2019 / BN:B20997AA Expiry date:10/2019
LA given: 1 x 2.2ml Septanest 1:100,000 (Articaine hydrochloride 4% with adrenaline

(epinephrine) injection 1:100,000) solution for injection BN: B21020AAA Expiry
date:03/2019 / N:B21020AAA Expiry date:03/2019
XLA: Careful Atraumatic XLA carried out with luxators and forceps, socket debrided,
encouraged bleeding.
SURGICAL GUIDE: Surgical guide planning completed preop. SurgiStent guide used with
Osstem One guide Kit. Checked fit of guide. Good retention and fit. sits well on teeth/soft
tissues.
ACCESS: No Flap (flapless approach), Crestal incision with Envelope Flap,
SURGERY: Initial bone assessment > bone quality D1, D2, D3, D4
Osteotomy prepared at implant site planned. Osstem system 122 kit, One Guide Kit, Esset
Kit for bone expansion, CAS Kit for sinus lift
Drilling sequence completed as per implant system guideline, lance, pilot and osteotomy
drills. As per sequence upto: WIDTH: LENGTH:
Implant placed: Osstem TS3 / TS4. LENGTH: 13mm DIAMETER: 4.5mm. Placed subcrestally
approx 1mm. Implant Motor used for placement.
Implant Torque: Placed to 35nm Torque
Implant ref: LOT/Batch/Expiry, see scans
Bone Quality: D1, D2, D3, D4.
Primary Stability: Poor, Fair, Good Excellent
Healing: Cover Screw placed Healing abutment placed, and torque tightened according to
manufactures guidelines (15-20nm torque)
Temporisation: Abutment placed and torque tightened, metal coping and a3 composite
crown placed-no cement, friction fit, pt advised care, risk debond,
CLOSURE : Flap replaced and sutures placed. 1 x Single Interrupted, Vicryl rapide suture
placed.
POST-OP : 1 pa taken to check implant position and anatomical structures - ROX: grade 1,
implant good angulation away from anatomical structures.
POST-OP MEDS: amoxycillin 500mg 21 caps. post-op instruction sheet.
POST OP ADVICE: Analgesia and soft food stressed/ OH care and advice. Advised arnica and
vit C/D for 1week to aid healing. No brushing the area immediately after, no rinsing
vigorously. Liely will be tender owing to surgery, likely to be swollen + Bruising risk. pt
aware. Full post op sheet given. Scanned copy to notes.
LA POIG after tx , inc take care with hot drinks, biting lip immediately. Perm/temporary
nerve sensations advised. If sutures get lose not to pull as will risk trauma to area.
FOLLOW UP: 10 days 20 r/v, assess and check healing. No further questions from pt. agreed
to contact back if any issues. clinic number, email and personal number on post up care
sheet given.
Suture removal planned.

CO- All ok and healing since LV. No issues to report. Pt states has been clenaing as
receommended. Was some discomfort directly after surgery, but settled after 48hours, no
isues to report.
eo - nad.
io- healing of soft tissues good, sutures present. Agreed removal of sutures. can implement
optimal oh after, but still no brushing around the area. agreed.
sutures removed with scissors to cut, no issues. corsodyl rinse completed.
poig ++ tca after healing est 6-8 weeks - implant exposure and healing abutment
attachment. agreed.
Appt with Ahmer Usmani (Hygienist)

C/O: nil
COVID status: asymptomatic. Pts temperature was checked and provided alcohol gel to
clean their hands with. See COVID form for COVID status. AGP PPE worn as per SOP
guidelines (including FPP3 mask that I have been fit tested for).
MH: checked no changes

PH: Pt brushes X daily, using X TP and uses X ID aids. Diet: well balanced.
SH: Stress level /10
DH: Recommended and strongly advised to visit their dentist as well as seeing me for any
treatment. Explained the risks of not seeing a dentist regularly.
FH: no family history
Pt pre rinsed with a diluted hydrogen peroxide mouthwash prior to exam and tx.
E/O-
TMJ, Lymph, submental, occipital, auricular nodes, lips: NAD
I/O-
Soft tissues: NAD
Gingivae: Gen erythema
Calculus:
Plaque:
Teeth:
Indices:
BOP: BPE: see chart
Diagnosis: Generalised Gingivitis- infomed pt
Pt education:
Showed pt intraorally using a hand mirror where the disease is. Explained the importance of
plaque removal as if bacterial plaque isn’t removed sufficiently it can eventually destroy the
bone which hold the teeth causing tooth loss. Aetiology explained pt understood.
Prevention- -Demonstrated BASS technique using a dry manual TB X2 daily. Pt

demonstrated back well. -Advised pt to spit don’t rinse when brushing and advised pt to dry
TB after use.
-Demonstrated ID aids. Pt demonstrated back well. Advised pt to use it X1 daily,
Diet advice
Explained to pt that whenever they eat sugary foods the normal bacteria produce acids
which make the teeth more vulnerable. Constant snacking increases vulnerability of the
teeth thus causing tooth decay.
- Advised pt to eat sugary snacks with meals advised to have 3-4 meals daily, explained the
importance of a well-balanced diet for their general health as well as their periodontal
health. - Advised pt to reduce sugary contents as much as possible substitute them with
non- sugary snacks. - Advised pt to chew on sugar free gum to help buffer back Ph.
Smoking and alcohol cessation advice given, explained increased risks: oral cancer and early
onset of perio, tooth loss. Made pt aware of the help they can receive to quit e.g.
pharmacy/ GP, nicorrete (nasal spray, patches, gum).
Denture advice given: Leave denture overnight in water. Sterilise with either Dentural
/Milton. Advised pt to make sure they clean/ remove their dentures otherwise they are at a
higher risk of fungal infections and plaque stagnation increasing risk of tooth loss.
Verbal consent gained for tx.
Explained the options for Gingivitis
1. Leave and monitor at pts request- strongly did not recommend as explained Gingivitis will
worsen leading to periodontitis (bone loss, recession and tooth loss)
2. FM fine using ultrasonic and hand instruments and thorough OHI Review in 3mths
Selective Polish
Pt opted for opt 2
Tx
FM fine using us w HVS and AGP PPE

Pt was made aware of the risks of having AGP tx
AGP start:
AGP finish:
Fallow time 10mins : windows opened, ventilators present in room put on high setting.
Post- Operative Instructions Given
Throughout appointment was polite to patient. Pt was happy with treatment provided.
NV
3mth Oh review/ post initial review

C/O: nil
clean their hands with. See COVID form for COVID status. Non AGP PPE worn as per SOP
guidelines.
E/O-

I/O-
Soft tissues: NAD

Gingivae: NAD
Calculus:
Plaque:
Teeth:
Indices:
BOP: BPE: see chart
Diagnosis: Generalised Gingivitis- informed pt
Pt education:

TB after use.
Diet advice
health.
- Advised pt to reduce sugary contents as much as possible substitute them with non- sugary
snacks. - Advised pt to chew on sugar free gum to help buffer back Ph.
Explained the options for Gingivitis

2. FM fine using ultrasonic and hand instruments and thorough OHI (explained as high risk
period u/s and polish is contraindicated due to production of aerosol) pt happy with hand
scaling. Review in 3mths Selective Polish
Pt opted for opt 2
Tx provided today FM fine using hand scalers w high volume suction
Throughout appointment was polite to patient. Pt was happy with treatment provided.
NV
Appt with Ahmer Usmani(Hygienist)
C/O: nil
AW: mum
guidelines
E/O-
I/O-
Soft tissues: NAD

Gingivae: Pink and stippled
Calculus:
Plaque:
Teeth:
Indices:
BOP: BPE: see chart
Diagnosis: Gingival health with calculus deposits- infomred pt and parent
Pt education:

TB after use.
Diet advice
Explained the options for Gingival health with calc deposits
2. FM fine using ultrasonic and hand instruments and thorough OHI (explained as high risk
period u/s and polish is contraindicated due to production of aerosol) pt and parent happy
with hand scaling. Review in 3mths Selective Polish
Pt opted for opt 2- parental and patient consent gained.
Tx provided today FM fine using hand scalers w high volume suction
Throughout appt was polite to both child and parent. Both child and parent happy with the
tx provided.
NV

C/O: nil
clean their hands with. See COVID form for COVID status. AGP PPE worn as per SOP
guidelines including FPP3 mask I have been fit tested for.

E/O-
I/O-
Soft tissues: NAD

Gingivae: Generalised erythema and oedema
Calculus:
Plaque:
Teeth:
Indices:
BOP:
DPC completed BPE: see chart
Mobility Furcation:
Working Diagnosis: Generalised periodontists Class X, Grade X, risk factors:
Informed pt of diagnosis
Pt education:
bone which hold the teeth causing tooth loss, recession and boneless.
Prevention- -Demonstrated BASS technique using a dry manual TB/ ETB X2 daily. Pt
TB after use.
Diet advice
Explained the options for periodontitis
1. Leave and monitor as pts request- strongly did not recommend as explained periodontitis
will worsen leading to bone loss, recession and tooth loss.
2. Treat periodontitis in house: Initial phase, corrective and post corrective review. DPC and
OHI
3. Given option for referral to a periodontal specialist either NHS or PVT explained the pros
and cons for both for the patient to make an informed decision.
Pt opted for opt 2
Tx:
FM fine with us w HVS. Explained the risks of having an AGP tx.

10 mins fallow time between patients with ventilator on and window opened
Throughout appt was polite to the patient. Pt was happy with treatment.
NV

C/O: nil
guidelines.

E/O-
I/O-
Soft tissues: NAD
Gingivae: Generalised erythema and oedema
Calculus:
Plaque:
Teeth:
Indices:
BOP:
DPC completed BPE: see chart
Mobility Furcation:
Working Diagnosis: Generalised periodontists Class X, Grade X, risk factors:

Informed pt
Pt education:
bone which hold the teeth causing tooth loss, recession and boneless.
Prevention- -Demonstrated BASS technique using a dry manual TB/ ETB X2 daily. Pt
TB after use.
Diet advice
Explained the options for periodontitis
1. Leave and monitor as pts request- strongly did not recommend as explained periodontitis
will worsen leading to bone loss, recession and tooth loss.
2. Treat periodontitis in house: Initial phase, corrective and post corrective review. DPC and
OHI
3. Given option for referral to a periodontal specialist either NHS or PVT explained the pros
and cons for both for the patient to make an informed decision.
Pt opted for opt 2
Tx:
FM fine with hand instruments with high volume suction
Throughout appt was polite to the patient. Pt was happy with treatment.
NV
1) pv implants from 2000 per tooth

2) dentures - nhs b3 acrylic, pv 600 acrylic, pv 700 valplast, pv 900 cocr
- immediate options discussed - pt aware may need replacement in 3-6m following
healing (same options as above) or can wait until healed for plate to be made
3)
pt opted
OHI
Explained to pt that his mouth will be stabilised before definitive treatment such as RCT is
carried out so that he is out of pain and active carious lesions are treated. pt aware and
understands.
Thorough discussion had with pt about his diet and OH

Diet advice given - advised to minimalise frequency of sugars to meals only. Advised water
most times and when drinking juices/squashes to use a straw.
fluoride
gum disease.
Thorough discussion had with mum and pt about pt's diet and OH in today's appt
rinse, recommended use of TEPE brushes. Advised mum to supervise pt's brushing of teeth
or even keep brushing pt's teeth for himself until pt is able to keep OH optimal on his own.
Diet advice given - advised dad to monitor pt's diet and to minimalise frequency of sugars to
meals only. Advised water most times and when drinking juices/squashes to use a straw.
Emphasised the importance of keeping sugar out of child's diet as much as possible to mum.
Advised mum that patient will be reviewed continously for improvement in OH and diet.
mum aware and understands.
Concern of dental neglect noted after this appt and discussion to be had with Safeguarding
Lead of the practice for advice on whether referral onwards should be sought.
DECLINING PERIO
perio
treatment options perio:

1. NHS B2 perio
2. PVT with hyg 45/session
pt declined perio tx and opted for neither options. Advised pt that declining perio tx is not
recommended but pt insisted she did not want it. Warned pt of the risk of periodontal
health deteriorating further without tx and that she will lose her teeth quicker if tx is
delayed further. pt is aware of this risk and accepts and understands everthing discussed in
today's appt regarding her periodontal disease.
DECLINING RADS
rads: pt declined radiographs to be taken. Explained to pt that without radiographs of
existing teeth we are unable to assess presence of decay or bone levels and there is a risk of
missing caries and problems. pt aware of risks, accepts them and understands and still
declined radiographs to be taken.

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Phone consultation completed

Duraphat varnish 50mg/ml F- applied

options for fill:

SK please do amalgam fill and use LA 2% lidocaine 1:80k adrenaline

treatment options perio:

pmh: checked and updated

diag: Generalised Gingivitis

recall set at 6/12 as per risk assessment

emergency appt, not CU, pt aware

moisture control achieved with high speed and cotton roll

Advised pt to book exam appt.

(L) BW taken for caries screening and bone levels assessment

pmh: updated and checked

tw: none noted

rads: nil taken as no justification

diag: no path detected

recall 6/12 as per risk assessment

Fluoride Varnish applied

OHI given - pt advised to brush 2x daily, spit don't rinse

tx: ULE mesial

emergency appt, not CU, pt aware

extraction socket irrigated w/ saline

emergency appt, not CU, pt aware

emergency appt, not CU, pt aware

tried in, pt happy with fit

Advised pt to book exam.

co: nil experienced

emergency appt, not CU, pt aware

pmh: checked and updated

SIs: percussion test - all teeth negative

Reassured pt that no teeth in URQ have changed colour.

Advised pt to book 6/12 exam.

UL1 assessed and trauma investigations carried out

IADT tauma guidelines followed

emergency appt, not CU, pt aware

prescribed Metronidazole 400mg, TDS, 7/7, script written

Advised pt to book exam.

upper and lower fixed braces fit

0.16 wire ni ti ligated upper

bitegaurds: not needed

POIG written and verbal and wax

We have reviewed the clincheck together and it shows:

1. IPR (enamel stripping/shaping) = no Explained IPR and the purpose of it.

Explained the importance of wearing a retainer after.

MH- Reviewed & Updated

C/O: Unhappy with position of teeth.. " __".

How long noticed for? What is it you don’t like?

Pt understands and accepts this.

Advised C/U if has not been carried out at Novel Dental.

Options briefly highlighted regarding malalignment.

Pt uninterested in 1,3 and 4. Would like more information regarding Invisalign.

Pt happy and understands.

Clinical Photographs taken & impressions sent for clincheck

Topical anaesthetic applied to the gingivae

N/V fit and photos.

Whitening review app.

Whitening tray fit

- Pt. happy with appearance and bite.

- POIG with regards to LA and post op sensitivity.

NHS band 3 metal, pv 650 gold, pv 550 porcelain

#A1 chosen - showed pt. in mirror - happy with choice.

1) Restore NHS band 2 amalgam

- Pt. happy with appearance and bite.