Case Presentation

ENDODONTIC AND ESTHETIC REHABILITATION OF GROSSLY CARIOUS TEETH

Saadia Hayee Shaikh

4-6/2016/043
Department of Operative Dentistry
Ziauddin University
 CASE REPORT
PATIENT INFORMATION
• Patient Name : Mrs. Khatija Begum
• Patients Age : 47 years
• Date of Birth : 30 –Jan-1973
• Status: Married
• Address : Sultanabad Karachi
• Occupation :Housewife

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 CASE REPORT
Presenting Complain
A 47 year old female presented to the dental OPD with a complaint of pain in upper
anterior teeth since 5 days.
History Of Presenting Complain
Patient had an unprecedented fall after waking up from a nap and walking briefly to
attend to the door. Her teeth suffered the impact. The maxillary central incisors
suffered trauma and chipped off from the incisal edges. Patient states that caries
initiated soon after that and spread entirely .Patient complain of sharp intermittent
pain since 5 days ,which is aggravated by hot and cold stimulus. The pain radiates to
head .Pain subsides on taking medication

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 MEDICAL AND DENTAL HISTORY
Medical History : Not significant
• Past Surgical History: Not significant
• Drug History : Tab Synflex 550 mg since 5 days for pain.

Dental History : Generalized sensitivity to hot & cold stimulus

Mild plaque & extrinsic stains present
Brushes once a day
• Extra Oral Exam : Facial symmetry present, No swelling or bruising
• Intra Oral Exam : Caries (#11 ,#21,#22) ,Missing (#37)

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 Clinical Examination
• Palpation : No pain
• Percussion : 1 1 digital tap was
done. Tender to percussion.

• Mobility : Absent
• Cold test : #11 , #21 Positive. Sharp
lingering pain

A PRE-OP CLINICAL PICTURE

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 INVESTIGATION

• A peri-apical xray was done of

the respected teeth

• DEFINITIVE DIAGNOSIS:
IRREVERSIBLE PULPITIS 11,21

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 TREATMENT PLAN

Counsel the patient (anxiety reduction protocol)

Advise endodontic treatment of #11 , #21 and #22

Advise ultrasonic scaling of teeth for extrinsic stains

Advise replacement of missing teeth with a prosthesis

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 STEPS OF ROOT CANAL

Inject Local Anesthesia-Infiltrate.

Isolation with rubber dam

Access Cavity Preparation

Pulpectomy followed by working length

MAF followed by step back

Obturation

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 FIRST VISIT
The patient was severely anxious.
Counselling took a significant amount of time.
• Working Length : 18 mm
• Reference Point: Incisal edge
• Master Apical File: 40
• Step Back: 55

WL confirmed with a radiograph

P/A radiograph to confirm Rubber dam quadrant
the working length isolation

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 SECOND VISIT

Endodontic Treatment of #11 and #21

The canal was irrigated then dried by paper points and calcium
hydroxide (multi cal) was placed in order to reduce microbial
activity.
Multi-cal was directly placed with the syringe.

Intermediate restoration was done by cavett.

Patient was recalled after a week.

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 THIRD VISIT
Endodontic Treatment of #11 and #21
• Master Cone placed after drying the canal
with paper points
• Gutta percha placed and condensed laterally.
• Post Obturation Xray.

Post Obturation Xray.

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 FOURTH VISIT
Post and Core of #11 and #21
• Removed GP using slow speed hand piece with GG Burs
2,3 . .H file was also used to remove GP.
• Removed 14mm of GP.
• Fiber post was selected . (20mm in diameter)
• Fiber post is placed and cemented at 14mm
• Composite was used for the core build up
• (Shade A2 & A1 were mixed to achieve an aesthetic match)

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 Post Core Build up

Post removing 14mm GP XRAY.

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 FOLLOW UP
The patient was appointed 17th Feb as the date for starting the work on her
prosthesis by the prosthodontic department. I’ll be personally following
this patients treatment course as I will be posted in the prosthodontic
department after finishing in the operative department.

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 CRITICAL APPRAISAL
• Removing of GP can be improved .As Some part of it stills seems to be intact on the
distal wall of #21.
• Better shade matching for composite could have been done .

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THANKYOU
!
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