III: Case Studies

Case
Studies

Introduction

The cases presented in this section are designed to stimulate discussion of the various dental materials that are used to restore or replace teeth. The questions involve not only dental materials but clinical dental hygiene as well. Maintenance of restorations, prostheses, and oral tissues should also be considered.

Case 1

The patient is a 63-year-old woman with a maxillary denture, and the appliance is presented in Figure CS1.1. She lives on a very limited income but visits the dental office yearly for a thorough dental examination and oral prophylaxis. At this visit, she presents with little plaque and stain but with a small amount of calculus on the supragingival, lingual surface of the remaining natural teeth.

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FIGURE CS1.1. A. Patient wearing dental appliance. B. Patient without appliance. C. Appliance.

Questions

Question 1.  The remaining natural teeth on the mandible include:

a.  Teeth #18, #22, #27, and #28

b.  Teeth #19, #21, #25, and #26

c.  Teeth #19, #22, #27, and #28

d.  Teeth #18, #21, #26, and #27

Question 2.  The replacement prosthesis is correctly termed:

a.  A removable bridge

b.  A removable partial denture

c.  A partial

d.  A fixed partial denture

Question 3.  The clasps of the prosthesis encircle which of the following teeth?

a.  Teeth #19, #22, and #27

b.  Teeth #18, #21, and #26

c.  Teeth #18, #22, and #28

d.  Teeth #19, #22, and #28

Question 4.  The composition of the prosthesis may include as many as ______ dental materials.

a.  2

b.  3

c.  4

d.  5

Question 5.  The polishing agent of choice for the patient’s natural teeth should be:

a.  A pumice slurry

b.  A coarse prophylaxis paste

c.  A fine prophylaxis paste for all teeth

d.  Selectively polish the stained teeth

Question 6.  After scaling and polishing the natural teeth, cleaning the dental prosthesis, and providing thorough patient education about calculus formation and removal, an appropriate recall recommendation would be:

a.  To continue the yearly recall date

b.  To change to a 6-month recall because of the calculus formation

c.  To keep the yearly recall but note in her record to closely assess the calculus formation and, if necessary, change the recall date accordingly

d.  To encourage the patient to accept a 4-month recall so that calculus formation can be closely monitored

Case 2

The photographs (Fig. CS2.1) show a 25-year-old man having three restorations placed during his appointment. His gums bleed easily, and the probing depths for this quadrant are noted on the charting in Figure CS2.2. His oral hygiene home care consists of brushing two or three times a week and swishing with Scope mouthwash on the days he does not brush. Flossing is not a part of his oral hygiene regimen.

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FIGURE CS2.1. A. Preoperative radiograph. B. Rubber dam isolation, ready to restore with amalgam. C. Amalgam restorations. D. Postoperative radiograph (Courtesy of Dr. Henry Miller, Martinsburg, WV).

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FIGURE CS2.2. Periodontal measurements of the teeth shown above.

Questions

Question 1.  The teeth being restored in the photographs below are:

a.  #2 and #3

b.  #14 and #15

c.  #13 and #14

d.  #1 and #2

Question 2.  In Figure CS2.1A, the “white” material on the floor of the preparation of the second tooth from the left is considered to be a _______________, and its purpose is __________________.

a.  Liner; to provide strength and thermal insulation

b.  Base; to provide strength and thermal insulation

c.  Liner; to protect the pulp from chemical irritation

d.  Base; to protect the pulp from chemical irritation

Question 3.  From the most distal surface of the last tooth and moving mesially, the amalgam restorations would be named:

a.  Disto-occlusal (DO), mesio-occlusal (MO), and disto-occluso-lingual (DOL)

b.  Occlusal (O), MO, and DO

c.  O, MO, and DOL

d.  MO, DO, and DOL

Question 4.  What two conditions also exist in this patient?

a.  Pulpal involvement and periodontal disease

b.  Premolar occlusal stain and gingivitis

c.  Root calculus and gingivitis

d.  Root calculus and periodontal disease

Question 5.  In between the patient’s restorative appointments, he has an appointment with you for the necessary dental hygiene care. Assuming that the dental and dental hygiene assessments and diagnoses have been made, implementation of the dental hygiene care would include:

a.  Scaling and polishing

b.  Scaling, root debridement, and polishing

c.  Radiographs, root debridement, and polishing

d.  Scaling, root debridement, polishing, and evaluation

Question 6.  The new amalgams could best be finished and polished with:

a.  Slurries of pumice and tin oxide

b.  A slurry of tin oxide

c.  Finishing burs and then slurries of pumice and whiting

d.  Coarse and then fine prophylaxis pastes

Question 7.  Which of the following teeth should be closely “periodontally monitored”?

a.  #2

b.  #2 and #3

c.  #2, #3 and #4

d.  All teeth in the case presentation should be monitored in the same way.

Case 3

The patient is a 31-year-old woman who is very self-conscious of a malformed tooth that everyone can see. She has yearly dental exams and also sees the hygienist during the same appointment. Her oral home care is excellent. She is most interested in having this tooth “look a lot better than it does.” The procedure to restore this tooth is illustrated in Figure CS3.1.

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FIGURE CS3.1. A. Presentation of patient. B. Crown preparation. C. Temporary crown. D. Casts with ceramic crown. E. Permanent crown placed (facial). F. Permanent crown placed (lingual).

Questions

Question 1.  Tooth #10 in Figure CS3.1A is commonly called:

a.  Fusion

b.  Traumatic injury

c.  Peg lateral

d.  Erosion

Question 2.  The final restoration is said to be a ________ restoration, and the restorative procedure used to fabricate this particular restoration is called a(n) _____________ technique.

a.  Removable; direct

b.  Fixed; indirect

c.  Removable; indirect

d.  Fixed; direct

Question 3.  After the crown preparation is made, the patient leaves with a restoration as the one shown in Figure CS3.1C. This is known as a ____________ restoration.

a.  Interim

b.  Provisional

c.  Permanent

d.  Substitute

Question 4.  We can assume that the crown shown in Figure CS3.1E and F contains no metallic materials. Therefore, the dental material usually used in this technique is a:

a.  Cold-curing resin

b.  Special restorative cement

c.  Composite material

d.  Ceramic material

Question 5.  The “polishing agent of choice” for the dental material selected in question 4 is:

a.  Toothpaste only

b.  A “mild” Prophy Paste

c.  A slurry of whiting

d.  Any typical Prophy Paste

Question 6.  The most desirable characteristic of the dental material selected in question 4 is:

a.  Translucency

b.  Abrasion resistance (hardness)

c.  Fracture toughness

d.  Availability of many shades

Question 7.  If the patient in this case had discolored teeth and wanted to have them whitened besides having the new restoration fabricated, when should the whitening take place?

a.  Before the restoration is fabricated

b.  After the restoration is fabricated

c.  Between the fabrication appointments

d.  Whitening is contraindicated in this case

Case 4

Wesley Mullins, D.D.S.

This patient is a 43-year-old woman with an unremarkable medical history. The patient reports that she brushes and flosses two times each day. She says that her gums bleed sometimes and that she really wants to “get my teeth in good shape and keep them that way.”

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FIGURE CS4.1. Occlusal photographs of maxillary and mandibular arches. (Courtesy of Dr. Wes Mullins, Knoxville, TN.)

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FIGURE CS4.2. Lateral and frontal photographs. (Courtesy of Dr. Wes Mullins, Knoxville, TN.)

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FIGURE CS4.3. Two appointments of dental and periodontal charting.

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FIGURE CS4.4. Full mouth radiographs.

Questions

Question 1.  Periodontally, the patient’s gingival health has ___________________________ compared to the original baseline probing.

a.  Greatly improved

b.  Slightly improved

c.  Not changed

d.  Slightly deteriorated

e.  Greatly deteriorated

Question 2.  Fractures are evident on which of the following teeth?

a.  Tooth #19

b.  Teeth #19 and #31

c.  Teeth #13 and #19

d.  Teeth #19 and #30

e.  Teeth #13, #19, and #31

Question 3.  Radiographically, tooth #30 has _______________ roots and ____________ canals.

a.  2; 2

b.  3; 2

c.  3; 3

d.  2; 3

Question 4.  Multiple restorations can be placed on one tooth. From this patient’s records, examples are present on teeth #2, #14, and #15.

a.  The first statement is true; the second statement is false.

b.  The first statement is false; the second statement is true.

c.  Both statements are true.

d.  Both statements are false.

Question 5.  What can be said about tooth #30 distal and tooth #31 mesial amalgam margins?

a.  Tooth #30 is open; tooth #31 is overextended.

b.  Tooth #30 is overextended; tooth #31 is open.

c.  Both margins are overextended.

d.  Both margins are open.

Question 6.  The canals in tooth #30 are filled with ___________________________ material(s).

a.  The same

b.  Two

c.  Three

d.  Temporary

Question 7.  Supereruption is apparent on what tooth?

a.  Tooth #19

b.  Tooth #21

c.  Tooth #30

d.  Tooth #31

Question 8.  According to the periodontal chart, the recession on tooth #31 has at least ____________ mm of gingival recession.

a.  2

b.  3

c.  4

d.  5

Case 5

This patient is a 73-year-old woman with controlled hypertension without dry mouth who takes medication for osteoporosis. She mentions that she smokes four or five cigarettes a week because of anxiety. Her oral home care consists of brushing and flossing two times each day. She says her gums rarely bleed, she has no sensitivity, and she really wants to “keep my teeth in the best shape as possible.” She is happy with her smile.

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Feb 11, 2020 | Posted by in Dental Materials | Comments Off on III: Case Studies
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