Case Presentation for Dentist of the Year Award
All periodontal, endodontic and restorative treatment was undertaken by Fahd Saleh with the assistance of Erika Sabkauskiene (RDH) and Paul Dumpleton (RDT) of Smile Design.
Background
Phil is a 45 year old regional bank manager who was referred due to dental anxiety, recurrent dental and periodontal abscesses and severe periodontal inflammation. The imminent arrival of a baby encouraged Phil to seek dental care after years of avoidance. Phil leads a busy and hectic life with demanding work and family commitments. His treatment objectives were:
1-Achieving a healthy mouth without pain or bleeding
2-Avoiding loss of any teeth
3-Reducing treatment visits where possible.
An extensive clinical and periodontal case assessment was undertaken. The following diagnoses were made:
A.Severe generalised chronic periodontitis
B.Combined perio-endo lesions were noted affecting UR5, LL6 and LR6
C.Dental anxiety (not phobia)
The treatment plan was designed in 4 phases with progression from one phase to the next dependent on Phil’s compliance with appointments and plaque control regimes. A bleeding on probing index of less than 15% from pocket bases and no signs of marginal erythema were also required for progression between phases.
Phase 1 (July 2015 to November 2015)
- Plaque control advice and coaching under Fahd’s care
- Intravenous sedation and local anaesthetic for removal of hopeless teeth, endodontic dressing of the UR5, LR6 and LL6, root resection of the mesial roots of LR6 and LL6 and non-surgical debridement
Objectives: We devoted this stage to increasing Phil’s confidence and rapport with dental team along-side inflammatory control. Three treatment visits were required and Phil was given lower doses of midazolam with each visit. Four separate visits were dedicated to plaque control coaching.
Initial presentation images |
Images post non surgical treatment |
Phase 2 (December 2015 to March 2016)
Objectives: Phil coped well with the previous phase of treatment and was eager to undertake replacement of the missing teeth and to avoid loss of any more teeth. Phase 2 of treatment was designed to eliminate any areas of residual pocketing with pocket reduction surgery and osteoplasty where necessary. Implant placement was undertaken simultaneously to utilise bone harvested from the osteoplasties for the purpose of guided bone regeneration.
Phase 3 (April 2016 to July 2016)
Objectives: This phase aimed to improve masticatory function by replacing missing teeth. We also placed a cuspal coverage restoration on the LL6 to reduce the risk of fracture. LL6 distal root was retained due to its periodontal and periapical healthy status. There is evidence to show that root resected molars can perform as well as dental implants (Fugazotto et al 2001).
- Plaque control advice and coaching under hygienist care
- Pocket reduction surgery with osteoplasty for the upper left, lower left, upper right and lower right posterior sextants
- Composite splinting of the LL1 to the LR1 and root resection
- Internal sinus lift and implant placement for the UL6 (Xive 4.5mm implant) site simultaneous with periodontal pocket reduction surgery in that area
- Implant placement in the LL4 (Xive 3.8mm Implant) and LR6 (Xive 3.8mm Implant) simultaneous with the periodontal pocket reduction surgery in these areas
Objectives: Phil coped well with the previous phase of treatment and was eager to undertake replacement of the missing teeth and to avoid loss of any more teeth. Phase 2 of treatment was designed to eliminate any areas of residual pocketing with pocket reduction surgery and osteoplasty where necessary. Implant placement was undertaken simultaneously to utilise bone harvested from the osteoplasties for the purpose of guided bone regeneration.
Phase 3 (April 2016 to July 2016)
- Completion of endodontic treatment in the UR5 and LL6 both of which demonstrated radiographic signs of reduction in apical radiolucency.
- Restoration of implants in LR6, LL4 and UL6 positions with screw retained implant crowns
- Restoration of distal root of the LL6 with an E-max crown to resemble a premolar
- Plaque control monitoring and motivation under Fahd’s care
Objectives: This phase aimed to improve masticatory function by replacing missing teeth. We also placed a cuspal coverage restoration on the LL6 to reduce the risk of fracture. LL6 distal root was retained due to its periodontal and periapical healthy status. There is evidence to show that root resected molars can perform as well as dental implants (Fugazotto et al 2001).
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Phase 4 (Jul 2016 and ongoing)
- Quarterly hygienist led periodontal maintenance visits
- Biannual periodontal reassessment under Fahd’s care.
Initial presentation images |
6 month post-operative images |
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Pocket charts demonstrating gradually improving periodontal condition.
Treatment outcomes
Read what Phil thought of his experience under Fahd's care.
- Compliant patient who adheres to plaque control measures and maintenance visits
- Number of teeth with probing depth greater than 5mm reduced from 21 to 1 tooth (LR8)
- Bleeding on probing reduced from 40% to 4%
- Plaque index reduced from 52% to 6%
- No persisting apical pathology and no edentulous gaps
Read what Phil thought of his experience under Fahd's care.
Initial presentation 3/7/2015
Presentation 6 months post-operatively 11/1/2017
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