![Page 1: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/1.jpg)
Welcome to our world, enter the AEGD-2
![Page 2: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/2.jpg)
Comprehensive Care II Treatment Plan Presented by
Captain Alfred G. Khallouf AEGD-2 Resident
Class of 2005
![Page 3: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/3.jpg)
Introducing Our Patient
37 years old Male African-American Attitude-Positive Patient type- Indifferent
![Page 4: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/4.jpg)
Historical Notes
Joined the USAF in Feb 1986, currently a MSgt Not married and has no children States that he is in good health and physically active Born and raised in Tx.
![Page 5: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/5.jpg)
Subjective Findings
Chief Complaint: “My upper left tooth is sensitive to cold since I received a filling.” Denies any history of smoking, occasional social drinker Majority of his treatment was completed prior to PCSing here to Lackland in April of 2002. . Previously, he had been seen as a periodontal maintenance pt
![Page 6: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/6.jpg)
Medical Hx. AF form 696
![Page 7: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/7.jpg)
Medical / Systemic
Reports a history of High Blood Pressure, which is controlled by diet Currently under the care of a physician at WHMC for the high blood pressure.
B.P. is high normal for him. B.P. average: 131 / 89
Previous history of Acid reflux (no meds) Reports no known drug allergies
![Page 8: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/8.jpg)
Med use, regimen, effects and concerns
HYDROCHLOROTHIAZIDE: - 25 mg once daily - Thiazide Diuretic - Management of mild to moderate hypertension. - Dental Tx. Concerns: No effects or Contraindications reported LISINOPRIL: -10 mg/day - ACE Inhibitor (Angiotensin-Converting Enzyme) - Tx. of hypertension, either alone or in combination with other hypertensive agents. -Dental Tx. Concerns: No effects or Contraindications reported
![Page 9: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/9.jpg)
Oral Pathology
![Page 10: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/10.jpg)
Oral Pathology
Pt. states that these lesions have been present for an unknown duration of time.
They have been there as long as he can remember. Pt states that occasionally his mouth becomes painful to very hot and spicy foods, which is only temporary, otherwise, it normally remains asymptomatic. These lesions were originally documented in July 1991, with no biopsy or follow up performed.
![Page 11: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/11.jpg)
Oral PathologyMultiple asymptomatic, generalized erythematous yellowish-white patches bilaterally on buccal mucosa and tongue and inner aspect of lower lip.
![Page 12: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/12.jpg)
![Page 13: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/13.jpg)
Oral PathologyAlso a large asymptomatic pink smooth-surfaced papule about 7mm in diameter which was firm and non-fluctuant on inner aspect of lower lip. Lip lesion had been present for several years with no apparent change in size.
![Page 14: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/14.jpg)
![Page 15: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/15.jpg)
Oral PathologyDeep-fissured grooves on dorsal surface of tongue consistent with fissured tongue.
![Page 16: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/16.jpg)
Oral Pathology
PRE-OPERATIVE DIAGNOSIS: A) Lip Lesion ● Irritation Fibroma ● Neuroma ● Papilloma
B) BUCCAL MUCOSA LESION ● Erythema Migrans ● Benign migratory stomatitis. ● Erosive lichen planus. ● Pemphigus ● Verruca Vulgaris
FINAL DIAGNOSIS: A) LEFT LABIAL MUCOSA: IRRITATION FIBROMA
B) LEFT BUCCAL MUCOSA: PSORIASIFORM MUCOSITIS (SEE COMMENT)
Comment: The histological findings, together with the submitted digital clinical images are consistent with ERYTHEMA MIGRANS
![Page 17: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/17.jpg)
Restorative Findings
Caries risk: low Carious teeth: none Defective / Incomplete restorations: • #2 and 4- partially prepared, into enamel for
Resin-Bonded FPD • #14 has a large amalgam overhang, which
is sensitive to cold (skin refrigerant causes lingering pain which reproduces pts C.C.)
![Page 18: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/18.jpg)
Anterior Dentition View
![Page 19: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/19.jpg)
Maxilla
![Page 20: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/20.jpg)
Max Right Sextant
1- Occlusal Amalgam 2- Occlusal Amalgam, with
partial prep for RR-FPD
![Page 21: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/21.jpg)
Max Right Sextant
3- Missing 4- Occlusal Amalgam, with
partial prep for RR-FPD 5- Sealant
![Page 22: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/22.jpg)
Max Anterior Sextant6- no treatment 7- no treatment 8- no treatment 9- no treatment 10- no treatment 11- no treatment
![Page 23: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/23.jpg)
Max Left Sextant12- DO Amalgam 13- MOD Amalgam
![Page 24: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/24.jpg)
Max Left Sextant14- Defective MODFL Amalgam Restoration Symptomatic, skin refrigerant cause lingering pain which reproduces pts. C.C.
![Page 25: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/25.jpg)
Max Left Sextant15 OL Amalgam Restoration 16- missing
![Page 26: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/26.jpg)
Mandible
![Page 27: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/27.jpg)
Mand Left Sextant
17 – missing 18 – DO Amalgam 19 – OF Amalgam
![Page 28: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/28.jpg)
Mand Left Sextant20 – Occlusal Pit Amalgam & Sealant 21 – Sealant
![Page 29: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/29.jpg)
Mand Anterior Sextant22 – no treatment 23 – no treatment 24 – no treatment 25 – no treatment 26 – no treatment
![Page 30: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/30.jpg)
Mand Anterior Sextant27- 6mm gingival recession on facial ● CT graft was first attempted in Oct 1999 ● CT graft failed for unknown reasons
![Page 31: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/31.jpg)
Mand Right Sextant28 – No treatment 29 – Occlusal Amalgam & Sealant
![Page 32: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/32.jpg)
Mand Right Sextant
30 – OF Amalgam 31 – MO Amalgam 32 – Missing
![Page 33: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/33.jpg)
OK now, where are those residents?
![Page 34: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/34.jpg)
Endodontic Findings14- defective restoration ● Large Amalgam overhang ● Symptomatic: skin refrigerant causes lingering pain, which
reproduces pts. C.C. ● No positive findings to apical palpation, percussion and biting
and no periapical pathology ● Periradicular Dx: Normal ● Pulpal Dx: Irreversible Pulpitis
![Page 35: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/35.jpg)
AF form 935Periodontal
Charting
![Page 36: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/36.jpg)
AF form 935, Maxilla
![Page 37: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/37.jpg)
AF form 935, Mandible
![Page 38: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/38.jpg)
Periodontics
Initial Modified O’Leary score was 76% plaque free surfaces PD: 1-5 mm BOP: 15 of 25 teeth Mobility: physiologic Diagnosis: ● Localized chronic severe periodontitis involving tooth #27. ● Localized chronic moderate periodontitis involving #s 1, 13-15, 18,
19 ● Generalized Gingivitis and moderate plaque present
Etiology: 1) Plaque 2) Calculus CT graft was first attempted in Oct 1999 for #27. CT graft failed for unknown reasons.
![Page 39: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/39.jpg)
Periodontics: Prognosis
Short term: ● Overall: Good ● Individual: Fair #27
Long term: ● Overall: Good ● Individual: Guarded/Fair # 27
Perio Maintenance: Every 3-4 months
![Page 40: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/40.jpg)
OrthodonticsNo Maxillary Anterior crowding apparent Midline discrepancy: mand 1mm to the left Mesial / Facial rotation of #22 Slight Mandibular Anterior crowding Pt. states he is not interested in Orthodontic Tx. Dental Class I Malocclusion
![Page 41: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/41.jpg)
OcclusionAngle class I molar on left side Class I premolar on right side ● #3 extracted several years ago
#1 Non-opposing No need to alter plane of occlusion
![Page 42: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/42.jpg)
Oral Surgery
![Page 43: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/43.jpg)
Oral SurgeryExtraction of #1 - malposed and not in function or occlusion Biopsy intra-oral lesions under local anesthesia
![Page 44: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/44.jpg)
Prosthodontic
![Page 45: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/45.jpg)
Prosthodontics
Missing teeth: # 3, 16, 17, 32 Single crown: # 14 3-unit Fixed Partial Denture: #’s 2 – 4 ● #2 – 7/8th crown ● #3 - pontic ● #4 – 3/4th crown
![Page 46: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/46.jpg)
![Page 47: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/47.jpg)
![Page 48: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/48.jpg)
Treatment Plan by Phase
I. Emergency Care ● RCT #14, address pts. chief complaint
II. Medical / Systemic ● HBP controlled by diet and Medication
![Page 49: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/49.jpg)
Treatment Plan by Phase
III. Diagnostic / Initial Therapy ● Medical Model and Caries Control
● Pt has no caries or restorative procedures planned ● OHI- Brushing & Flossing ● Extract #1 (Disease control) ● Biopsy Intra-oral lesions
![Page 50: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/50.jpg)
Treatment Plan by Phase
IV. Re-Evaluation ● Check O.H. and Pt. Compliance ● Re-chart 935 ● Assess Key Teeth # 2, 14 & 27
V. Corrective Surgical ● Orthodontics:
● Discussed with pt. ● Pt. does not desire any Tx.
![Page 51: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/51.jpg)
Treatment Plan by Phase
V. Corrective Surgical ● Periodontics
● #14 - crown lengthening ● #15 - Distal Wedge ● #27 – CT graft with lateral pedicle graft
![Page 52: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/52.jpg)
Treatment Plan by Phase
V. Corrective Surgical ● Single Crown
● #14 - Full Gold Crown
● 3-unit Fixed Partial Denture ● #2 – 4
● #2 – 7/8th crown ● #3 – pontic ● #4 – 3/4th crown
![Page 53: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/53.jpg)
Treatment Plan by Phase
Nightguard / Occlusal Guard
VI. Maintenance ● Re-evaluation ● Perio Recall every 3-4 months
![Page 54: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/54.jpg)
Tooth by Tooth Treatment Plan
1: Extraction 2: Abutment for a 3-unit FPD 3: Pontic (Hygenic or Bullet shaped) 4: Abutment for a 3-unit FPD 5: No Treatment 6: No Treatment 7: No Treatment 8: No Treatment 9: No Treatment 10: No Treatment
![Page 55: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/55.jpg)
Tooth by Tooth Treatment Plan
11: No Treatment 12: No Treatment 13: No Treatment 14: RCT, Amalgam build up, Crown Lengthening
and Gold crown 15: Distal Wedge 16: Missing
![Page 56: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/56.jpg)
Tooth by Tooth Treatment Plan
17: Missing 18: No Treatment 19: No Treatment 20: No Treatment 21: No Treatment 22: No Treatment 23: No Treatment 24: No Treatment 25: No Treatment
![Page 57: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/57.jpg)
Tooth by Tooth Treatment Plan
26: No Treatment 27: CT graft with possible lateral pedicle graft 28: No Treatment 29: No Treatment 30: No Treatment 31: No Treatment 32: Missing
![Page 58: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/58.jpg)
Alternative TX. Plan
Maxilla ● Implant to replace #3 ● Single unit crowns #2 and 4 versus ● Posterior composites #2 and 4 Mandible ● If pt chooses not to undergo a 2nd CT graft
surgery to correct recession, monitor #27 for continued recession
![Page 59: Comprehensive Care Treatment Plan Presentation, Part II | Dr. Alfred Khallouf](https://reader034.vdocument.in/reader034/viewer/2022042907/587820e91a28aba12d8b67d3/html5/thumbnails/59.jpg)
Everybody, out of the Residency