Case History Discussion pt5l

CASE HISTORY DISCUSSION

HARD TISSUE EXAMINATION • Following is a brief description of three most commonly followed tooth notation systems, – Palmer notation System – Universal notation System – FDI System

Zigmondy/Palmer

Universal

FDI

Occlusion • Angle’s classification

Wasting diseases Attrition The loss of tooth substance as a result of tooth to tooth during normal or parafunctional masticatory activity.

Abrasion

The pathological wear of tooth substance through bio-mechanical frictional processes, e.g. tooth brushing.

Erosion

The loss of tooth substance by acid dissolution of either an intrinsic or extrinsic origin, e.g. gastric acid or dietary acids.

Abfraction

The pathologic loss of tooth substance caused by bio-mechanical loading forces.

Ablation

It is the lesion caused due to forceful frictional action between the oral soft tissue and adjacent hard tissue.

Pathologic tooth migration • Pathologic tooth migration is tooth displacement that results when the balance among factors that maintain physiologic tooth position is disturbed by periodontal disease. • Extrusion • Facial flaring • Rotation • Diastema

Proximal s • Normal proximal s do not allow any food impaction in between the teeth. • The interdental papilla fills the space upto tooth in normal conditions. • However due to periodontal disease there is loss of interdental soft tissue and bone levels. Due to this, the position of interdental papilla recedes from its normal position.

Classification for Interdental Embrasures • According to Perry and Schmid (1996) – Type I embrasure – Type II embrasure – Type III embrasure

Food impaction • Food impaction is the forceful wedging of food into the periodontium. • There are two type of food impaction: – Vertical – Horizontal/Lateral

• Vertical food impaction: – Open s – Irregular marginal ridge – Plunger cusps

• Horizontal food impaction: – It is seen in gingival inflammation in areas with enlarged gingival embrasure.

Tooth mobility • The AAP definition of tooth mobility is “The movement of a tooth in its socket resulting from an applied force”.

Miller classification: • Class 0 - Normal (physiologic) movement when force is applied. • Class I - Mobility greater than physiologic • Class II - can be moved up to 1mm or more in a lateral direction (buccolingual or mesiodistal). Inability to depress the tooth in a vertical direction (apicocoronal). • Class III - Tooth can be moved 1mm or more in a lateral direction (buccolingual or mesiodistal). Ability to depress the tooth in a vertical direction (apicocoronal).

Glickman grading of tooth mobility • Normal • Grade 1 Slightly more than normal • Grade 2 Moderately more than normal • Grade 3 Severe mobility Faciolingually and /mesiodistally combined with vertical displacement.

Hypersensitivity

Trauma from occlusion • Definition: – When occlusal forces exceeds the adaptive and reparative capacity of the periodontal tissues, tissue injury results is called as Trauma from occlusion.

ACUTE

PRIMARY

CHRONIC

SECONDARY

Fremitus Test

Classification • Class I fremitus : Mild vibration or movements detected. • Class II fremitus : Easily palpable vibration but no visible movements • Class III fremitus : Movements visible with naked eye.

Dental Stains • Extrinsic stains – Dental plaque & Calculus – Food beverages – Tobacco use – Chromogenic bacteria – Metalic compounds – Medications

• Intrinsic stains – Dental caries – Pulpal trauma – Medications – Genetic & Hereditary disease

Furcation involvement • The extension of inflammatory periodontal disease into the interradicular area of multirooted-teeth is known as furcation involvement.

Classification • According to Glickman (1953): – Grade I: It is the incipient stage of furcation involvement, but radiographically changes are not usually found. – Grade II: The furcation lesion is a cul-de-sac with a definite horizontal component. Radiographs may or may not depict the furcation involvement. – Grade III: The bone is not attached to the dome of the furcation and may be filled with soft tissue only. – Grade IV: The interdental bone is destroyed and soft tissue has receded apically so that the furcation opening is clinically visible.

Classification • According to Hamp et al (1975): – Degree I: Horizontal loss of periodontal not exceeding 1/3rd of the width of the tooth. – Degree II: Horizontal loss of periodontal exceeding 1 / 3rd of the width of the tooth. – Degree III: Horizontal through and through destruction of periodontal tissue in the furcation area.

Classification • According to Tarnow and Fletcher (1984): • Based on vertical component. Depending on the distance from the base of the defect to the roof of the furcation: – Subgroup A: Vertical destruction of bone upto 1 / 3rd of the inter-radicular height (1-3 mm). – Subgroup B: Vertical destruction of bone upto 2/3rd of the inter-radicular height (4-6 mm). – Subgroup C: Vertical destruction beyond the apical-third (7 mm or more).

Rating

Score s

Excelle nt

0

Good

0.1 – 0.6

Fair Rating Poor Excelle nt

0.7 – 1.8 Score s – 1.9 3.0 0

Good

0.1 – 1.2

RADIOGRAPHIC EXAMINATION