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In: Biology

A 35 year medically fit non-smoking patient presents complaining of a buccal intraoral swelling associated with...

A 35 year medically fit non-smoking patient presents complaining of a buccal
intraoral swelling associated with his lower right posterior teeth. In addition, the
patient complains of bleeding gums and wishes to improve the appearance of
the gingivae around tooth FDI 23 that clinically has associated Class II gingival
recession.
Initial clinical examination indicates an intraoral swelling with a draining sinus
between teeth FDI 45 and 46, grade 1 mobility of 46, generalized clinical loss
of attachment of 3-4mm and generalized pocketing of 5-6mm with bleeding on
probing around all teeth.

A. Describe and justify the steps you will take to establish a diagnosis
for this patient’s symptoms.

B. Explain and justify the differential diagnoses. Discuss the
investigations you would undertake and the findings that you expect,
explaining their relevance to the clinical scenario above.

C. Discuss the treatment options available for the management of this
patient.

D. Discuss the pros and cons for the non-surgical and surgical
management of this patient.

Solutions

Expert Solution

Answer- a)

b) Differential diagnosis of Generalised Periodontitis:- generalized interproximal attachment loss affecting at least 3 permanent teeth other than first molars and incisors.

-Generalised Aggressive Periodontitis:-

Cause: Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis.

Clinical feature: pus discharge from gums, Mobility of affected tooth. Patients is healthy with good oral hygiene. Generalized inter-proximal attachment loss on 3 or more permanent teeth, excluding the first molars or incisors.

Investigation: OPG

Radiographical feature: vertical bone loss around teeth including the first molars and incisors. Appearance of arc-shaped loss of alveolar bone extending from the distal surface of the second premolar to the mesial surface of the second molar.

C)treatment of chronic Periodontitis is :-

Plaque control, Scaling and root planing procedures, Probing depth reduction procedures like Gingivectomy, Repositioned flaps like Apically positioned flap without osseous resection or with osseous resection.

D) Gingivectomy:

Advantages- simple technique, good visual access suprabony pocket are completely eliminated and good prognosis.

Disadvantages- postoperative pain, Healing is by secondary intention, loss of attached gingiva, bone exposure can occur and may cause sensitivity.

Apical positioned flaps:

Advantages- Eliminates periodontal pocket. It establishes gingival morphology and preserves attached gingiva.

Disadvantages- Esthetics are compromised and Hypersensitivity Risk of root caries.

gladiator answered 2 years ago
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