Case Presentation 1

Operative Dentistry:
Blackish Spot On The
Incisor.
Student: Hanis Farhana bt Amiruddin
Student ID: 2016259648
Date: July 2020
Content of Presentation
Background
Clinical Examination
Special Examination
Finding and Diagnosis
Prognosis
Overview Treatment Required
Treatment Provided
Discussion
Conclusion
References
 Patient Demography

Name : MOHD SHAHRIL SHARIFUDDIN

R/N : 002409
DOB : 21TH MARCH 1982
Age : 38Y 3M 14D
Race : MALAY
Occupation : ASSISTANT SCIENCE OFFICER AT FACULTY
OF MEDIC.
Commencement of Treatment : 12 June 2019
 12 June 2019

Chief Complaint History of Presenting Complaint

• Present of blackish color at

tooth 12 which is esthetically
“Patient request for unfavorable.
• He notice the blackish color
filling and scaling since last year during brushing
especially on the teeth.
front tooth because • Complaint of no pain but
hypersensitivity especially when
present of blackish having cold drinks.
spot.” • Scale for hypersensitivity is 6/10
within few seconds.
 28 November 2019

Chief Complaint History of Presenting Complaint

• Presented with localized pain on
tooth 48.
• He experienced the pain since
last 2 months (September 2019).
• The pain is throbbing and
“Patient complained progressing especially during:-
✓ laying down
of pain on the lower ✓ drinks hot and cold water.
right wisdom tooth.” • The pain radiated to the right
side of the face.
• Disturbed sleep.
• The pain relieved whenever
patient took pain killer.
• Scale of pain is 8/10.
 Medical History

Contents
“Diagnosed Since Mei 2018 at CTC.
with lower
back pain.”
Has follow up every 3 months at CTC .

Currently on physiotherapy 3 times in a month at Klinik

3 Uitm Sungai Buloh.

Triggering factor : when the patient is waking up from

the bed.
 Medication / Supplement

Patient took Celebrex (Celecoxib) 50mg daily and stop early of

2020.
Patient once took Diclofenac Sodium one per day during
experienced terrible pain on his wisdom tooth.

History of Hospitalization, Allergy and Dental History.

No history of hospitalization.
No known allergy towards food and medication
Irregular dental attendee and his last visit was on March 2020.

Social and Family History

Patient married with 2 children.

He smoke 14 pack years since 20years ago.
Currently on 2nd visit of Tobacco Cessation program with a lot of
improvement.
 Clinical Examination
( Extra-oral)

Symmetrical face
Competent and moist lips
Normal mouth opening (50mm)

Non Palpable lymph nodes

TMJ has no deviation, tenderness and sound
 Clinical Examination
( Intra-oral)
• All mucosa are normal.
• Present of plaque accumulation at dorsum of the tongue

BPE 2 for all quadrants

2 2 2
2 2 2

• Plaque score : 25.78%

• Oral hygiene : Fair

High CRA
 Site of Complaint:
Tooth 12

12 June 2019 14 October 2019

• ICDAS 04(M) • ICDAS 05(M)
• No TTP
• TTP
• No Mobility
• No tenderness upon
• No tenderness upon
palpation
palpation
• No Mobility
 Site of Complaint:
Partially Erupted Tooth 48

12 June 2019 28 November 2019

• ICDAS 05 (O) • ICDAS 05 (O)
• Surrounding tissue • TTP
is normal • Surrounding tissue is
• Present of plaque eryhtematous and
accumulation (O) swelling.
• No sign and • Present of plaque
symptom accumulation (O)
• Tenderness upon
palpation
• No mobility
• No abscess
 Clinical Examination
( ICDAS Charting- Upper Arch)
17 12 27

Tooth Finding Tooth Finding

11,13, Sound 21,22,23, Sound
14,15,16 24,25,28
12 Shadow at the mesial 26 Missing due to caries
17 Mesial and palatal caries 27 Enamel caries at the
occlusal
18 Congenitally missing
 Clinical Examination
( ICDAS Charting- Lower Arch)

48 46 36 37

Tooth Finding Tooth Finding

41,42,43, Sound 31,32,33, Sound
44,45 34,35
46 Enamel caries at occlusal 36 Shadow at occlusal and
buccal
47 Missing due to caries 37 Enamel caries at occlusal
48 Deep caries at occlusal 38 Congenitally missing
 Special Investigation
Panoramic Radiograph Findings

• Horizontally impacted
tooth 48
• Mesiolabially rotated
tooth 12
12
• Abnormal radiolucency
on tooth 48(O),
36
48
12(M), 36 (inner
third of dentin)
indicating caries.
 Special Investigation
Bitewing Radiograph (12 June 2019)

R L

• Abnormal radiolucency at • Abnormal radiolucency at

inner third of dentin on tooth 48 middle third of dentin on tooth
and occlusal tooth 46. 36.
 Special Investigation
Sensibility Test

Test Tooth Control Tooth

(12) (22)
Cold Test + +
EPT 8 9
+ = Normal ressponse

Finding: Equiresponsive
 Finding and Diagnosis
FINDINGS DIAGNOSIS
• Smoking 10 - 14 packs per year.
• Heavy smoker
• Poor oral hygiene
• Generalized chronic plaque induced
• Generalized plaque and calculus gingivitis.
deposited.
• Kennedy class III (Upper & lower
• Deep caries at mesial of tooth 12. arches)
• Deep caries which is extending into • Reversible pulpitis with symptomatic
inner third of the dentin of tooth apical periodontitis on tooth 12
48.
• ICDAS 05(O) – tooth 48
• Difficulty in cleaning at interdental symptomatic
area of tooth 11 and 12- due to
• ICDAS 03 – tooth 17,27,37,46.
mesiolabially rotated of tooth 12.
• ICDAS 04 – tooth 36
• Multiple missing teeth.
• Multiple caries lesion.
 Prognosis
Tooth 12 Tooth 48
-GOOD- -HOPELESS-
• The tooth is restorable. • Severely decayed tooth 48.
• Improper tooth positioning
(partially erupted)
• Extraction was suggested by
specialist.
 Overview Treatment Required
Definitive
• Oral hygiene motivation and instruction.
• Full mouth scaling and prophylaxis.
• Full mouth topical flouride.
• Compliance review after 1-2 weeks.
• Operative Dentistry:
– Tooth coloured restoration: tooth 12,17,27,37,46 and 36.
• Oral Surgery: Extraction of horizontally impacted 48 symptomatic under
minor oral surgery.
• Perio review after 4-6 weeks.
 Treatment Provided

14 October 25 October 21 November 28 November

2019 2019 2019 2019

Scaling and Tooth coloured Tooth coloured Removal of 48

Prophylaxis + restoration on restoration on under minor oral
OHI motivation 12 36 surgery
and instruction
 Clinical Photograph tooth 12
After caries free Final restoration
 Discussion
• Patient requested to do restoration on tooth 12 for esthetic concern.
• Upon examination, present of shadow at the mesial part of tooth 12.
• However, 4 months later upon inspection, the enamel loss at the mesial
side due to caries and left the exposed dentin.
• The patient started to show signs and symptoms and need immediate
treatment for that particular tooth.
 Discussion
• For tooth 48 – upon inspection, ICDAS 05(O) can be seen.
• Patient did not shows any sign and symptom at the first place.
• After multiple visits, patient started to complain throbbing pain and
hypersensitivity at that particular tooth.
• It is worsen when the patient experienced throbbing pain during sleep until
he woke up at the middle of night.
• Upon discussion with specialist, tooth 48 need to be removed surgically.
• During the pre and post procedures, there are no complications.
• The socket healed properly after review for the next 2 weeks.
 Conclusion
• Thorough history taking and examination is important – to
address other pathology besides the main concern of the
patient.
• Emphasizing oral hygiene to the patient after the treatment is
very important to get the better result which can be last for the
long term.
• Multidisciplinary approach is important to manage dental patient.
 Conclusion
• When teeth are discolored, malformed, crooked, or missing,
often the person makes a conscious effort to avoid smiling and
tries to “cover up” his or her teeth because of the unattractive
teeth.
• Correction of these types of dental problems can produce
dramatic changes in appearance, which often result in improved
confidence, personality, and social life.
 References

• Heymann, H. O., Swift, E. J., Jr., & Ritter, A. V. (n.d.).

Sturdervant's Art and Science of Operative Dentistry
(6th ed.).
• Rakesh, R. R., Sapna, C. M. (n.d.). Management of
Cervically Fractured Central Incisors: A
Multidisciplinary Approach. The Open Dentsitry
Journal, 12, 238-245.