36 year-old male patient CC: "I want to fix my frontal teeth" HxCC: teeth were decayed, extracted, and have not been restored or replaced since many years MHx: anxietic patient Clinical and Radiographic findings revealed that there are: - Bad oral hygiene - Plaque accumulation - Multiple caries - Missing teeth - Mobile teeth What is proper management?



It's again multidisciplinary management case. Briefly -Reflect the flap quadrant wise..(perio management) -Extract all loose/hopeless teeth & do needed Alveoplasty, falling in that quadrants simultaneously. -Rest All teeth intentional RCT. Upper is good enough for individual crowns or give bridge. Clinically your discretion. Lower will be anterior bridge with posterior Precesion attachment....with "rhein-83" attachments. Some teeth may need custom/chair side post & core too.... Of course height adjustments according to jaw relations. To say any thing about implants in lower posterior (instead of precesion attachments), i need still more 'clearer OPG' or 'CBCT'. & Any systemic issues which might hamper prognosis?? It will almost take 2months minimum, healing & lab work... Nice case to take up, provided pt is comfortable to afford....which I doubt on seeing this kinda hygiene maintenance. I had done similar full mouth case with missing posterior & broken teeth & improper old crowns (but, not so gross damage) with precesion attachments on all quadrants, on 54ys diabetic female. Only thing, I had no much perio work. Here is the pic

Ur case alwys inspire me...hope one day I will able to work like this

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Sir generally if the patient is have such condition like multiple carious teeth and history of anxiety we should never forget to check salivary gland disorders like sjogren syndrome. Or may be like if patient might have been using anti anxiety drugs which also effect salivary glands leads to such condition. If in case such factors are present they effect the overall prognosis . i accept the plan given by dr narayana sir . but please think of this also

Absolutely a very valid point.....thanks doc. Any salivary gland issues--Xerostomia? ...all need to be also ruled out. salivary PH test

Very poor oral hygiene.... Go for scaling polishing.... Extractions..... Restorations...... Rcts..... Lots of work to be done

Counselling is very much needed....and d reason for care now and y not before