60 yr old female came with chief complaint of calculus and shaky lower teeth, want to replace missing teeth and restore normal smile without gaps.... Medical history: No relevant past medical history.. History of drug Allergies:Nil Clinical examination revealed Generalised gingival recession, calculus ++++ Pathological migration seen in upper and lower anteriors. Missing 37 grade 3 mobility in 15,31 Mobility couldn't be assesed in other teeth due to calculus covering all over Two sittings of scaling and root planing done last march... Now review showed Oral hygiene maintenance good except for lower anteriors Mobility is Grade 1 in 14,13,11,22,33,43, Grade 2 in 32,41,42. Grade 3 in 31,15.. Posteriors except 14,15, and 21,23 show no pathologic mobility despite the loss of alveolar bone support. Planned for open debridement.. Clinical pics attached after scaling Kindly suggest all your valuable opinions for management of the case



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Maintain the oral hygiene for 3-6 months. Take a review n follow up esp on lower cannines. As right now grade 1 mobility. After deep cleaning n curettage chances that mobility will reduce.. Then u can plan for denture.. Or fpd canine to cannine. Pt is a tongue thruster. So cant close the gaps completely. Take a follow up after 3 months

Investigation Iopa with 26 & 38 From the given clinical examination, photographs & OPG Diagnosis- 1. Chronic generalised periodontitis with periodontal abcess with 26 2.periapical abcess with 38 also check for deep caries with it at the cervical of crown Treatment plan with follow up Rx, Tab.amoxiclav 625mg +Tab.Metrogyl 400mg BD for 5days Rexidine M Forte gel S.O.S( to be applied on the gingiva) -Oral prophylaxis will maintain periodontal health & will also decrease mobility provided patient is also maintaining oral hygiene instructions -Extraction of hopeless tooth 31 -26 needs endo perio treatment -38 needs endodontic treatment & restoration or extraction depending upon the pros and cons - splinting of anteriors if required depending upon the results of the oral prophylaxis Also -flap therapy +periodontal regeneration therapy will help -37 can be replaced with prosthesis depending upon the improved periodontal status of patient. -Ask TO INCREASE THE VITAMIN C Rich Foods intake.

Thank you doctor... Planned for restoration in 26 ... And as of now no clinical symptoms in those teeth doctr... Butressing bone formation seen in 36 and 38 and due to loss of 37 appears like a swelling in pics doctor... Otherwise no palpable soft fluctuant swellings, tenderness, mobility suppuration or pain from patient side in those teeth... Hence planned for full mouth curettage Doctr

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Maxillary & Mandibular anteriors (Centrals& Laterals) have a lot of recession, pathological migration and look hopeless to me, Longer you wait for them, more bone resorption is anticipated. And rehabilitation would become more difficult. Same stands true for a few posteriors as well. If you are periodontist then probably would do CT grafting and help the patient. Otherwise please let a periodontist handle it. For me, I shall go for oral prophylaxis, flap surgery and extraction of hopeless teeth & restore them with implants.

Thank you sir ....Totally agreed... Waiting for periodontist opinion only sir..

Dr. @Narayana S sir, Dr @Partha Sarathi Sahana sir Dr. @Munish Kumar sir

There is generalized horizontal alveolar bone loss ... Plan for OFD .... Hopefully u will get better results provided patient is able to maintain a good oral hygiene

Thank you doctor

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Generalized periodontitis Need sclaing If grade II moblity splitings is needed Mouth wash and gumpain

Pathological migration needs to be managed Proper oral hygiene and maintainence Flap surgery and endodontic treatment wherever necessary

Periodontist consultation required and take a call.

Try with steroidal application for 15-20days followed by gum paint containing some astringent like tannic acid Both thrice daily

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