Professional Documents
Culture Documents
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or coordinated and very type treatment should be done on it is
proper time and proper avenue.
So , because we r not dealing with a tooth ,we dealing with full
dentition in the mouth and this mouth for human being for a
patient.
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6-restoration of caries,if the patient has caries.
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and irritating the patient .these r kind of emergencies that we
should take care of it before any thing else.
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4- we correct restoration and prosthesis.
Open cavity r consider from the 1st category, kind of emergency
treatment , u should not leave open cavity, I should temporize it.
I put temporary filling ,clean soft caries a little pit put temporary
filling until finish my treatment.
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we don’t make provisional splinting () تثبيت السنانroutinely
nowadays, in the past we used to think that mobility is some
thing bad . provisional some thing temporary, splinting: means
unite or joint teeth to gather .
joint them with wire, bond it with composite . but we don’t
make final splinting in this phase.
You may want to extract the tooth later , but the patient cant go
without a tooth for example , some times we extract the tooth ,
cut the root and put it back , fill it from the lower end of the
tooth with composite .
To see the patient doing his job or not , if not we have to repeat
and keep after the patient , and I should not proceed to more
advance treatment or more sophisticated treatment if this phase
is not fully achieved .
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Now, how to evaluate the response to the restorative
procedures. you see we have sheets called recall sheet , I need
every time I see the patient to take certain landmarks and write it
down because I will forget with time .
I see patient I have been treated them for 10 years how could I
remember how she or he was ?
So if I have good record , then we can look how this patient
coming up , and its also called(maintance phase) .
Now, the 1st 3 months like experiment time , testing period for
this patient or the performance of this patient .and we keep after
the plaque and calculus ,we keep after the gingival condition .
Check the occlusion and other pathological changes.
And the most important thing every time, keep it in ur mind,
always ,always ,always…∞ recheck the medical history because
people don’t stay healthy for ever.
Some time u have good loyal patient that stick with u for 10,15
or 20 years during that patient may get married ,have children ,
get sick, get certain disease .so every time recheck the medical
history again.
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Now, why we do all of this ???
we talk about periodontal therapy, what is rationale behind
periodontal therapy???
unfortunately what most people remember about dentistry is
pain .that’s why so many people don’t go to dentist unless they
are in pain, that sever and in an excruciated pain( )ألم قوي وموجع.
4- Eliminate infection .
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Local therapy depends on removal of plaque or/and all
factors that favor its accumulation as we said earlier. And keep
in mind that’s plaque is a biofilm and the best way to get rid of
its by mechanical removal, mechanically disturb them because
they are at least (1000*100) more resistance to antibiotics.
And as we know also that’s part of normal flora they live with
us all the time , if you give antibiotics then the inflammation go
away for a week then its come back .
and this is the worst thing the dentist to do outside is patient
with gingivitis they prescribe antibiotics and strong antibiotics
and say ok. When the inflammation subside come back and then
I clean your teeth this is stupid, ridiculous and unaccepted .
The best way we give antibiotics only when they are needed.
and they are not needed that much .
so we should remove all the plaque and all the factor that favor
its accumulation its our primary consideration .
Plaque, keep in mind, remove plaque then you will have a
healthy gingiva.
The gentler you are with your work the better the outcome, the
less the trauma, the less pain and the faster the healing.
That’s why we keep saying perio is the difficult-easy (السهل
)الممتنع
that’s the difference between surgery and us they are tuff , they
have to cut bone use chisel and hummer, but we use a tiny
instrument and we should use them carefully.
There are factors that’s will interfere with healing for example,
the ability for healing diminish by :
Then you have new attachment that’s means you have new PDL
fiber into new cementum ,new sharpees fiber and new gingival
epithelium to a tooth surface ,and every thing is new. Is
regenerated .
Its delusive goal we try to achieve it, but its not fully achievable
so far.
3- Diagnosis.
4-Prognosis is base on your diagnosis you
give your prognosis ,prognosis is the outcome
of disease ,the patient will ask you and you 16
have to know how to answer.
Then base on that all what you did so far you do your treatment
plane .
So prognosis : actually is prediction of the course and
termination of the disease and its response of treatment .
Never ever brag , never ever make your patient over confidence.
If you sure about 80%that this tooth save for example, give him
70% because you don’t know what will happen in the course
,and you should give your patient the condition that in which
you built your assumptions, but if you don’t do the treatment
you definitely lose this tooth , but if you do treatment we have
the chance to do so and so .base on what you learn and base on
your experience .sometime there is reason ,sometime the patient
doesn’t aware in what he/she has, you assume that patient
healthy and the patient is not for example .
Many time ,the risk factors and the prognosis factors are the
same ,they interfere like in case of diabetes .
the diabetes is risk factor for perio-disease ,but again it
interferes with prognosis as well .
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We have to know that there :
1-prognosis of gingival disease.
2- prognosis of periodontal disease .
and we have:
1- overall prognosis .and
2- prognosis for individual or single tooth .
THE END
شكر خاص وحار وجزيل لخواتي أيسر طشطوش ودعاء العودات و رانية
لجهودهم الجبارة في كتابة هذه المحاضرة) جزاكم ال خيرا.)البصول.
Done by: AMAL ABU
OMAR. 1
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