CBL english
(Scenario)
A female teacher , 35 years old , came to the dentist to complain the uncomfortable sensation due to luxation of her front teeth. Intraoral
examination showed that element 11 has degree 2 luxation and color changing. The radiograph resulted that alveolar bone until 2/3 root.
The patient wanted to take out the tooth but didn’t want to be toothless.
(Question)
1. What are the classification of tooth luxation and mobility ?
2. How can the element 11 of the teeth to be luxation or what the causes the teeth luxation and color changing ?
3. What is the treatment planning and the procedure of the treatment in the scenario ?
4. Indication and contraindication of the treatment ?
5. What is advantages and disadvantage in the scenario ?
6. What is the denture classification maybe use in the scenario ?
7. How long does it take complete how many visited of the dentist ?
8. What is the intructions from the dentist for the patient ?
1. What are the classification of tooth luxation and mobility
?
• Tooth mobility from miller
0 class = is normal movement when forced is applied
1 class = mobility greater then 0 class
2 class = tooth can be moved up to 1 mm or more in a lateral directions
Bucal lingual or mesiodistal
3 class = tooth can be move up to 1 mm or more in lateral but ability to
depress the tooth in a vertical direction
2&3 class = the patient will feel pain because there is demage to the
periodontal tissue alveoli and vasicular supply
2. How can the element 11 of the teeth to be luxation or what the
causes the teeth luxation and color changing ?
• There are is 3 causes in general
1. Loss of attachment (causes by periodontal abcess, periodontal
disease, or alveolar bone)
2. Patological condition (pregnancy hormone)
3. Increase force on tooth (ex: bruxism , dental trauma, mallouclusion,
or failure orthodontic treatment)
• 11 = because in the scenario alveolar bone is resorption
• Maybe it because the patient have comporomise systemic condition
like diabetes melitus or etc
3. What is the treatment planning and the procedure of the
treatment in the scenario ?
• The treatment in the scenario is immadiet denture.
• Because the patient want to take out the tooth, but the patient didn’t want to be
toothless.
• Treatment planning :
1. Patient examination
2. Consultation interview (ask the pastient about past dental history and systemic
condition)
3. Record work model
4. Do extraction tooth 11
5. Do immadiet denture
6. Control
• The procedure of immediet denture :
1. Sharpening for the clams
2. Recording the maxilla to make a working model
3. Fixing the bite
4. Put the work model in the articulator
5. Sharpening the work model and grinding the work model
6. Making the clams from the tooth for continue acrilyc process
7. Extraction of the teeth
8. Insertion of the denture ( at the time of insertion we should to taking care of retention, stabilitation , and
occlusion and aestetic.
9. The denture shouldn’t be removed during the first 24 hours and the patients should eat soft food and shouldn’t
bite on the front teeth
10. Control after the first 24 hours
11. The next control is then 3 and 7 days later.
4. Indication and contraindication of the treatment ?
• Indication :
Severe caries in anterior teeth or severe discoloration due to ekstrinsik or instrinsik factor.
Teeth with severe periodontal abnormalities are character by periodontal attachment and alveolar bone damage
Abnormalities in potition of anterior teeth such as protusion , retrusion and cross bite
Patient with stable health condition
Patient with immadiet denture is the phylospical type there motivation is the maintance and appearance
Patient don’t mind some additional visit
Anterior multiple extraction
• Contraindication :
- The patien has a periodontal abcess or periapical abcess
- Patient with uncontrol diabetes melitus and hemofili
- Patient who are poor oral healt or surgical risk
- Patient with recurrent history or post extraction hemorhage
- Patient with radiation therapy
- eldery patient
- Unvailable for appointment
- And patient with gagging reflex
- Patients with extensive bone loss
- Acute infection that required drainage
Contraindication :
- There as cysts or impacted teeth
- patient not cooperative
- Patient with history of rheumatic disease destructive heart
5. What is advantages and disadvantage in the scenario ?
• Advantages :
Related the patient and related to the dentist
Related to the patient
1. Maintaining of dental appearance and facial conture
2. Minimize disturbance of mastication and speech
3. Maintaince of the patient physical and mental well being
Related to the dentist :
4. Transfer of the jaw relationship
5. Reduction in ridge resorption
6. Achiev a good appearance
Disavantaged :
7. The increase cost
8. More difficultthe procedure this is additional appointment
9. Can’t always see how the denture will look before the teeth are extract and immediet denture is inserted
10.Immediet denture increase complication of clinical procedure that may have bad prognosis the treatment
11.Retention is potentially less then the optimum retention
6. What is the denture classification maybe use in the scenario ?
• Two type immadiet denture :
1. Temporary immadiet partial denture ( in cases where the
permanent the immediet is likely to become I’ll fitting due to more
than normal bone resorption )
2. Permanent immediet partial denture (it use when cases the bone
resorption is expected to be less and the denture prognosis is good)
7. How long does it take complete how many visited patient to the dentist ?
• There are 4 Visit :
• 1. Examination and record model
• 2. Extraction and immediet denture
• 3. Control (we have 2 control
- 1 control ( need open and wash the denture, we look of tissue , the color or
the mucosa and we can reduce the denture immediet) (after 24 hours)
4 2nd control repair the occlusion replace articulation disorders ( after 7 days )
Next control need to routinely do the control resorption the bone if the
denture relining if the basis loosening we can do relining
8. What is the intructions from the dentist for the patient ?
1. don’t removed immediet denture from your mouth 24 hours following surgery
2. if your lip, tongue, or cheeks is numb please take care not to bite it
3. Is treatmet has been complete under sedation or you have second unsiolitic medication ,
responsible adult belonging go to home and rest until you are fully recovered from the
effect of the medication
4. Swelling will occurs and will ridge maximum to until 3 days following surgery before
gradualy subsiding
5. Don’t rinse or gurgle of 24 hours
6. Don’t eat or drink anything that to hot or cold and to hard for 24 hours following surgery
If youre smoker , smoking is not advice for 24 hours as it may delay healing or increase the
risk of a dry socket complication.
• Are adviced to control the next 1 day or after insertion of the denture
• Patient should have a soft diet it can be traumatic
• If there is the pain , the doctor give the analgetic medication.
Tambahan untuk belajar :
1. Material / bahan yang digunakan
2. Komplikasi
3. Design dan cara preparasi (misal pengurangan model kerja
apabila terjadi kelonggaran pada jaringan)
