1. Problem Based Learning:
Clinical case
L E B A N E S E U N I V E R S I T Y- S C H O O L O F D E N T I S T R Y
DUB1-DRE
S T E P H A N I E M O U AWA D
0 9 - 0 3 - 2 0 11
2. Case presentation
Localized hypersensitivity
Mr. I.
Cervical lesions
Age: 75 Chronic periodontal disease
Sex: Male Occlusal overload
Diastemas
3. 1- Defining the problems
Localized hypersensitivity
Possible causes:
Pulp exposure and potential pulpal
pathology
Exposed root
Enamel loss with exposed dentin
#14
4. Cervical lesions on premolars and molars
Tensile stresses causing
abfraction,
Associated with other local
chemical and biomechanical
factors, causing erosion and
abrasion
Increased stress (tooth # 14:
opposing crown)
5. Severe chronic periodontal disease with gingival recession
Poor oral and dental
RECESSION
hygiene
Occlusion problems
and bad parafunctional
habits
SEVERE
BONE LOSS
27. Review
Treatment Aesthetics Preservation Resistance Cost Time
*Direct ok short
Veneers(C)
+ - -
(large gaps
* ClV post
= large
*Crown 44
teeth)
And or
Crown 14
*Splinting
28. Treatment Aesthetics Preservation Resistance Cost Time
*Orthodontic High Long
*ClV, ClIV,
+++ +++ +++
ClI(C)
*Crown 44
And or Crown
14
*Splinting
and retention
29. Treatment Aesthetics Preservation Resistance Cost Time
*Full mouth High Ok
restorations
+ -- ++
with crowns (long
*Splinting
crowns)
30. Treatment Aesthetics Preservation Resistance Cost Time
*Keep the - Low short
diastemas
+++ +++
*ClV, ClIV,
ClI(C)
*Crown 44
And or
Crown 14
*Splinting
32. 5- Proceeding with the treatment
Option # 4 Keep the diastemas, treat all other lesions
Option # 1 Direct composite Veneers
33. Maintenance and recall
Check the state of the splints/effect of night guard
Check for gum health and bone support
checkups every 6 months for overall treatment control