Treatment plan

Question 1

What is the modified bass technique

Answer 1

It is a technique for tooth brushing

Question 2

What are the steps in modified bass technique?

Answer 2

• Hold the toothbrush at a 45-degree angle to your gums.
• Place the bristles slightly into the gumline.
• Use gentle vibrating or circular motions.
• Follow up with a gentle scrubbing motion.
• Repeat for each tooth, inside and outside surfaces.

Question 3

Why did you take a diet diary?

Answer 3

• to address the patient dietary factors that may be contributing to her tooth-wear and secondary caries

Question 4

What are the factors in the patient diet diary that may be contributing to her erosion?

Answer 4

• carbonated drinks such as pepsi max

Question 5

What are the components of the patient diet that contribute to her caries? (cariogenic food that are high in sugar)

Answer 5

• kitkat
• she drinks tea and coffee with two table spoons of sugar
• hidden sugars (in sauces)

Question 6

What diet advice would you give to your patient?

Answer 6

• Avoid adding sugars to your tea and coffee and if you want you can have these during meal times and limiting the frequency of them as the frequency of exposure to sugar is more risk of decay than the amount of it
• avoid drinking carbonated drinks and if you want to drink it, it is better to use a straw as this will make your teeth less exposed to it , and avoid swilling carbonated drinks in your mouth
• Snack on healthier snacks such as vegetables , cheese and bread sticks

Question 7

Why did you choose composite?

Answer 7

Because it is the gold standard core material
It is durable and strong and creates a chemical bond with the tooth
- it also have a similar thermal expansion coefficient as enamel

Question 8

What difficulties might you face when placing a composite ?

Answer 8

• moitsture control and it can be hard to manipulate

Question 9

How would you avoid these complications which are associated with composite?

Answer 9

• by placing dental dam for moisture control
• by placing the composite in increments of 2mm at a time

Question 10

Why did you choose amalgam for the 35?

Answer 10

because the cavity is very large and it would be difficult to achieve moisture control in that area, amalgam does not need very good moisture control and it is strong for big cavities

Question 11

What will you use for assessing periodontal health?

Answer 11

• MPBS
• which will ecourage the patient to keep her teeth clean when seeing the plaque and bleeding scores

Question 12

Which teeth are involved in the plaque and bleeding scores?

Answer 12

Ramford teeth

Question 13

What would be your denture design?

Answer 13

• RPI systems on the upper on 23 and 14 and a mid palatal bar with a cingulum rest on 13 for indirect retention
• For the lowers cingulum rest on the 34 and a distal rest on the 45 with gingivally approaching clasps and rests on the molars with occlusally approaching clasps as with lingual bar major connector?

Question 14

Justify the choice of your major connectors?

Answer 14

• upper - to allow more clearance for cleaning and to avoid irritation
• lower - because there is 8mm space available subgingivally and to allow more clearance for cleaning

Question 15

Why do we need 8mm clearance to place a lingual bar?

Answer 15

• so it does not interfere with the occlusion and to ensure the patient comfort and to avoid soft tissue irritation and ensure adequate oral hygiene

Question 16

Why did you choose MCC over other crown options?

Answer 16

• because they combine strength and aesthetics as they have good mechanical properties and good aesthetics they also have a long survival rate up to 90-95% over ten years

Question 17

Why are you replacing the veneers on 13 and 23?

Answer 17

• these veneers kept coming off during the treatment due to the patient having group function , this is why restoring the canine guidance by replacing these veneers would be beneficial to the patient and would give the patient a balanced occlusion

Question 18

Why did you build up the lower anterior?

Answer 18

• To improve appearance
• To prevent further wear to these teeth

Question 19

Why did you restore palatal the 23 and 13 with composite?

Answer 19

• to prevent further erosion
• these restorations should also be monitored and adjusted or replaced if any signs of deterioration occurs

Question 20

Why did you choose to restore these restorations for wax ups and vacuum formed stent?

Answer 20

• To keep up with the patient high aesthetic demand
• because they can minimise the operator error
• they are more time efficient during the appointment than placing the composite with free hands

Question 21

Why did you use wax ups?

Answer 21

• to visualise the treatment outcome
• to show the patient the results before definitive restorations
• to allow better sequencing of the treatment

Question 22

Why would you splint the teeth after giving the patient the treatment?

Answer 22

• to prevent them from fracturing until the partial denture has to be made and to get the patient to get used to them
• to prevent toothwear

Question 23

What material would you choose for pu/pl dentures?

Answer 23

• COCR

Question 24

Why did you choose CoCr?

Answer 24

Because it required less maintenance than acrylic , it is strong and durable and does not feel bulky in the mouth, also giving into consideration that the patient have never worn a denture before , an acrylic denture may cause a big difference in the patient mouth as it would feel bulkier