Page 25 - GP Spring 2025

Treatment Plan: Phase 1. Data collection was completed
including taking preliminary impressions. However, the
patient’s A1C was unknown at the time of preliminary ex-
amination. Reevaluation of periodontal disease resulted in
scaling and root planing for all quadrants. There was an oral
surgery consultation for extractions of lower central inci-
sors due to severe bone loss and mobility. Probing depths
ranged from 1-5mm and there were 8 surfaces with pock-
ets > 4mm. There were 31 sites with clinical attachment
loss and 14% of sites had bleeding upon probing. Caries risk
was high due to the presence of three or more active carious
Figure 2. Patient EC demonstrates torus palatinus and lingual tori. lesions, which were both visually and radiographically con-
firmed (#7, #8, #10), as well as xerostomia, caused by the high blood pressure medications.

Radiographic analysis revealed open margin and caries on crowns of tooth #7 and #8, caries on the mesiolingual surface of tooth #10, and
furcation involvement of #18 (Figure 3).
Phase two included SDF
application on teeth # 7
and #8 in order to pre-
vent further exacerbation
of dental caries. (Fig-
ures 4,5). In addition, a
composite restoration on
ML surface of #10 was
placed.

Figure 3. Full mouth radiographs.
Phase three consisted of extractions of lower central incisors (#23-#26) in preparation for removable partial dentures (Figure 6).

Figure 4. Armamentarium needed for the SDF Figure 5. Application of SDF Figure 6. Occlusion pattern of the patient
application procedure showing edentulous areas with sufficient
space for upper and lower partial dentures.
The occlusal pattern demonstrated by the study casts was Class II with adequate occlusal space noted for the removable appliances (Figure 7).

Phase four included fabrication of an upper resin based
partial denture and lower metal cast partial denture.

The patient was placed on 3-month periodontal main-

tenance follow-up, 3-month clinical revaluation and
reapplication of silver diamine fluoride for #7 and #8
as well as 6-month radiographs, denture recall once a
year , and denture oral hygiene instruction.
Figure 7. Study casts.
www.nysagd.org l Spring 2025 l GP 25