Treatment Options for Fractured Bridge

Treatment Options for Fractured Bridge Case Study: Discuss the treatment options of a case that you have treatment planned as part of your ICEi clinical portfolio. Patient complaint: Had a bridge in upper left area which had fractured and wanted to enquire about the possibility of implant treatment to replace the teeth and close the gap . History of present condition: Patient had a bridge for years for his one front missing tooth , and had recently fractured the bridge .No pain or discomfort from the broken tooth and has left the gap as such .Patient also had tried dentures for his other missing teeth but was not able to get used to them. Patient wanted to explore the options to replace his front missing teeth, in particular with dental implants. Patient not in any discomfort, and did not report any other dental problems. Patients’ expectation from the treatment is to replace front teeth, so that they look, function and feel like his own teeth and can give him confidence to smile as before . Social History: Patient rarely consumes alcohol and is a non-smoker Low sugar intake in diet Medical History: High blood pressure Medications: Ramipril, Cardioplen (Felodipine) / Simvastatin Extra oral examination: No abnormality detected Intra oral examination Soft Tissue: The soft tissues intra-orally were in good health. Periodontal condition: Bleeding on probing at some areas and calculus in lower front teeth. Grade 1 mobility with LR1, LL1 teeth but the pocketing depth was within normal range. Patient had average oral hygiene. Teeth :Teeth and existing restorations and crowns were generally in good condition. Generalised mild attrition was noted. Missing teeth: UR8 UR7 UR6 UR5 UL3 UL6 UL7 UL8 LR7 LR6 LR5 LL5 LL6 LL7 Crowned teeth (PBC) UR4 UR3 UR2 UR1 UL2 Restored teeth UL5 LR8 LR4 LL8 restored with amalgam restoration LR8 LL8 drifted mesially. UL4 tooth was fractured which was an abutment for mesial cantilever bridge (UL3-pontic, UL4- retainer crown), No caries, minimal coronal tooth structure present Occlusion: Upper arch Kennedy’s Class 1, Modification 1, considering missing UL3. Lower arch Kennedys Class 3, Modification 1 relationship was present. Due to missing posterior teeth in both upper and lower arch, patient had an edge to edge bite No obvious canine guidance or group function on lateral movements. Lip / Smile line: Lip and smile lines were positioned in such a way that when smiling broadly some of the gum margins of teeth were seen. An average (Moderate) lip line was hence recorded.(Van der Geld, Oosterveld et al. 2011). Bone morphology on palpation: UL3 area was noted to have buccal bone defect on palpation. UL4 tooth was having good hard tissue height and width due to the presence of the tooth. Diagnostic tests: Radiographs taken: DPT x-ray was done to assess the alveolar bone levels Periapical X-ray UL34 was done to assess the quality and quantity of bone available for the implant fixture. Photographs: Front view (close up) to record the lip line Intraoral view of UL3, UL4 area Bone defect picture Diagnosis: Failed anterior cantilever bridge (UL3 pontic, UL4 retainer) UL4 fracture tooth (no caries minimal tooth to restore) Upper and Lower partially edentulous arches. Generalised chronic mild gingivitis Patient wishes: Patient prefers a fixed option for the gap in the front. Treatment planning, objectives and considerations: Treatment is indicated to restore aesthetics and function and would also benefit the patient psychologically to have confidence in his smile again (Lindsay, And et al. 7). Considering patient desires, specific objectives of the treatment should be to restore missing UL3 tooth and UL4 tooth with a fixed option. The bone around the fractured tooth (UL4) is adequate, and there is sufficient bone height and width to allow the restoration of implant fixture. However, the bone around the missing tooth (UL3) was inadequate with bony defect and would need bone grafting to aid the long-term stability of the fixture. This can also further help to improve aesthetic results after implant treatment. Risk factors / limitations: Fracture of buccal bone can occur during extraction of UL4. UL3 has been noted to have less adequate bone, the implant restoration may have a higher restoration margin than the natural teeth, and tooth might appear to emerge higher up the gum than the adjacent teeth. No posterior support present in the present compromised occlusion and risk of excessive load on implants and hence failure of implants due to biomechanical reason and occlusion overloading(Kim, Oh et al. 2). Lack of primary stability of implants and Implant failure. (Chrcanovic, Chrcanovic et al. 6). Treatment options for the replacement of the missing teeth are: No treatment Leave Gap UL3 (Kanno, Carlsson 2006),Leave alone UL4 Extraction of UL4 and partial dentures (Davenport, Basker et al. 2000). Bridge (Not advised in this case, considering UL2 heavily restored and not suitable as an abutment). (Anonymous 2007). Implant options : UL4 implant and mesial cantilever bridge with UL3 UL4 (Implant supported bridge), (Kim, Ivanovski et al. 2). b. UL4 implant supported crown and UL3 Implant supported crown with bone grafting in UL3 (Al-Khaldi, Sleeman et al. 2011). Advantages and Disadvantages of different treatment options : 1. Leave, accept gap / Leave alone fractured UL4 Advantages: No treatment required No surgery Accept gap, no cost Disadvantages: Unaesthetic Drifting / Tilting of adjacent teeth Function and phonetic compromised Continuous bone loss, making restoring site more challenging at later date. Development of occlusal interferences Risk of caries developing UL4 Risk of acute pain / swelling and infection UL4 2. Partial dentures Advantages: No surgery Low cost Few visits for treatments Disadvantages: May be unstable Food accumulation Does not prevent bone loss Tolerance can be difficult 3. Bridge work (Not advised / feasible in this case) Advantages: No surgery Low cost Few visits for treatments Teeth are fixed Disadvantages: Healthy teeth prepared for support, Risk of loss of vitality ,may need Root canal treatment or Extraction at later date . Food accumulation as difficult to floss Does not prevent bone loss High cost Fracture of bridge or any part of it , needs replacing with new bridge as difficult to repair . Implant options: a) UL4 implant and mesial cantilever bridge with UL3 UL4 (Implant supported bridge) Advantages: Less cost as one implant to be placed No bone grafting needed, one surgical visit would be less. Treatment completion would be early as no bone augmentation needed. Fixed prosthesis Prevent bone loss at UL4 site Disadvantages / Limitations: Risk of implant failure is high due to excessive occlusal load due to missing posterior support. Compromised aesthetic outcome for UL3 due to bone defect present. If bridge work fails, would then plan to put two implants as planned as the next option and hence further cost. Oral hygiene needs to be maintained. b) UL4 implant supported single crown and UL3 Implant supported single crown with bone grafting in UL3 area. Advantages: Fixed prosthesis Prevent further bone loss at UL3 UL4 sites. Better aesthetic results. Individual implants, easy to maintain oral hygiene. Risk of failure due to occlusal load decreases as forces divided on two fixtures. If an implant fails, they could be replaced or treated individually. Long term clinical data reveals that the prognosis for implant treatment is very high, in the region of 90-95%. (Pjetursson, Pjetursson et al. 6). Disadvantages / Limitations: More cost as two implants and bone augmentation required. One surgical appointment added and wait for bone material to mature and hence prolonged treatment time. Risk of implant fixtures failure to ossteointegrate. The success of implant treatment will mainly depend on the ability to maintain a very high level of oral hygiene and plaque control measures in the long term. Need to attend dentist at 3-6 monthly intervals to ensure good periodontal (gum) condition is maintained around your implant fixture and standing natural teeth. Provisional restoration options: No Provisional restoration or Denture Patient opted for No Provisional restoration Type of bone grafting options 🙠 Dib 2010) An osseous graft can be osteogenic, osteoinductive or osteoconductive agent. Osteogenic graft contains vital cells, which will contribute to new bone growth. Osteoinductive graft stimulates the differentiation of osteoprogenitor cells into osteoblasts due to the bone morphogenetic proteins (BMPs). Osteoconductive graft will serve as a scaffold for new bone formation. Graft materials are also classifies as: Autograft bone, obtained from the same individual. Allograft bone, obtained from a different individual, but from the same species (Bone bank) Xenograft bone, obtained from different species (Bovine) Alloplast graft is made of synthetic materials. Patient had no reservation for xenograft and hence xenograft Bio-oss was agreed to be used. Patient information leaflet given on same. Treatment agreed and planned: From the options discussed and considering patients’ wishes , it was agreed to plan two individual implant retained single crowns with bone augmentation at UL3 site and it was proposed to do: Scale and polish Extract the UL4 tooth and Bone Graft UL3 area Place two implant UL3 and UL4 Fabricate new upper and lower partial dentures Maintenance instruction and regular follow up A report was sent to the patient with all the options written after the consultation and attached with a breakdown of the costs for consideration and consent to proceed. Reference list : AL-KHALDI, N., SLEEMAN, D. and ALLEN, F., 2011. Stability of dental implants in grafted bone in the anterior maxilla: longitudinal study. British Journal of Oral and Maxillofacial Surgery, 49(4), pp. 319-323. ANONYMOUS, 2007. Long-term survival of complete crowns, fixed dental prostheses, and cantilever fixed prostheses with posts and cores on root canal-treated teeth. British Dental Journal, 203(9), pp. 523. DAVENPORT, J., BASKER, R., HEATH, J., RALPH, J. and GLANTZ, P., 2000. The removable partial denture equation. British Dental Journal, 189(8), pp. 414-24. DIB, M., 2010. Successful Bone Grafting. Oral Health, 100(4), pp. 106-107,109. KANNO, T. and CARLSSON, G.E., 2006. A review of the shortened dental arch concept focusing on the work by the Kà ¤yser/Nijmegen group. England: Blackwell Publishing Ltd. KIM, P., IVANOVSKI, S., LATCHAM, N. and MATTHEOS, N., 2. The impact of cantilevers on biological and technical success outcomes of implantà ¢Ã¢â€š ¬Ã‚ supported fixed partial dentures. A retrospective cohort study. Clinical oral implants research, 25(2), pp. 175; 175-184; 184. KIM, Y., OH, T., MISCH, C.E. and WANG, H., 2. Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale. Clinical oral implants research, 16(1), pp. 26; 26-35; 35. LINDSAY, S., AND, K. and JENNINGS, K., 7. The psychological benefits of dental implants in patients distressed by untolerated dentures. Psychology Health, 15(4), pp. 451; 451-466; 466. PJETURSSON, B.E., PJETURSSON, B.E., BRÄGGER, U., LANG, N.P. and ZWAHLEN, M., 6. Comparison of survival and complication rates of toothà ¢Ã¢â€š ¬Ã‚ supported fixed dental prostheses (FDPs) and implantà ¢Ã¢â€š ¬Ã‚ supported FDPs and single crowns (SCs). Clinical oral implants research, 18, pp. 97; 97-113; 113. VAN DER GELD, P., OOSTERVELD, P., SCHOLS, J. and KUIJPERS-JAGTMAN, A.M., 2011. Smile line assessment comparing quantitative measurement and visual estimation. American Journal of Orthodontics and Dentofacial Orthopedics, 139(2), pp. 174-180.

Firefighter Employment Scenario Essay

Although it’s not clear in the story whether an associates degree is a precondition for taking the exam, in your opinion, should a degree be a requirement to sit for the exam? Yes Why or why not? A Fire science degree should be a requirement to take the test. It shows that the fire fighter it trying to improve him or her self and become more knowledgeable of their craft. It also shows that they are committed to their career. Working and going to school is not an easy thing to do. Like the question states we do not know if the degree is required to sit the exam, if not stated as a requirements, then the degree should not be a factor in the selection process. Based on the fact that Doug and Sam earned the first and second highest test scores, is it a reasonable assumption that the city of Davis will add Doug and Sam to the certification list? Yes Why or why not? According to what we know of the information provided they should both be on the list. They have both meet the requirements to sit for the exam and scored the two best scores. Can the City successfully defend itself on the basis of â€Å"disparate impact?† Yes Why or why not? The city did will not effect anyone of a protected class, under Title VII Once disparate impact is established, the employer must justify the continued use of the procedure or procedures causing the adverse impact as a â€Å"business necessity.† Under what circumstances may racial discrimination be proved by â€Å"disparate impact?† One does not need to be direct about the discrimination. Example would be â€Å"Whites only need to apply†.

Franz Kafka s The Metamorphosis - 1014 Words

Franz Kafka’s The Metamorphosis (1914) is about the transformation of Gregor Samsa into a giant insect. His life has been miserable due to the fact that he works to meet the standard necessities of the family after his father has lost his business. Kafka implies that Gregor’s transformation is simply a manifestation of what he was already experiencing. It is a punishment for Gregor not having attempted to engage with others. Kafka’s main theme is alienation and he explores it passionately through Gregor’s introverted life before his transformation, the metamorphosis of the family’s treatment towards Gregor after he turned into an insect, and Gregor’s behaviour after his drastic change. According to the author, Gregor has always been an introvert. He would lock the door of his room and stay there and he would not even make any connection to anyone in his family, but her sister, Grete. Before his transformation, he would lock his door for priva cy (class notes). Gregor is a hard-working man and he has dedicated his life to his work even though he is unsatisfied with his job. He would often think about rebelling against his family, but he can’t quite grasp the idea of leaving them. His willingness of working tirelessly for the sake of his family proves that he loves them. It is proven that he is lacking human contact because he cuts out a picture of a model off a magazine and he hanged it on his wall (414). This means that he has no special someone to spend his life withShow MoreRelatedThe Metamorphosis Franz Kafka s Metamorphosis1663 Words   |  7 PagesIn The Metamorphosis Franz Kafka tells the story of a young man named Gregor who observes the radical changes in his life after transforming into an insect. Gregor’s life was centered on his job as a traveling salesperson and his family. One morning Gregor woke up transformed into an insect. Afraid of the transformation Gregor stays in his room and ignores calls from his family. When Gregor realized that his new body did not allow him to have a normal life, he tried to adapt. After his metamorphosisRead MoreMetamorphosis By Franz Kafka s Metamorphosis1496 Words   |  6 PagesIn Franz Kafka s Metamorphosis, Grete changes from a child into an adult while also trying to do the opposite with her own family. Gregor’s metamorphosis leaves her family without anybody money to pay for their needs. Consequently, Grete replaces Gregor and begins to cook and clean for her family and go to work. These jobs allow Grete to become more experienced and to mature. Similarly, Grete shows displays these changes by dressing more provocatively and becoming more interested in romance. HoweverRead MoreReview Of Franz Kafka s The Metamorphosis 958 Words   |  4 PagesBibliography of the Life of Franz Kafka There are several aspects about the writing of Franz Kafka that make it enticing to the reader and tantalizing enough to keep the reader intrigued. The narrative that I find most intriguing by Kafka is The Metamorphosis. The Metamorphosis is a tale wherein Kafka essentially gives his perception of the story of his life through the use of storytelling devices, which without the use of them would have made it a less interesting tale. Franz Kafka was born on July 3rdRead MoreAnalysis Of Franz Kafka s The Metamorphosis 3979 Words   |  16 PagesAustin Day Professor Imali Abala English 357 18 February 2015 The Theme of Alienation in Franz Kafka’s The Metamorphosis The Metamorphosis written by Franz Kafka in 1915 is said to be one of the greatest literary works of all time and is seen as one of Kafka’s best and most popular works of literature. A relatively short novel; the story explains how the protagonist, Gregor Samsa wakes up one morning to find himself transformed into a vermin which completely estranges him from the world even moreRead MoreAnalysis Of Franz Kafka s The Metamorphosis 1087 Words   |  5 Pagesmercy were ignored. Franz Kafka’s novella is not about a dictator but it alludes to a person close to Franz that was as close to a dictator that he ever go to. Franz Kafka’s The Metamorphosis, is about a young man that wakes up one day and is a vermin and has to maneuver around his home and come to terms with his six itchy legs. It probably sounds like a load of fictitious ramblings that somehow became a classical novel. Wrong! Look a little closer and the secret message Franz Kafka wrote for his fatherRead M oreFranz Kafka s The Metamorphosis882 Words   |  4 Pagesâ€Å"The Metamorphosis† is a surreal story by Franz Kafka surrounding the transformation and betrayal of Gregor Samsa, who wakes up one day, reborn into a large insect. Along with the bizarre and nightmarish appearance of his new hard back, brown segmented belly, and many legs, Gregor only desire is to live a normal life, unfortunately, this is impossible because he struggles to even get out of bed. Gregor transformation into an insect is a vivid metaphor for the alienation of humans from around theRead MoreFranz Kafka s The Metamorphosis1222 Words   |  5 Pagestear you down. In Franz Kafka’s The Metamorphosis this destruction is what is seen in the Samsa family. Through what they believe to be necessary, Gregor’s family destroys the environment that he knows, Gregor Samsa destroys his family, and Mr. and Mrs. Samsa bring unnecessary destruction to both of their children. The very nature of Kafka’s The Metamorphosis is change and the effect on people. The first very obvious change is that of Gregor Samsa into a â€Å"monstrous vermin† (Kafka 3). However, oneRead MoreFranz Kafka s The Metamorphosis814 Words   |  4 Pages When Franz Kafka first penned his short novel The Metamorphosis in 1915, he had no idea that it would become one of the most influential pieces of fiction of the twentieth century, continuously being studied in colleges and universities across the Western world. The novel rotates around the life of a man named Gregor Samsa, who wakes up on a routine day, and suddenly finds himself transformed into an insect. As the story progresses, the reader can see how Gregor’s physical transformation triggersRead MoreAnalysis Of Franz Kafka s Metamorphosis1985 Words   |  8 Pagestruly seen? Does one view one’s external self, or do they see a reflection of past experience? Not many have the value of altruism, bu t some do. Sometimes altruism can turn extremist though, to the point where it can be a negative thing. In Franz Kafka’s Metamorphosis, the main character Gregor Samsa is a workaholic that randomly one day awakens as a bug. Initially, Gregor sees himself with a condition, and then slowly tries to adapt to his bug transformation. Gregor did not put himself first when heRead MoreFranz Kafka s The Metamorphosis1630 Words   |  7 Pagesomnipresent in the context of Franz Kafka’s The Metamorphosis. Throughout the story, the Samsa family struggle to balance their own lives and the sympathy for Gregor, the only son, as his transformation from human to cockroach leaves a burden on the family and results in the loss of Gregor’s humanity. Despite the fact that Gregor had been the sole income of the family, the loss of humanity from becoming a cockroach was overwhelming to the family, resulting in selfish tendencies. Kafka displays how humans are

Essay on Educational Goals and Philosophy - 1175 Words

Educational Goals and Philosophy As I prepare for my life long goal to be an educator, I continuously realize the complexity and great responsibility of this career. Instead of becoming overwhelmed and intimidated by these realizations, I try to concentrate my efforts on organizing my beliefs and goals. In this philosophy statement, I will display my beliefs and goals by discussing the nature of students, the nature of knowledge, the purpose of public education, methods, and curriculum. This is a beginning basis of my philosophy of education. To be a successful educator, it is imperative to understand the nature of students. Due to the great diversity in American schools today, I believe the teacher must try to discern each†¦show more content†¦Also, in physical geography, psychology, and sociology, there is absolute knowledge such as weather systems and patterns, and laws of interaction among individuals and groups of societies. On the other hand, there is a great deal of relative knowledge; explanations of economic success or failure in cultural geography and social stratification models in sociology are great examples. This information is dependent upon certain cultures and places, and therefore changes according to different people and times. Understanding definite pieces of absolute knowledge is a good basis and application to understanding a variety of relative topics. A truly educated student will acquire both types of knowledge. The purpose of public education is greatly debated in this country. The obvious, ultimate goal is to educate people. I believe it can be argued that by trying to create perfect citizens, encourage free expression, change society, control behavior, and produce high standardized test scores, that goal has been blurred. Not saying that these are improper objectives, but the main goal has been lost. Social Reconstructionist Paulo Freire noticed this problem in the 1960’s. He states, â€Å"Schools can either educate and liberate, or miseducate and oppress.† (143) I agree with Freire; a proper education is irreplaceable. It not only empowers individuals and improves their self-concept, but it also improves societyShow MoreRelated Educational Goals and Philosophy Essay945 Words   |  4 PagesEducational Goals and Philosophy Making a career choice can often be a tormenting decision, and many people choose a profession or line of work that may not satisfy their creative abilities, but only pays the bills. I have known, specifically since the first day I spent in kindergarten class, that my purpose is to teach, and for that knowledge I am especially fortunate. The philosophies that I support have been part of my educational beliefs and standards for the majority orRead MoreEssay on Educational Goals and Philosophy956 Words   |  4 PagesEducational Goals and Philosophies My life has been greatly influenced by family members who are educators: my mother is a third grade teacher, my father an elementary school principal, my sister a high school English teacher, and my brother who obtains a degree in agricultural education. This has instilled in me the desire to become, like them, a good educator but is defiantly not the only reason for my decision to peruse teaching as an occupation. There are several reasons why I haveRead More Educational Goals and Philosophy Essay785 Words   |  4 PagesEducational Goals and Philosophy Teaching has always been an honorable and valued profession. With teaching you instill the knowledge and values that the student will take with them throughout life. I have volunteered at the elementary school with my children and have enjoyed watching the encouragement and nurturing of these teachers towards their students. I felt that I have the ability to nurture and share in the wonderment of the knowledge that prevails around us. To achieve this goalRead More Educational Goals and Philosophy Essay921 Words   |  4 PagesStatement of Educational Goals and Philosophy My desire to become a teacher began while I was in junior high school however; my family, friends, and coaches basically turned me against it. They said it was a jobless market with no future. At that age, those people were very impressionable on my decisions, and because of this I became disillusioned about my career, and at that point I just knew I wanted to attend college. Once in college, I found my niche in the social sciences. I loveRead MoreEssay on Educational Goals and Philosophy1072 Words   |  5 PagesEducational Goals and Philosophy Most individuals can recall when they were very young saying, â€Å"When I grow up, I want to be a . . . † For some people, over the course of growing up their ambitions changed several times. But for many, they ended up in a career which was a life long desire, goal, or ambition. Today, students must begin to think about their future on a more serious note than that of childhood during the latter part of their middle school years. This is during theirRead MoreEssay Educational Goals and Philosophy1281 Words   |  6 PagesEducational Goals and Philosophy As a child, playing â€Å"school† occupied most of my time. My younger sister and I taught a bedroom full of stuffed animals and filled in imaginary names in our old school books. From the bad bears and loud bunnies to the good puppies and smart kittens, each stuffed animal possessed his or her own personality. The thought of teaching never entered into my mind when I was asked, â€Å"What do you want to be when you grow up?† Uncertain aboutRead MoreEssay on Educational Goals and Philosophies1840 Words   |  8 PagesEducational Goals and Philosophies For the past seven years, I have had the same dream - to someday be a high school math teacher. I am finally on my way to turning that dream into a reality. Along the way, I am learning a lot of things and forming a number of opinions. One of the main areas in which I am forming new beliefs is in relation to what methods I will use in teaching my class and what aspects of what philosophies I will employ. First of all, however, I must reach the pointRead More Educational Goals and Philosophy Essay901 Words   |  4 PagesStatement of Educational Goals and Philosophy Every student is an individual, with his or her own personality and style. When teaching, I will remember and understand that students are children, not small adults. They will try my patience and understanding, then test the limits of my indulgence. My approach to teaching leans toward the essentialism. The student is there to learn what they need to know so they can become self-reliant adults. I want to be a teacher who under standsRead MoreEssay on Statement of Educational Goals and Philosophy689 Words   |  3 PagesStatement of Educational Goals and Philosophy I can still remember coming home from school after an exciting day in the first grade. I would go straight to my room, line all of my dolls up in the floor, and â€Å"teach† them everything I had learned earlier that day. But of course, not every child who pretends to be a teacher in his or her early years actually becomes a teacher. So although I enjoyed â€Å"teaching,† I never really considered it as a choice for my life-long career. Read More Educational Goals and Philosophy Essay examples1264 Words   |  6 PagesEducational Goals and Philosophy As a student of education, I have been able to gather many ideas and opinions about practices and ideals I want to implement in my future classroom. My philosophies about education are still being formed and continually change with every class I visit and with every educator I encounter. My ideas, admittedly, come from random experiences and intangible texts, but as I gain more experience in the field through my courses, my philosophies about teaching