DTP example

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Hi everybody I was studiyng today Dental treatment plan and I have some examples from the RCS.Would you mind telling me if you agree with the treatment and in your words ,how would you explain the following situation to the patient and treatment options ?Pt:

woman, aprox 50 ,main concern pain coming from URquadrant, second complaint concern about gaps in the upper jaw because of aesthetics and function.Third problem patient not aware of : big carious lesion in 23 reaching the pulp ( showed in PA) Fourth problem: Generalized chronic periodontitis with BPE X,2,X 3,2,3Teeth presents: 18 13 12 11 21 22 23 28 47,46,45,44,43,42,41,31,32,33,34,35,36,18 has mobility =2In the paper says that the diagnosis is endoperio lesion so,

we have to explain that to the patient and suggest treatment options (also taking into account that she wants to know options for replacements of missing teeth that she has lost in the upper jaw.)I

found it very difficult to explain specially related with the UR8 and the endo periolesion, taking into account that if patient can not afford implants,(and removable dentures is the most possible option)it would be

good to save this tooth. ( the UR8)I was thinking that is more than

relevant to expalin the patient that the chances of succes in this tooth ar low and that the treatment will need to be done by an endodontic specialist first. I considered first to an endodontist

who will ,after a while, do the assessment and then perio treatment ( maybe can be done but ourselves) or will need a perio referral aswell!.For

the emergency treatment I thought about openning the tooth ( leave it opened because patient is in a lot of pain) and in the following day to clean and disinfect the canal and place a medication like calcium hydroxide to reduce the infection while the patient waits to see the endo specialist, also Atb prescribed from the first day taking into account that infection can not be treated yet with a definitve treatment ( until pt sees the endo specialist) To sum up.I would propose:Emergency treatment:Fo pain and infection: openning the tooth and prescribing ATB and analgesicssecond appointment after 24 hs, to clean, disinfect and placing calcium hydroxidePrimary phase treatment:Referral to endondontics specialist.OH instructions , scaling and root planing where is neededUR3 caries removed, RCT( if necessary) and restoration according to amount of structure left after previous treatment mentioned.After deciding if UR8 is removed or treated succesfully: able to design RPD ( if that is the option) Posible restorative options to replace the missing teeth: Removable acrylic denture or cobalt chromium or implants .Reinforcing

the idea that treatment of UR8 needs to be done first in order to have a

final design of partial denture which will be quite different if this tooth is not present. Secondary phase of treatmentI f patient is interested in implants, referral to an implantologist specialist (after perio conditions stabilized) for treatment options with implants . ( maybe the patient can have the interview with the implantologist as soon as she wants but letting her know that to be preapared for this type of treatment she needs to have the periondontal disease under control!)Maintenace phase:Reassessment, reinforce and decide recall visitsWhat do you think?Any kind of feedback is well come and also haw to approach and explain this treatment to the patient what I think is the most difficult part!Thank you!!!regards