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Case Presentation

Regine Glyza Gepanaga Darryl John Villar

- For suprabony pockets which need access for restorative dentistry, when moderate gingival enlargements or aberrations are present, and when moderate gingival enlargements or aberrations are present, and when there is asymmetrical, or unaesthetic gingival topography.

Patient Picture

Name: Jan Michael Caedo Address: Calumpang, Iloilo City Age: 28 Gender: Male Birthdate: August 19, 1985 Civil Status: Single Occupation: Student
Quantity: 10 sticks per day Quantity: 3 5 bottles per week

Smoker: Applicable Drinking Alcohol: Applicable

Nag damul liwat akon na gums kg ga sige dugo mag tooth brush ko

10 years PTC, patient suffered from severe swelling of the gingiva. Consulted Dr. Robles and was diagnose with gingivitis treated with deep scaling. 9 years and 11 months PTC, Patient undergone gingivectomy. 2 months PTC, patient had oral prophylaxis at IDC CD Upon consultation patient presents with a hyperplastic gingiva with enlarged rounded margins and covers 1/3 of the clinical crown.

History of hospitalization: 3 years ago patient broke his ankle due to a sport accident. Systemic Diseases: No known problem Allergies: None Medications: None

Frequency of Dental Visits: Seldom Previous Treatments:


Oral Prophylaxis Restoration: Tooth # 36 and 46 Extraction: Tooth # 28 Gingivectomy (10 years ago) Odontectomy: Tooth # 38 ( 2 years ago)

Last Dental Visit: September 21, 2013 (Extraction of tooth #28)

Maternal side: Hypertension Paternal side: Diabetes Milletus

Extraoral

Absence of assymetry Lymph nodes not palpable Absence of growths and swellings Medium-sized jaw Developed muscles of mastication

Intraoral Findings
Medium sized tongue Reddish gingiva with enlarged rounded margin Presence of composite filling on selected teeth Gummy smile

Tooth Length 27mm 22mm 23mm Crown Length 12mm 9mm 11mm (CEJ)

24mm 22mm 27mm 12mm 9mm 12mm

Periapical and Panoramic Radiographs reveal no bone loss

7mm

7.5mm 9mm

7.5mm

6.5mm

7mm

Tentative:

Hyperplastic Gingiva
Gingival Fibromatosis

Definitive:

Gingivectomy

Help the patient feel calm Check the blood pressure of the patient Have the patient mouthwash or gargle with any antiseptic agent to reduce the intraoral bacterial count Wash the area around the mouth with an antiseptic solution Dry the area to be anesthetized and apply topical anethesia for 2 3 minutes Anesthetize the area by local infiltration the let the patient gargle Check if the area anesthetized is already numb Use an electrocautery to recontour or remove excess gingiva Mix ZOE powder and Liquid and apply it to the surgical site and let it stay for 30 mins. After 30 mins. Remove the ZOE and let the patient gargle

Do NOT eat anything until the anesthesia wears off, as you might bite your lips, cheek, or tongue and cause damage Slight swelling of the operated area is not unusual even bruising and chapped lips may occur. A reusable ice bag or a frozen vegetable bag, wrapped in a soft towel, may be applied to the area of surgery to help minimize the swelling of your face. Alternating 20 minutes on and 20 minutes off will usually be adequate during the first 24-48 hours after surgery. Avoid extremely hot foods for the rest of the day and do NOT rinse out your mouth, as these will often prolong the bleeding. If bleeding continues, apply light pressure to the area with moistened gauze or moistened tea bag. Keep in place for 20-30 minutes without looking to see if bleeding has stopped. Please follow a soft food diet, taking care to avoid the surgical area(s) when chewing. Chew on the opposite side and do NOT bite into food if the procedure was done in the front of the mouth. Avoid sticky, hard, brittle, spicy, highly seasoned, or acidic foods in your diet. Maintain normal oral hygiene measures in the areas of your mouth not affected by the surgery Avoid alcohol (even beer and wine) and smoking until after your post-operative appointment. Smoking is not advised during the 7-14 days following surgery. Please do NOT play with the surgery area with your fingers or tongue. Do NOT pull up or down the lip or cheek to look at the area and do not have someone else look at the area. Do NOT use a drinking straw, as the suction may dislodge the blood clot. Avoid extremely hot foods. Cold foods such as ice cream or shake are OK as long as you use a spoon

Initial response-formation of protective clot, underlying tissue has acute PMN infiltrate and some necrosis. Clot replaced by granulation tissue. 24 hours increase CT and angioblast below surface layer. 12-24 hours epithelial cells at margin migrate into the granulatin tissue, beneath the necrotic tissue. After 5-14 days surface epithelialization is complete but keratinization is incomplete Vasodilation and vascularity begin to decrease about the 4th day and appear normal by about 16 days. Epithelium grows about 0.5mm per day. Complete repair of the connective tissue takes about 7 weeks.

Mefenamic acid 500mg # 24 tabs Sig. Take 1 tablet every 6 hours for 3 days Chlorhexidine Sig. Gargle 15ml for 30 seconds twice a day (morning and night)