X-rays and how to read them
MDDr. Julie Bartáková
STK FNUSA
LF MU
Department of restorative dntistry
OPG (orthopanthomogram)
 X-ray of upper and lower jaw, sinuses, temporomandibular joint
Right orientation of OPG
Wrong orientation
Wrong orientation
Level of alveolar bone
Level of alveolar bone
Horizontal resorbtion of alveolar bone
Vertical resorbtion of alveolar bone
Gingiva level
Oral hygiene ???
It is not possible to say according to X-ray – you are
able to consider according to:
 Number of teeth in oral cavity
 Number and size of caries and secondary caries
 Number of fillings
 Type and size of fillings:class I.,II.,III.,IV.,V.,VI.
 Number of teeth with and without endodontical treatment
 Quality of endodontical treatment
 Number of roots (radices)
 Number and type of prosthodontic works
 Dental stone
Hygiene probably good
Hygiene probably average
Probably bad oral hygiene
Localisation of teeth
Teeth localisation ?
Red – axis of tooth in current position, after moving into the gap after
previous extracted tooth/teeth
Green – probably original position of tooth, after straightening the
axis of tooth to physiological position (it is only indicative position,
sometimes it doens´t correspond with real position of tooth)
Teeth localisation
Red - current position of tooth
Green- probably the real position of tooth and number of tooh
Fillings
Amalgam fillings
Filling in foramen caecum
Filling in foramen caecum
Filling close to the pulp chamber
Composite fillings X-ray contrasting
Composite fillings not X-ray contrasting
GIC fillings
Extensive caries
Small caries
Caries - middle extension
Caries – caries pulpae proxima
Caries – caries pulpae proxima
Caries – caries pulpae penetrans
Caries – class V.
Caries – class V.
Caries – caries secundaria
Tooth crown destruction caused by caries
Dental stone
Dental stone and ( guess what is
between teeth 32 and 42?)
Dental stone and (dental stone between
32 and 42)
Radix
Periapical lesion
Periapical lesion
Periapical lesion – resorption of the apex
Teeth after endodontical treatment
After endodontical treatment –
number of root canals
Be careful!! - First molar – at least 3 root canals
Second molar – mostly at least 3 root canals ( variability in
number of RC)
Third molar – variability ( 1-3 RC)
After Endo treatment – number of root
canals and poor endodontical treatment
Wrong : all root canals are not found, filling of root canals doens´t
reach the apex, filling of root canals is not homogenous
After Endo treat. – poor endo treatment
Wrong: all root canals are not found, filling in root canals
doesn´t reach the apex, periapical lesion, root inlay in tooth
with poor endo treatment
After endo tr. – number of root canals
Be careful!!: mostly 1-2 root canals, !first upper premolars can
have 3 root canals, 2 buccally and 1 palatally
After endo treatment – root canal filling
is not homogenous
After endo treatment – root canal
filling doesn´t reach the apex
After Endo treatment – root canal
filling is homogenous
After Endo treatment – root canal
filling is homogenous
After endo treatment – root canal filling
is over the apex
After endo treatment – root canal
filling is over the apex
Crown
Full – metal crown/ Faset crown
On X-ray: metal replace the whole crown up to occlusion/incisal edge
Metal – ceramic crown
On X-ray everytime 2 parts: metal construction of crown ( white colour) and
ceramic layer reaching the occlusion/ incisal edge (gray-white colour)
Full – ceramic crown
On X-ray: ceramic replace the whole crown (grey colour, on X-ray
is the colour similar to the tooth colour)
Resin crown
On X-ray: almost invisible. If you see on X-ray root inlay or tooth after
preparation for the crown and it seems to be without a crown
EVERYTIME!!! check the X-ray , if resin crown is not there. (on X-ray it
is a thin gray transparent line making the crown outline )
Dnes pendens
Root canal inlay – short, unsatisfactory
Root canal inlay - suitable
Root canal inlay 1:1
What´s on the picture??
Partial removable denture
Implant
Erupted third molar
Erupted third molar
Partially impacted third molar
Impacted third mollar
Dystopically stored molar
Dystopically stored tooth
Dystopically stored tooth
Tooth fracture
Cases
Instructions
 1. Diagnosis of the patient
 2. OPG
 3. Describe the OPG and write down a treatment plan if
the patient is healthy ( oral hygiene determine from OPG ,
description at the beginning of presentation)
 4. Describe the changes in treatment plan, if the patient
has a diagnose written at the beginning of the case and on
what you shoud pay attention during the treatment
 (5. At the end of ppt are treatment plans to the cases to
compare with your treatment plans)
Description of the treatment plan
 1.Hygiene
 2. Extractions
 3. Endo/ re-endo treatment
 4. Fillings
 5. Prosthetic treatment : Partial/ Total removable dentures/
crowns/bridges/ prosthetic work(s) carried by implants
Case n.1
Diabetes mellitus II.type -
compensated
DM II.type - compensated
Treatment plan:
 1.Hygiene
 2. Extraction: 26, 37,34
 3. Endo treatment:15,13
 4. Re-endo treatment: 23-25
 5. Fillings: 13-22, 33
 6A. Partial rem.denture LJ:replacing 36-37,34,43-47
 6B. Implants: (v UJ (26)) v LJ ( v area 36/37, in the
area.43, 45 a 46/47)
 7. Crown and root inlay : 15, 24,25
 8. Crown: 23, Implant and crown :26
 9. Metal – ceramic bridge on implants 43-47
 10A. Metal – ceramic bridge 33-35 and crown on implant in
the area.36/37
 10B. Metal – ceramic bridge 33-37
Diabetes mellitus
 Clinical symptoms: Polyuria
 Anorexia
 Parodontitis
 Hyposalivation
 Red coloured tongue
 Glossitis
 Atrophy of papillas, atrophy of mucosa ( predisposition to
inflamations and ulcers)
 Candidosis
 Higher amount of car.pulp.prox., pulpitis a periodontitis
 Stomatodynia, glosodynia
 Taste disorder
 Bilateral, not painful enlargement of gl.parotis,caused by sialosis
 Acetodynia ( uncompensated DM)
 Rizika: 1. Hypoglycemia, 2. Stress ( Flooding of adrenalin and
corticoids – antagonists of inzulin), 3.Slower healing, 4. More often
periodontopathys, 5. Hyposalivation and lower fluidity of saliva
(dekubitus), 6. Candidosis under PRD/TRD
Diabetes mellitus
 Ordination: 1. Uncompensated DM( Compensate !!!)
 2. Never on an empty stomach!!!
 3. After aplication of PAD/insulin
 4. Urgent operation on uncompensated person need to be consulted
with the diabetolog
 5. By injuries in orofacial area/ operation in the OFA never prohibit the
food
 6. LA without adrenaline /max 1:200000 6 ML
 7. Surgery in ATB preparation (PNC ATB 2 G 1 H before surgery, after
every 8 H. Klindamycin 300 mg 1H before, after every 6H, for 5-7 days)
 8.Orofacial inflamation: everytime ATB!! and send the patient to
spicialised hospital
 9. Treatment of periodontopathies and HYGIENE!!
 10. Treatment of all teeth, prevention of pulpitis, peridontitis, longer
irrigation ( edndo treatment)
 11. Reconstruction by partial/total removable dentures, prevention of
decubits, addition of tooth in denture after extraction
 12. If patient is compensated, it is possible to do implants
Case n.2
Operation in ECC( Extra
corporal circulation) such as
valve transplantation, bypass, ..
Operation in ECC( valve,bypass,..)
Treatment plan:
Version 1. Short time before operation:
1. Exraction: 18-14,24-27 – (teeth with poor or no endo treatment), the rest
of treatment after operation
2A. 21,22 – fillings
2B. 21 – end.treatm.,root inlay, metal-ceramic crown 22 – root inlay and
metal-ceramic crown
3A. Partial removable denture : 17-14, 24-26
3B. Implants: 16,14,24,26 and metal-ceramic bridges 16-14, 24-26
Version 2. Long time before operation:
1. Hygiene
2. Extraction: 18,27
3. Endo treatment: 17
4. Re-endo treatment: 16-14, 24-26
5. Fillings: 33,32,44
6. Root inlay: 17-14, 21,22, 24-26
7. Metal-ceramic bridge: 17-14, 13-23, 24-26 / MC bridge 17-26
Complication:
 Infection and rejection of implant
 Complicated healing
 Transport of infection from oral cavity by blood circulation to
another place
 Exclusion of infection localised in oral cavity before operation
 Extraction:All teeth with periapical lesion
 Radices
 Teeth with vertical, oblique fracture or horizontal fracture in
middle part of root
 Teeth with poor endo treatment
 Teeth with caries pulpae penetrans
 Teeth with a crown and root inlay without endo treatment
 Partially impacted teeth, teeth with chronical pericoronitis
 Be careful!!: Ulcers,decubits,periodontal trunks,inflamation of
saliva glands, sialolithiasis, periodontitis, gingivitis,regional
lymphadenitis, cysts (risk on infection)
Case n.3
Epilepsy Grand mal/ Petit mal -
compensated
Epilepsy grand/petit mal compensated
Treatment plan:
 1. Hygiene
 2. Extraction : 28
 3. Endo treatment:16 a 24
 4. Re-endo treatment: 14,35, 46,47
 5. Fillings: 18,26,27, 48
 6A. Root inlay a MC crown: 14, 35,46,47 and implant
with MC crown: 36
 6B. Root inlay and MC crown: 14,46,47 and 35 – root
inlay and MC bridge: 37-35
Complication
 Danger or new episode when using a light in the eyes
 Danger of new episode when threatment in one visit is
long (in hours)
 Can´t be any partial/total removable dentures, danger
of fracture during episode
 All prosthetic works must be ONLY fixed
 Can´t be any resin or full ceramic crowns and bridges,
danger of fracture during episode and swallow or
inhalation of small parts
 Danger of new episode caused by pain
Case n.4
Astma bronchiale
Astma bronchiale
Treatment plan
 1. Hygiene
 2. Extraction: 38,48
 3. Re – endo treatment: 25,27, 46
 4. Fillings: 16-14, 12, 24,26, 37-35, 45,47
 5. Root inlay a MC crown : 25,27, 46
 6. Implant and MC crown:17
Astma bronchiale
 Klinical symptoms: shortness of breath, tachypnoe, stridor, difficulti
talk,blue-grey coloured mucous membranes, tachycardia, unrest,
perspiration, overfilled A.carotis,
 Orofacial symptoms.: Allergic rhinitis, mounth breathing, cyanotic
coloured mucouc membranes, pseudomembranous candidosis ( caused
by inhalation cortisosteroidy), changed Ph of saliva (caused by
sympathomimetics), stomatitis, caries, gastroesophageal reflux (caused
by symphatomimetics), enamel erosion
 Danger: 1. episode during treatment ( stress, allergen, toxicity of
chemicals), 2. breathing problems ( rubberdam, bilateral anesthesia,
long preparation, impressions), 3. inhalator ( risk of candida albigans)
 Ordination: 1. minimalise stress, 2. don´t use barbiturates, k.ASA,
nonteroid antiflogistics ( release of histaminu), 3. room with afresh air
4. before longer treatment use corticosteroids
Case n.5
Before (re)operation of hip joint
Before (re)operation of hip joint
Treatment plan
Version 1. Short time before operation:
extraction: 15,14, 24-26, 46,47
Treatment after operation:
1. Endo treatment: 27,36, 45
2. Fillings: 13-22, 38,37, 44, 48
3. Implants: 15,14, 24,26, 46,47
4A.MC crown on implant : 15,14, 46,47 and MC bridge on
implants: 24-26
4B.Partial removable denture: 15,14, 24-26 and partial
removabe denture 46 a 47 ( if patient has no money)
4C. MC bridges: 17-13, 23-27 a 44-48 , but there is a big
danger of fracture 23, because of big pressure
Treatment plan
Version 2. Long time before operation:
1. Hygiene
2. (Extraction: 46)
3. Endo treatment: 16,27
4. Re-endo treatment: 15,14,24-26,46,47
5. Fillings: 13-22, 38,37, 44,48
6. Root inlay and MC crown korunka: 15,14, 24-26, (46), 47
Before (re)operation of hip joint
 Exclusion of infection localised in oral cavity before operation
 Danger of transport of infection from oral cavity by blood circulation to
another place
 Extraction:All teeth with periapical lesion
 Radices
 Teeth with vertical, oblique fracture or horizontal fracture in middle part of
root
 Teeth with poor endo treatment
 Teeth with caries pulpae penetrans
 Teeth with a crown and root inlay without endo treatment
 Partially impacted teeth, teeth with chronical pericoronitis
 Be careful!!: Ulcers,decubits,periodontal trunks,inflamation of saliva
glands, sialolithiasis, periodontitis, gingivitis,regional lymphadenitis, cysts
(risk on infection)
Case n.6
Before treatment by bisphosphonates
Before treatment by bisphosphonates
Treatment plan
Version 1. Short time before treatment: extraction: 14,11,22, 26,27, 36
After treatment:
1.Hygiene
2. Fillings: 15,13, 21,24,25
3A. Partial removable denture in UJ: 16,14,11, 22, 26 and LJ: 36,46
3B. MC bridge in LJ: 44-47 and 35-37 and MC bridge in UJ: 17-25
Version 2. Long time before treatment:
1. Hygiene
2. Extraction: 11,22
3. Endo treatment: 27
4. Re-endo treatment: 14,26,46
5. Root inlay a MC crown: 26, 27, 46
6. MC bridge: 17-14( root inlay), 13-23, 35-37
Complication
 Exclusion of infection localised in oral cavity before operation
 Transport of infection from oral cavity by blood circulation to another place
 Danger of bone necrosis after tooth extraction during treatment by
bisphosphonates without ATB
 Extraction:All teeth with periapical lesion
 Radices
 Teeth with vertical, oblique fracture or horizontal fracture in middle part of
root
 Teeth with poor endo treatment
 Teeth with caries pulpae penetrans
 Teeth with a crown and root inlay without endo treatment
 Partially impacted teeth, teeth with chronical pericoronitis
 Be careful!!: Ulcers,decubits,periodontal trunks,inflamation of saliva
glands, sialolithiasis, periodontitis, gingivitis,regional lymphadenitis, cysts
(risk on infection)
Case n.7
Before transplantation of
kidneys, livers, lungs, …
Before transplantation of kidneys,
livers, lungs, …
Treatment plan
Version 1. Short time before operation: extraction: 16,14,26, 36,46
After operation:
1.Hygiene
2. Endo treatment:15,25
3. Fillings: 17, 27, 38, 37, 35, 47
4A. MC bridges: 17-13, 25-27, 37-35, 45-47
4B. Implant and MC crown: 16,14,26,36,46
Version 2. Long time before operation:
1. Hygiene
2. Endo treatment: 15,25,26,36
3. Re-endo treatment: 16,14,46
4. Root inlay and MC crown: 16,14,26,36,46
Complication
 Exclusion of infection localised in oral cavity before
operation
 Transport of infection from oral cavity by blood circulation
to another place
 Extraction:
 All teeth with periapical lesion
 Radices
 Teeth with vertical, oblique fracture or horizontal fracture in
middle part of root
 Teeth with poor endo treatment
 Teeth with caries pulpae penetrans
 Teeth with a crown and root inlay without endo treatment
 Partially impacted teeth, teeth with chronical pericoronitis
 Be careful!!: Ulcers,decubits,periodontal trunks,inflamation
of saliva glands, sialolithiasis, periodontitis,
gingivitis,regional lymphadenitis, cysts (risk on infection)
Case n.8
Onkological patient
Onkological patient before therapy
Treatment plan
 Version 1. Short time before therapy:
extraction: 16-14, 24-26, 36,35, 73, 47
After therapy:
1. Hygiene
2. Fillings: 17, 21-23, 37, 44
3A. Partial removable denture in UJ: 16-14, 24-26 and PRD in LJ: 36,35, 46, 47
3B. Implants and MC bridge: 16-14, 24-26 and implants and MC crowns: 36,35, 46, 47
Version 2. Long time before therapy:
1. Hygiene
2. Endo treatment: 15, 26, 37
3. Re-endo treatment: 16,14, 24, 25, 36,35
4A.MC bridge: 45-47
4B: Implant and MC crown: 46
Onkological patient complication
 Exclusion of infection localised in oral cavity before
operation
 Transport of infection from oral cavity by blood circulation
to another place
 Extraction:
 All teeth with periapical lesion
 Radices
 Teeth with vertical, oblique fracture or horizontal fracture in
middle part of root
 Teeth with poor endo treatment
 Teeth with caries pulpae penetrans
 Teeth with a crown and root inlay without endo treatment
 Partially impacted teeth, teeth with chronical pericoronitis
 Be careful!!: Ulcers,decubits,periodontal trunks,inflamation
of saliva glands, sialolithiasis, periodontitis,
gingivitis,regional lymphadenitis, cysts (risk on infection)
Case n.9
Pregnant patient
Pregnant patient
Treatment plan
 Version 1. : Better to wait after gravidity and then:
 1. Hygiene
 2. Extraction: 18,28,38,48
 3. Endo treatment: 37
 4. Fillings: 16-14, 24-26, 36,35, 45,46
 Version 2. Acute problem during gravidity:
 Treatment of acute problem and the rest after gravidity
Coplication
 Since 2nd trimester must patient sit or half sit -half lay
during the visit
 Complete treatment before gravidity
 Anestezsia without adrenaline/ max. 1:200 000
 Extraction/Endo treatment in 3rd trimester
 NO XRAYS!!!
Case n.10
Patient for exlusion of danger of
infectious endocarditis
Exclusion of danger of IE
Treatment plan
 1. Hygiene
 2. Endo treatment: 13,23,37,47
 3. Re-endo treatment: 15,12,24,25,27
 4. Fillings: 18,28,36, 38
 5. MC bridge: 17-15, 13-23
 6. MC crown and root inlay: 24,25, 27
 7.Extraction: 18,28
Infectious endocarditis
 Anamnesis: IE in the past , after heart operation, heart defect and disease,
medication: antikoagulants, antiagregants
 Klinical symptoms: 1. Valve defects ( murmur, heart failure), 2. Embolism
3. Symptoms of infective disease ( sick, fever, shivering, tiredness, pain of
joints,..)
 Orofacial symptoms: petechie and bleeding from mucose membranes in oral
cavity
 Danger: 1. bakteriemia after intervention in oral cavity 2. bakteriemia after
removing of dental stone 3. ATB according to the level of danger of
development of IE
 Ordinaction 1. ATB before invasive intervetion in OC
 2. invasive intervetion until 1 h after regular use of ATB
 3. (it´s possible to use ATB 2 h after intervention)
Infectious endocarditis
 Extraction:
 All teeth with periapical lesion
 Radices
 Teeth with vertical, oblique fracture or horizontal fracture in
middle part of root
 Teeth with poor endo treatment
 Teeth with caries pulpae penetrans
 Teeth with a crown and root inlay without endo treatment
 Partially impacted teeth, teeth with chronical pericoronitis
 Be careful!!: Ulcers,decubits,periodontal trunks,inflamation
of saliva glands, sialolithiasis, periodontitis,
gingivitis,regional lymphadenitis, cysts (risk on infection)
Case n.11
Hypotension
Hypotension
Treatment plan
 1. Hygiene
 2. Endo treatment: 27,37
 3. Re-endo treatment 16-14,24-26, 36,46,47
 4. Fillings: 17,22
 5. Root inlay and MC crown: 16-14, 24-26, 36,46,47
Hypotension
 Clinical symptoms: 1.Orthosthatic sickness (sickness,weakness,
black spots in fron of one´s eyes, vertigo when quickly stand ing
from sitting), 2.Depression, tiredness
 Orofacial symptoms: none
 Danger: 1.vazovagal faint, 2.orthosthatic colaps, 3. paradox
reaction after adrenaline – deeper hypotension
 Ordination: 1. patient is lying/ half lying-half sitting, 2.careful
with prescription of benzodiazepins (deeper hypotension),3.
slowly changing the possition into sitting after treatment
Case n.12
Infarction of myocardium
Infarction of myocardium
Treatment plan
 1.Hygiene
 2. Extraction: 13,28, 38
 (3: Endo treatment: 27)
 4. Re-endo treatment: 11,47
 5. Fillings: 17,15,21, 26,37,36
 6. Implant and MC crown: 13
Infarction of myocardium
 Acute: angina pectoris which doen´t stop after
nitrates, retrosternal pain radiating to upper extremities/
neck/ belly,.., úzkostanxiety, sickness, vomiting,
dyspnoe, uneasines, sweaty skin, tachycardia
 St.after.IM: none
 Orofacial symptoms: not typical, after medication: dry
mucous membranesm change of taste, stomatitis
 Danger: 1. flood out of adrenaline after painful and
stresful treatment causing IM, 2. new episode of IM, 3.
higher bleeding (anticoagulants/ antiagregants)
 Ordination: 1. No surgical and big interventions 6
months after IM, 2. shorter time of treatment
Case n.13
Patient with ICD
Patient with ICD
Treatment plan
 1.Hygiene
 2. Extraction: all teeth in upper jaw, 34
 3. Total removable denture in upper jaw:17-27
 4. Partial removable denture in lower jaw: 37,36,34, 44-47
Patient with ICD
 Klinical symptoms: none
 Orofacial symptoms: none
 Danger: development of electromagnetic interference
( mobile phone, ultrasound for removinf dental stone,electrocauter)
failure/ change of development of electroimpulses
 Precautions: 1. never turn on repeatedly the elecric machines close
to the patient, min.distance is 30 cm, 2. never use high frequency
bipolar electrocauters, 3. cardiostimulator ( Adrenalin v LA), 4. ICD (
small amounts of LA, 1:200000, only bigger interventions)
Case n.14
Chronical bronchitis/CHOPI
Chronical bronchitis/CHOPI
Treatment plan
 1. Hygiene
 2. Endo treatment:13,22,27
 3. Re-endo treatment: 15,11,21, 35,44
 4. Fillings: 16, 12, 37, 34
 5. Root inlay and MC crown: 15, 11,21,22, 27
 (6. MC crown – 12)
 7A. MC bridge: 35-37, 44-47
 7B. Implant and MC crown: 36, in the area 45/46 and
root inlay and MC crown: 35, 44
Chronical bronchitis/CHOPI
 Klinical symptoms: caugh, shortness of breath, mucus-pus sputum
 Orofacial symptoms: cyanosis of face, halitosis
 Danger: 1. long term using corticosteroids ( decreased immunity), 2.
problems with breathing during preparation and impressions
 Ordination:1. DON´T USE: hypnotics, sedatives barbiturates,
benzodiazepines: danger of depression of breauthing ,dry mucous
membranes, adhesion of mucus, 2.breathing problems when using
bilateral MA/ treatment with rubberdam, 3. patient is siiting during
the visit, 4. never use bilateral anesthesia, 5. (treatment without
rubberdam) feeling of suffocation
Case n.15
Gastroesophageal reflux
Gastroesophageal reflux
Treatment plan
 1. Hygiene
 2. Extraction: 18,38,48, konzultation with surgeon, if tooth
between 11 and 21 need to be extracted
 3. Re – endo treatment: 17,15, 45,47
 4. Fillings: 24
 5. Root inlay and MC crown: 17,15, 36
 6A. MC bridge: 45-47
 6B. Implant and MC crown: 46, root inlay and MC crown: 45,47
Gastroesophageal reflux
 Clinical symptoms: stomatitis, change of taste, burning in
oral cavity, erythema of soft palate and uvula, erosions on
frontal teeth palataly and on premolars
 Ordination: fluoridation, hygiene, treatment of erosions,
soft toothbrush, toothpaste without abrasive particals,
elevation of the bite by fillings, perfect prosthetic treatment
Case n.16
Crohn disease
Crohn disease
Treatment plan
 1. Hygiene
 2. Endo treatment: 17,26, 35
 3. Re-endo treatment: 16,36, 45-47
 4. Fillings: 15,27,34
 5. Root inlay and MC crown: 17,16, 36,35, 45-47
 6A. Implant and MC crown: 25 and root inlay and MC
crown: 26
 6B. MC bridge: 24-26
Crohn disease
 Clinical symptoms: erosions/ ulcers in oral cavity, irregular
fattering of soft palate, diffusive oedema of lips, angular
stomatitis, atrophic glossitis, orofacial lesion is in 20 percents of
cases first symptom
 Danger: 1. suppression of inflamation in oral cavity by medication
and after that spreading to other tissues, 2. H.Simplex induce by
medication
 Ordination: 1. perfect restorative and prosthetic treatment, 2.
stomato-surgical procedures during ATB use, 3. ATB medication
during less serious orofacial inflamation, 4. if we suspect
undiscovered Crohn disease, send the patient to specialist
Case n.17
Acute/Chronical leukemia
Acute/Chronical leukemia
Treatment plan
Version 1. Short time before treatment: extraction: 17-14, 12-22, 38, 45
After treatment:
1. Hygiene
2. Fillings: 13,23, 25,26, 35,34, 44, 46
3. Partial removable denture in upper jaw: 16-14,12-22 and partial
removable denture in lower jaw: 37-36, 45
Version 2. Long time before treatment
1. Hygiene
2. Extraction: 17-14, 12-22, 38, 45
3. Fillings: 13,23,25,26,35,34,44,46
4. Resin bridge: 13-23
5. Partial removable denture in upper jawí: 17-14 and lower jaw: 36,37
which keep the height of occlusion. After treatment of leukemia is possible
to do implant: 36,37 and in upper jaw widening of partial removable
denture after extraction of single tooth
Acute/Chronical leukemia
 Clinical symptoms: tiredness, loss af apetite, subfebrilia,loss of
weight, anemia, bleeding of the gums, hyperplastic
gingivitis/periodontitis which doesn´t improve after good oral
hygiene, bleeding from the nose, hyperplastic gingiva, mucosal/
gingival ulceratons/necrosis, paresthesia of lower lip,
enlargement or saliva glands,paleness of mucosa
 Danger: infection,bleeding, all surgical and invasive procedures
must be on specialised departments after consultation with
hematologist!!
 Ordination: treatment of all teeth before treatment of leukemia
, if something is acute, every procedure in oral cavity must be
consulted with hematologist!!!, hygiene, prevention!!!, on
patients witch chronical leukemia is possible to do some
procedures during using ATB
Acute/Chronical leukemia
 Extraction:
 All teeth with periapical lesion
 Radices
 Teeth with vertical, oblique fracture or horizontal fracture in
middle part of root
 Teeth with poor endo treatment
 Teeth with caries pulpae penetrans
 Teeth with a crown and root inlay without endo treatment
 Partially impacted teeth, teeth with chronical pericoronitis
 Be careful!!: Ulcers,decubits,periodontal trunks,inflamation of
saliva glands, sialolithiasis, periodontitis, gingivitis,regional
lymphadenitis, cysts (risk on infection)
Case n.18
Hepatitis A/B
Hepatitis A/B
Treatment plan
 1. Hygiene
 2. Extraction: 27
 3. Endo treatment: 16,22,23,36
 4. Re- endo treatment: 15,24,25
 5. Fillings: 17,11,21,23, 26, 34,33,42-45
 6. Root inlay and MC crown: 15,22,24,25, (36)
 7A. Partial removable denture: 37,46,47
 7B. Implant and MC crown: 46,47 and implant in the
area and MC bridge: 34-37
Hepatitis A/B
 Clinical symptoms: Yellow eyes, mucosa, skin
 Only first aid treatment
 As a last patient!!!
 Special hygienical regulations
 Clothes and instruments for one use
 Preparation without cooling
 Impressions for prosthetic work in special containers
and desinfection
 Extraoral X-rays are prefered
 Lab technician has also special clothes
Case n.19
HIV/AIDS
HIV/AIDS
Treatment plan
 1.Hygiene
 (2. Extraction: 28,48)
 3. Endo treatment: 22-24,27,36,47
 4. Re – endo treatment: 14,35, 44,45
 5. Fillings: 12-22, 37,34,33, 46
 6. Root inlay and MC crown: 36,35, 44,45
 7A. MC bridge: 16-14, 23-27
 7B. MC bridge: 16-14, implants: 25,26 and MC crowns:
23,24,25-26
HIV/AIDS
 Clinical symptoms: Cervical lymphadenopathy , repeatedly
H.Zoster, repeatedly infections caused by cytomegalovirus,
hairy leukoplakia, HIV necrotising gingivitis and
periodontitis, repeatedly candidosis, angular cheilitis,
Kaposhi sarcom, non - Hodhgin LY, ulcerations
 Ordination: Hygienical regulation same as Hepatitis
 Only first aid treatment
 As a last patient!!!
 Special hygienical regulations
 Clothes and instruments for one use
 Preparation without cooling
 Impressions for prosthetic work in special containers and
desinfection
 Extraoral X-rays are prefered
 Lab technician has also special clothes
Thank you for your attention