By Ian Fontenot, DDS
This particular patient came to our office with dental restorations requiring immediate attention and reached out for sedation due to dental anxiety. The patient requested a long-term dental treatment plan. His medical history included artificial joints, craniotomy, rheumatism, heart surgery history, and a lot of medications being taken.
ASA Classification: ASA III. Physical evaluation with tonsil classification: Mallampati Class II.
Diagnosis included multiple tooth fractures, extensive wear on natural teeth as well as existing crowns. Broken root tips to the gumline that need extractions and replacements. A treatment plan was devised to address all of the patient’s oral disease as well as cosmetic needs.
The patient was presented with a treatment plan at a comprehensive exam visit. Pano and FMX were taken. Implant placement, maxillary crowns (bruxir), and occlusal guard were planned. Also proposed was to replace existing crowns due to wear and fractures, and full coverage of remaining teeth to restore function and esthetics.
Due to the patient’s high level of anxiety, all treatment was planned under oral sedation. The patient consented to the treatment plan. The plan is to complete implants and maxillary reconstruction now and do lower arch with implants and crowns next year.
Due to ASA III status, a medical consult was obtained and a pre-sedation workup, including cross-referencing of the patient’s medications with the sedative drugs, pre-operative blood pressure, heart rate, and oxyhemoglobin saturation as measured with a pulse oximeter was performed.
Pre-operative and post-operative instructions were reviewed as well as written consent obtained for both dental care and sedation care. Instructions were given to both patient and caregiver.
This patient did very well throughout all sedation appointments. With a dose of 0.25mg tab of triazolam crushed sublingual to achieve minimal to moderate sedation with nitrous oxide, the patient responded well. With this dose of triazolam, given to achieve a minimal/moderate level of sedation, the patient was able to respond to verbal commands. To our surprise, at the time of delivery for restorations, the patient did not need sedation.
Follow Up and Results
The patient was very pleased with all of the sedation appointments at our office. Follow-ups were performed and all treatment was completed.
The patient had multiple appointments, two of which were achieved with oral sedation, including the extractions, implant placements, and crown preps. For all deliveries and post-ops, the patient did not receive sedation.
The patient has completed the restoration of the maxillary arch. The final restoration is secure and finalized. This patient has three dental implants with full maxillary bruxir crown reconstruction. Next year, we will restore the mandibular arch.
Author: Ian Fontenot DDS owns Fontenot Family Dentistry in Carencro, LA. He graduated from LSU Alexandria Magna Cum Laude with a BS in Biological Sciences and went on to receive a Doctorate of Dental Surgery.