Clinical Notes

COVID SCREENING

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Patient was pre-screened per OS protocol prior to appointment.

Patient was additionally screening via phone when they arrived outside the practice and temperature was checked. 

COVID-19 Consent was completed in addition all OS paperwork . Patient signature was verified.

Room was disinfected using Super Sani-Cloth Germicidal Disposable Wipe (EPA Reg # 9480-4 ) techniques per manufactures protocols, followed by Clorox® Clean-Up® Cleaner + Bleach (EPA Reg. No. 5813-21) Spray and room dry. Room was verified by the other assistant for completion via COVID-19 Room disinfection checklist.

Patient also rinsed with 1.5% hydrogen peroxide for 30 second 

PROGRESS NOTE

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Patients seen at the request of the office general dentist for evaluation of dental implants to support a denture . Discussed in length various available option including but not limited to conventional denture, overdenture (removal) vs Fixed with implants. After patient demonstrated complete understanding of the proposed options decided to proceed with placement of 4 implant in XXXX jaw and use of removal prosthesis. Reviewed all steps with patient from placement to over denture. Risks /Benefits / Complications discussed including all steps with patient from placement to final restoration. Risks, benefits, complications in particular to their case were also discussed.​

Past Medical History
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Refer to patient history form

Past Surgical History
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Refer to patient history form

Medications
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Refer to patient history form

Allergies
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Refer to patient history form

Social History
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Smoking – Refer to patient history form
Alcohol - Refer to patient history form
Drugs - Refer to patient history form

CLINICAL EXAMINATION: 
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Extraoral, Head and Neck exam: 

Constitutional: general appearance of patient  
No extraoral swelling or erythema 
Parotid and submandibular glands soft, nonpainful to palpation bilaterally 
No lesion noted on facial skin
Facial palpitation exam reviews no swelling or no lymphadenopathy 
CN V1, V2, V3, CN VII intact bilaterally 
No neck masses noted
Thyroid midline with no evidence of any swelling
Musculoskeletal: TMJ joint seems to be normal. No poping upon opening
Maximum mouth opening within normal range


Intraoral Soft Tissues: 

Clear saliva extruded from bilateral Wharton’s and Stenson’s ducts 
Tongue soft and non-tender with no apparent lesions 
Buccal mucosa without lesions bilaterally 
Hard palate, soft palate, and pharynx are within normal limits no pathology visualized 
Floor of mouth without an evidence of pathology

Dentition: 

Refer to dental chart for detail dental caries evaluation

Radiographic examination: 
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Panorex reviewed demonstrates
No bony pathology. 
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ASSESSMENT / PLAN / RECOMMENDATION
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4 Dental Implants - Position 20,23,26,29

 


CONSENT
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Discussed risk, benefits, complication of surgery including but not limited to bleeding swelling, infection, pain, retained root tip, numbness of lower lip, chin, tongue. Patient understood risks informed, verbalized understanding and consented accordingly.

Local Anesthesia
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___ 2% lido w/ 1:100,000 epi Carpules (1.7 cc)
___ 4% sepocaine Carpules (1.7 cc)
___ 3% Carbocaine w/o epi Carpules (1.7 cc)

Procedure Performed
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SURGEON 1:  Joseph Krajekian, D.M.D., M.D.
DENTAL ASSISTANT : Monika/ Melinda


OPERATION/PROCEDURE : 
    4 Dental Implants

    Position 20,23,26,29 (Implant placement x 4 (mandible) :

                  ABDE position according to Misch protocol)

After proper time for local anesthesia to work.
Mouth prop utilized, throat pack used followed by sweetheart.

Following Midridge incision , rongeur and drill (with copious irrigation) was used to smooth the bone (alveoplasty) after full the mucoperiosteol flap was reflected and remove any sharp edges that may protrude through the gingiva.  Bone file was used to smoothen any rough edges. 

With use of sequential drilling sequence per Straumann guidelines 800/600 RPM with chilled saline Round bur was then used to create the bone osteotomy holes x4 (A/B/D/E position) and they were place in canine and 1/2 premolar position bilaterally. The mental nerve was identified during the dissection and avoided during sequential drilling. Careful attention was make to protect and not to stretch the nerve.

 

Next the pilot drill was placed at 8mm  depth in 4 osteotomies and Panorex was taken to confirm placement, angulation. Appropriate adjustment were made and the osteotomies were completed with copious irrigation.  Angulation and position was confirmed again prior to placement of implant via panorex. Which seemed satisfactory. Implant were then placed in following sequence below

After implant placement bone graft placed followed with membrane and 3.0 vycril suture to obtained primary closure tension free.

Implant Position

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Canine Positions B/C implant Position
4.1  x 10 mm Straumann BL with Cover screw @ 35 N

PreMolar Positions   A/D  

4.1  x 10 mm Straumann BL with Cover screw @ 35 N

Areas was then closed with 3.0 gut suture and patient discharged in stable condition after showing the patient picture of panorex demonstrating the implants placements. 


All patient and escort questions were answered prior to discharge
 

STIMATED BLOOD LOSS:  minimal

DISPOSITION : Home 

PRISCRIPTION DISPENSED:
Pen VK 500mg    PO q6 hrs Disp 7 days                            refill 0
Norco 5/325        1 tabs PO q6 hrs prn Disp 10 for 5 days refill 0
Peridex                Provided from the office                          refill 0
Mortin 800mg      1 tablet every 8 hrs prn x 28 pills            refill 0

 

FOLLOWUP : 
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next day with general dentist. 2 weeks with me if needed. Patient was provided post-op instruction/medication sheets in writing and they were also review with patient escort. Pt and escort were also provided with my 24 hour direct contact number and was also instructed to contact the office with any questions

DICTATED BY :                    
Dr. Joseph Krajekian DMD, MD

           

(C) 2020 Dr. Joseph Krajekian

Telephone :  (440) 646-0597 Office 

                     (888) 774-7773 Answering Service

Fax #         :  (888) 774-7970