Clinical Case Portfolio

(MClinDent Periodontology)

• 10 cases required in the 3 years,

• 4 cases to be completed and submitted before the end of

the 2nd Year.
 Clinical Case Portfolio
PT Students (UK Registered)
1.Achievable in your own Clinical Practice with adequate
Mentoring (a DwSI or a Specialist in Periodontology or
Restorative Dentistry),

2.Achievable at BPP Dental Institute under the Faculty

Members supervisions from the batch of your current
patients,

3.Achievable at BPP Dental Institute under the Faculty

Members supervision from the batch of Referred Patients
to the Uni centre.
 Clinical Case Portfolio
PT students (UK Registered)
Rules
• Option 1: Regular Meetings or Presentations with the
Programme Lead to check the suitability of the Case and
the Documentation provided,

• Option 2: Fixed Schedule for Appointments, Contract with

the BPP Dental Institute regarding attendance or fixed
fees for the patients or for the Student,

• Option 3: Fixed Schedule for Appointments on a regular

basis, Contract with the BPP Dental Institute regarding
the attendance and providing extra Dental Restorative/
Perio Treatments to the patients of the Institute.
 Option 2 and 3
• Professional Health check up,

• Personal Professional Indemnity,

• Sharp attendance rota,

• Internal Rules/Professionalism,

• Liaising with FT students in sharing Cases,

• Requirements of managing data collection duties and ability to

record (pictures, DPC, FMPS/FMBS, impressions),

• Consent records/Patient Management.

 Complexity Score
based on BPE score
 Complexity 1

• BPE score 1-3 in any sextant

 Complexity 2

• BPE score of 4 in any sextant

• Surgery involving the periodontal tissues.

 Complexity 3
• Surgical procedures associated with osseointegrated implants,

• Surgical procedures involving periodontal tissue augmentation and/or bone removal (e.g
Crown lengthening surgery),

• B.P.E. score of 4 in any sextant and including one or more of the following factors:

✓Patients under the age of 35,

✓Smoking 10+ cigarettes daily,

✓A concurrent medical factor that is directly affecting the periodontal tissues,

✓Root morphology that adversely affects prognosis,

✓Rapid periodontal breakdown,

✓2mm attachment loss in any one year.

Modifying Factors (1/2)
• A modifying factor can only increase complexity by one increment.

• Multiple factors are not cumulative.

• Co-ordinated medical (e.g. renal : cardiac) and/or dental

• (e.g. oral surgery : orthodontic) multi disciplinary care

• Medical history that significantly affects clinical management (See below)

• Special needs for the acceptance or provision of dental treatment

• Mandibular dysfunction

• Atypical facial pain

• Undiagnosed facial pain

Modifying Factors (2/2)
• Presence of a retching tendency

• Limited operating access

• Concurrent muco-gingival disease (e.g. Erosive Lichen Planus)

• Medical History that Significantly Affects Clinical Management

• Patients requiring IM or IV medication as a component of clinical management.

• Patients with a history of head/neck radiotherapy.

• Patients who are significantly immuno-compromised or immuno-suppressed.

• Patients with a significant bleeding dyscrasia/disorder.

• Patients with a potential drug interaction.

Complexity Case Number Case Descriptor Case Presentation Treatment
Requirement

1 1 Gingivitis (BPE 1-2) •S & P

Localised or generalised. Plaque- •OHI
induced
Modifying Factors: N
2/3 2 Gingivitis (BPE 2) - with Tissue •S & P
hyperplasia (non plaque-induced) •OHI
Modifying Factors: N •Gingival surgery (gingivectomy or
localised gingivoplasty)

1 3 Periodontitis (BPE any 3) •S &P

Modifying Factors: N •OHI
•RSD

2 4 Periodontitis (BPE any 4) •S & P

Localized •OHI
Modifying Factors: N •RSD
•Conservative Perio Surgery
2/3 5 Periodontitis (BPE any 4) •As above
Generalised •Demonstrates manage of extensive
Modifying Factors: Y/N (Medical/ disease.
Smoking)
3 6 Periodontitis (BPE any 4*) •S & P
Generalized/Localized •OHI
Modifying Factors: Y (Furcas) •RSD
•Osseous Resective Surgery and
Furcation Management.
3 7 Periodontitis (BPE any 4) •S & P
Localized/Generalised •OHI
Modifying Factors: N •RSD
•GTR
3 8 Periodontitis (BPE any 4) •S & P
Localised/Generalized •OHI
Modifying Factors: Y (Aggressive) •RSD
•Perio Surgery/GTR
3 9 Recession (teeth/implants) •Eventually S & P
Localized/Generalised •Eventually OHI
Modifying Factors: N •Root Coverage/CTG/FGG

3 10 Periodontitis (BPE any 4)/Implant •S & P

Replacement •OHI
Localised or Generalised •RSD
Modifying Factors: Y/N •Perio Surgery/GTR/ORS
•Implant Placement.
3 *10 Management of Perimplant disease •S & P
Localised or Generalised •OHI
Modifying Factors: Y/N •RSD
•Perio Surgery/GTR/ORS
•Peri-implant Surgery.
* Alternative acceptable case type
Essential Documentation
Case Number 1 2 3 4 5 6 7 8 9 10 10*

BPE Y Y Y Y Y Y Y Y Y Y Y

FMPS/FMBS Y Y Y Y Y Y Y Y Y Y Y

BL 6 / chart N N Y Y Y Y Y Y Y/N Y Y

BaselinePicture Y Y Y Y Y Y Y Y Y Y Y
s
BL Risk chart N N Y Y Y Y Y Y N Y Y

Radiographs N N Y/N Y Y Y Y Y Y/N Y Y

Stone Models N Y N N N Y N N N Y N

CBCT N N N N N N N N Y/N Y Y/N

Rev BPE Y Y Y Y Y Y Y Y Y Y Y

Rev FMPS/ Y Y Y Y Y Y Y Y Y Y Y
FMBS
Rev 6/Chart N N Y Y Y Y Y Y Y/N Y Y

Rev Pics Y Y Y Y Y Y Y Y Y Y Y

Rev Risk Chart N N Y Y Y Y Y Y N Y Y

Postop BPE Y Y Y Y Y Y Y Y Y Y Y

Postop FMPS/ Y Y Y Y Y Y Y Y Y Y Y
FMBS
Postop 6/chart N N Y Y Y Y Y Y Y/N Y Y

Postop Risk N N Y Y Y Y Y Y N Y Y
Chart
Postop Pics Y Y Y Y Y Y Y Y Y Y Y
 Checklist
1. BPE

2. FMPS/FMBS
On 4 sites, Disclosing Agent. %antage.

3. 6 Points Charting.
Including:

•PPD
•REC
•CAL
•Furcation Grade (I,II,III)
•Mobility Grade
•Diastemata
•Crown/Implants/Missed/Filled/Decayed
4. Intra-oral Radiographs

•2 Vertical BW in complete dentition,

•PAs (max 1 each 2 teeth),
•OPG (in case it is justified).
Grading and justification (IRMER Guidelines)
 Checklist
5. Intra-Oral Pictures (9 views)

•Frontal
•Lateral: right and left
•Palatal frontal
•Palatal lateral: right and left
•Lingual Lateral: right and left
•Lingual frontal,
•Close up of smile,
•Smile line (Extra-oral if needed).
(Additional views if essential)

6. Intra-Operative Pictures

•Baseline,
•Outline of incision,
•Flap elevation,
•Degranulation and debridement,
•Regenerative or resective or root debridement or flap repositioning or grafting,
•Sutures,
•Healing 1 week,
•Healed 1 month (and more if possible),
•Complications.
(Ensure that the patient is not identifiable in any pictures)
 Checklist

7. Stone Models

•White plaster
•Boxed Models
•Pics: same views as intraoral pictures.
6. Individual Profile Risk

*Materials available at www.perio-tools.com

 Timeline
Periodontal Treatment Time Line

Treatment phases Initial Active Evaluation Review Surgical Maintenance

Evaluation Treatment Phase Phase
and (RSD)
treatment
plan
confirmation

Time Line Baseline 0 within 12 At 6 weeks At 12 weeks within 8 within 12

(weeks) weeks of after active after weeks of last weeks
initial therapy intervention phase or completion of
evaluation evaluation active perio
and therapy and/
treatment or the last
plan periodontal
confirmation maintenance
visit
 The Template

• MRD Examination RCSEd,

• You need to have all the information about the case,

• Please do not copy and paste pictures from the R4 or

pics from the Charts…

• Edit the Charts yourself! (www.perio-tools.com)

 The Template

• It is always a Level 7 Writing Exercise: it needs to report

references and deep knowledge of the literature to justify
treatment actions and options (EBD),

• Harvard Referencing System in the text and at the end of

the Case Presentation.
 Case Template
DATE OF EXAMINATION: [month, year of examination]

CASE NUMBER : [N]

PATIENT’S INITIALS : [I.I]

SECTION 1: DIAGNOSIS

CASE SUMMARY

[A brief description of the case, maximum 100 words]: Mention the Achieved Consent

SECTION 1. PRE-TREATMENT ASSESSMENT

PATIENT DETAILS

Initials:

Sex:

Date of birth:

Age at start of treatment:

 Case Template
PATIENTS COMPLAINTS (RFA)

RELEVANT GENERAL MEDICAL HISTORY: Use the template!

DENTAL HISTORY

SOCIAL HISTORY

FAMILY HISTORY

CLINICAL EXAMINATION: EXTRA-ORAL FEATURES: Use the template!

CLINICAL EXAMINATION: INTRA-ORAL FEATURES: Use the template!

Soft tissues:

BPE

6 Pocket Chart (if required)

Oral hygiene (FMPS/FMBS)

Charted teeth present and general dental conditions.

 Case Template
OCCLUSAL FEATURES

• Static occlusion

• Skeletal Pattern

• Incisor relationship

• Overjet

• Overbite

• Dynamic Occlusion

• Relationship between retruded contact position and intercuspal position

• Lateral excursion

• Right

• Left

• Protrusion
Case Template
PRE-TREATMENT PHOTOGRAPHS:

PRE-TREATMENT PHOTOGRAPHS: INTRA-ORAL

[Attach anterior, left and right, upper and lower occlusal intraoral photographs to this

page]

GENERAL RADIOGRAPHIC EXAMINATION

Pre-treatment radiographs taken:

PRE-TREATMENT RADIOGRAPHS

[Enclose the radiographs]

RELEVANT RADIOGRAPHIC FINDINGS

including (as requested from Radiological Guidelines):

Periodontal defects (suprabony, infra bony)

Peri-radicular disease

Dental caries

Poor/overhanging margins

OTHER SPECIAL INVESTIGATIONS: pulp test(s), microbiological tests….

[This is optional. Present details and results of any other tests or measurements which

are available and which contribute to the assessment of the case]

STONE MODELS PICTURES AND EVALUATION

Case Template
DIAGNOSTIC SUMMARY

DIAGNOSIS

[Add as few or as many as are appropriate to the case]

1.

2.

3.

4.

5.

6.
 Classification
of Periodontal Diseases

• Armitage, 1999: use this if the patient has received

already the treatment or if it is planned and he/she has
received the Diagnostic Evaluation,

• 2017 Classification: use this if the patient is starting and

he/she has not received yet the Treatment Planning and if
a Diagnosis has not been formulated yet.
Case Template
AIMS AND OBJECTIVES OF TREATMENT

[Add as few or as many as are appropriate to the case]

7.

8.

9.

10.

11.

12.
 Aims & Objectives
• The aim is about what you hope to do, your overall
intention in the treatment. It signals what and/or where
you aspire to be by the end. It’s what you want to have. It
is the point of doing the treatment. An aim is therefore
generally broad. It is ambitious, but not beyond
possibility.

• The objectives, and there are usually more than one, are
the specific steps you will take to achieve your aim. This
is where you make the treatment tangible by saying how
you are going to go about it.
 Aims & Objectives

• Main Aim for Periodontal Treatment is to reduce and/or to

eliminate Systemic and Local Risk Factors in order to
prevent the re-occurrence or the progression of the
Disease.

• The Objectives are to reduce the Plaque, the Bacterial

Load, the plaque retentive factors, the deep pockets, the
effect of smoking, the systemic interacting diseases
etc….
Case Template
TREATMENT PLAN

1. Immediate

2. Transitional

3. Reconstruction

4. Maintenance

SECTION 2. TREATMENT

Outline of treatment

Start of active treatment:

End of active treatment:

KEY STAGES IN TREATMENT PROGRESS

POST-TREATMENT RADIOGRAPHS (if relevant)

[Enclose the radiographs]

POST-TREATMENT PHOTOGRAPHS:
 Case Template

SECTION 3. CRITICAL APPRAISAL INCLUDING PROGNOSIS AND REFLECTION OF MANAGEMENT

[Not more than one page]

 Critical Appraisal
• it should contain:

• Endpoints of the delivered treatment and comparison with

the expected ones according to the Literature (use
Golden Literature): i.e. CAL gain in Regeneration of Infra-
bony defects (Tonetti et al., 1993),

• Patient’s response and communication outcomes,

• Efficacy of maintenance (adhesion to recalls),

• Possible alternative treatments to the delivered one.

Advices
 Advices
• Download the Case Template and the Critical case Criteria and start to fill
the boxes with your Portfolio,

• Order your Case Tracking on a weekly basis in order not to miss any
information and/or documentation,

• Order your Case Tracking in order to know which cases you need to
complete your Portfolio and ask your Supervisor(s) to check any
availability,

• Bring your own Camera in order not to miss anything if the Uni Camera is
busy at the moment,

• Train yourself in Picture taking in order not to rely on anyone for the
documentation,
 Advices
• Download the Pictures and Edit the charts (on the Uni computers)
on a weekly basis in order not to face a huge amount of duties
close to the deadline and start writing the Case Documentation in
order to check if any info is still needed,

• Start to collect the cases from the beginning in order not to miss
any and in order to comply with a peaceful allocation,

• PT students are required to share their cases with the FT students:

pair allocation is required even in case of personal patients. This
will bring a more complete documentation and a benefit for both.

• Check patients’ appointments and ask if needed to change the

rota in order to take part to your case evaluation and treatment.
 Case Portfolio (4Ps)

• Precise,

• Proactive,

• Professional,

• Periodontist.