<figcaption>Disscusion Case: Intraoral image of a full arch lower denture where there is transition from the tongue side to buccal side of alveolar ridge with tongue growing over the distal part of the ridge indicating Kennedy Class IV case. Frontal view of the patient with mouth closed indicating a central lower lip fullness which is suggesting extrusion of the extruded teeth and extra gingiva in the anterior teeth. This can further be observed on opening the mouth which gives limited amount of room for the prosthesis to be seat which leads to difficulty in having good esthetics. <div style="font-weight: bold;">DISCUSSION CASE</div>   #### Intraoral and Extraoral Observations An intraoral examination of the full arch lower denture reveals a transition from the lingual to the buccal side of the alveolar ridge. The tongue appears to be growing over the distal part of the ridge, which is characteristic of a Kennedy Class IV case. #### Esthetic and Functional Analysis - **Frontal View:** With the mouth closed, the patient exhibits central lower lip fullness. This suggests the extrusion of anterior teeth and the presence of extra gingiva in the anterior region. - **Functional Limitations:** Upon opening the mouth, there is a limited amount of vertical room for the prosthesis to be seated. This lack of space presents significant challenges in achieving satisfactory esthetics for the restorative treatment. An intraoral close-up photo showing the lower dentition and alveolar ridge. The image displays a full arch lower denture with significant transition and overgrowth of the tongue over the distal ridge, consistent with a Kennedy Class IV case, and limited room for prosthesis seating. The text identifies this as a discussion case highlighting esthetic challenges. A frontal view photo of the patient's face, focusing on the lower lip and chin area. There is visible central lower lip fullness which suggests the extrusion of the teeth and extra gingiva in the anterior region mentioned in the context. The patient appears to be middle-aged or older and is wearing a pink shirt. # DISCUSSION CASE **Case description:** <div style="background-color: #e0ece4;"> * A 68 year old male presented for a routine appointment with a complaint of being unable to chew well and wanted to know his restorative treatment options. He could not remember when he last saw a dentist but it was “ a long time ago.” His medical history is significant for hypertension, hypercholesterolaemia, ischaemic heart disease, osteoarthritis and skin cancers. He has not smoked in 30 years and reported consuring 1-2 alcoholic drinks per week, on average. </div> **Activity:** 1. Identify the pathosis and describe the clinical features 2. What is the differential diagnosis? 3. What are the relevant clinical investigations? 4. What is the diagnosis? 5. How would you manage this patient? #### Patient Profile and Chief Complaint A 68-year-old male presented for a routine appointment. His primary complaint was an inability to chew effectively, and he requested information regarding restorative treatment options. The patient noted that his last dental visit was "a long time ago." #### Medical and Social History - **Medical Conditions:** Hypertension, hypercholesterolaemia, ischaemic heart disease, osteoarthritis, and skin cancers. - **Social History:** - Non-smoker for 30 years. - Alcohol consumption: Average of 1–2 drinks per week. #### Clinical Activity and Assessment 1. Identify the pathosis and describe the clinical features. 2. Determine the differential diagnosis. 3. Identify the relevant clinical investigations required. 4. Establish the definitive diagnosis. 5. Outline the management plan for this patient. [^1]: Original PDF page 1: [[10. Epithelial Pathosis II.pdf#page=1|10. Epithelial Pathosis II, p.1]] [^2]: Original PDF page 2: [[10. Epithelial Pathosis II.pdf#page=2|10. Epithelial Pathosis II, p.2]]