2020 Volume 62 Issue 2 Pages 107-120
We report the case of a patient with periodontitis complicated by occlusal trauma who received initial therapy using a psychological approach, which was reinforced at every follow-up visit, regenerative therapy with enamel matrix derivative (EMD) and autogenous bone, and supportive periodontal therapy (SPT), and has been followed up for 11 years.
The patient, a 55-year-old woman, visited the dental office complaining of inter-dental spaces in the anterior teeth. Examination revealed the following: bleeding on probing (BOP): 97%; probing depth (PD): 7 mm or more in 9 teeth; vertical bone resorption in the maxillary anterior teeth. Tooth mobility was observed for many teeth and the patient reported having a habit of clenching her teeth while working. We diagnosed the patient as having periodontitis with inflammation and occlusal trauma.
Focusing on removal of the cause for periodontal treatment, we adopted a psychological approach for the initial therapy, a motivational approach, followed by Otani's guidance and cognitive behavioral therapy for bruxism, and counseling about work-related stress reduction.
After re-evaluation, periodontal surgery and oral rehabilitation were carried out, and an occlusal splint was provided as a countermeasure for bruxism, and self-implicit therapy under Ikeda's guidance as another psychological treatment. We have recalled the patient every 3 months after the transition to SPT, the psychological treatment was strengthened at every visit, and 11 years have passed favorably.
From these results, introduction of a psychological approach to periodontal treatment seems to be effective in improving the patient's motivation for treatment and enhancing the effects of treatment.
