Fifteen-year treatment period in a patient with generalized aggressive periodontitis and lessons learned from the use of supportive periodontal therapy

Abstract

For transition to supportive periodontal therapy (SPT) or oral health maintenance following periodontal treatment, it is imperative that certain criteria indicating a stable condition or cure be met. However, the purpose of the treatment itself is not to achieve transition to SPT or maintenance, but rather to sustain a favorable condition for a long period of time after the transition. Unlike the positive attitude that they exhibit during active treatment, patients often tend to lose motivation for self-care and regular clinic visits in their busy daily lives. For long-term SPT cases, not only the technical aspects related to periodontal treatment, but also a trusting relationship between the patient and caregiver is indispensable, with the latter realized by the provision of care with compassion. Moreover, even when long-term SPT is planned, it is not assured that the oral environment that is observed at the time that the therapy is begun will be maintained over several years. Furthermore, especially in cases requiring comprehensive treatment, a variety of factors, such as damage to the prosthetic appliance, root breakage, aggravation of the condition of a tooth once diagnosed as conservable, aging of the patient, and onset of systemic disease, could complicate the course during the long SPT period.

In the present article, we present the case of a patient with generalized aggressive periodontitis who underwent comprehensive treatment combined with periodontal regenerative therapy, periodontal plastic surgery, implant treatment, and orthodontic therapy for approximately three years, and was then transitioned to SPT. Nine years later, active treatment was performed as therapeutic re-intervention was required, and successful transition to SPT was again achieved. In addition to the approximately 15 years of treatment from the first consultation to the present, findings over a total of nearly 30 years, including information obtained at a medical interview conducted before the start of treatment, are reviewed and discussed.