2020 Volume 63 Issue 4 Pages 320-326
Purpose: In this case report, we describe the application of behavior change in a patient who had generalized severe chronic periodontitis and was unconcerned about her oral health. After the behavior change, the patient agreed to periodontal therapy including autogenous bone graft and enamel matrix protein (Emdogain) applied to experimental periodontal bone defects.
Case: A 58-year-old female visited our clinic complaining of mobility of the maxillary left lateral incisor. The patient did not expect tooth extraction. At this visit, pus from buccal apical gingiva was detected. There was no supragingival calculus, but redness was detected on marginal gingiva. The probing depth (PD) was>4 mm in 39.8% of sites and PD>6 mm in 22 sites, and the rate of bleeding on probing (BOP) was 27.6%. Radiographic examinations disclosed the presence of moderate horizontal bone loss, and the presence of angular bone defects with vertical bone loss in the maxillary right first molar, maxillary left first molar and mandibula left second premolar. Especially, PD was>10 mm on the maxillary left lateral incisor.
The patient was unconcerned about periodontitis, but we applied behavior change therapy. After re-evaluation, she was concerned about her oral health and requested treatment. We subsequently performed flap surgery with an autogenous graft and enamel matrix protein for periodontal tissue regenerative therapy on the remaining deep periodontal pockets. After surgery, fixed bridges were fabricated at edentulous areas and supportive periodontal therapy (SPT) was initiated.
Results: After 4 years, the patient had PD<3 mm in 98.7% of sites and PD=4 mm in two sites, and the rate of BOP was 0%. Radiographic examinations showed increased radiodensity. We performed SPT every 3 months, which appeared to be sufficient for effective periodontal tissue maintenance.
Conclusion: This case report indicates that behavior change is beneficial to improve patient compliance with periodontal therapy. After the behavior change, the patient was motivated to undergo periodontal treatment, and SPT was necessary for long-term stabilization.
