I report the case of a patient with generalized severe chronic periodontitis who improved with initial periodontal therapy. During the initial periodontal therapy, we asked patient characteristics carefully and made her aware of the importance of oral self-care. The patient was a 39-year-old woman and her main complaint was sharp pain in no. 17 when biting down. At the initial clinical examination, gingival recession, redness and swelling were noted. Dental X-ray revealed severe alveolar bone loss in large parts of the jaw and some vertical bone loss at the molar teeth. Furthermore, 92.2% of sites exhibited bleeding on probing and 41.9% of the sites had a probing depth of ≥7 mm.
At the time of obtaining the medical history of the patient, we understood the patient's strong distrust of dental treatment; we asked patient characteristics and carefully recorded her past history of dental treatments. For patient education, we undertook periodontal treatment not only for her, but for her family, which made her reflect on the cause of her disease and contributed to her oral self-care progress.
We also performed scaling and root planing (SRP) for her using hand scalers to remove subgingival infection. We undertook several sessions of SRP and after confirming that her gingival condition was stable, we shifted her to supportive periodontal therapy (SPT). After three years, her condition remains stable and clinical examination revealed bleeding on probing at 1.8% of sites, with a probing depth of ≥4 mm at 4.8% of sites.
In this paper, we report successful treatment of a case of localized chronic progressive chronic periodontitis related to bruxism and/or some type of tooth contact habit (TCH), by periodontal regenerative therapy after full mouth disinfection with the use of antibiotics.
A 64-year-old woman visited us complaining of right upper molar gingival swelling and pain. Radiographic examination revealed wedged resorption of the upper and lower molars and furcation defects associated with conscious bruxism and TCH. A night guard was fitted, with instructions on the autosuggestion method. The initial subgingival examination revealed periodontal pathogens at high rates: Porphyromonas gingivalis, 16.16%; Tannerella forsythensis, 3.48%; and Treponema denticola, 3.68%.
Azithromycin was prescribed before full mouth disinfection (FMD) was carried out. Then, periodontal regenerative therapy was undertaken with a combination of β-tricalcium phosphate, an enamel matrix derivative, and an absorbable membrane at four sites which showed 1-2 wall intrabony defects and mandibular class II furcation defects. Compliance was obtained from the patient, because the FMD prevented the development of acute periodontal abcess. The granulation tissue and subgingival calculus which remained on the root surface were less than generally performed what would warrant scaling and rootplaning, and the operative field for periodontal regenerative therapy could be easily secured. Then, the operation time was shorter than that for usual flap operations. Clinical examination after surgery revealed improvement of the probing pocket depth, bleeding on probing and clinical attachment level. P. gingivalis, T. forsythensis and T. denticola were no longer detected, and intrabony and furcation defects appeared to have become filled in radiographs. The periodontal health of the patient has been well maintained on supportive periodontal therapy.
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