Dr Teresa Chanting Sun
Comprehensive management of severe periodontitis patient- a case report
Periodontitis is a complex disease that involves interactions among pathogenic bacteria, host immune response, and environmental and genetic risk factors. Treatment of periodontitis requires a proper diagnosis to identify the etiology and also to modify risk factors of the specific patient, followed by control of periodontal infection and application of periodontal surgery when indicated. In modern dentistry, when implant therapy is merged into conventional approaches, it is critical and sometimes difficult for the dentist to make a final decision of treatment approach and often the main question “to retain or to extract” comes into consideration when facing a compromised dentition. However, we have to always keep in mind that dental implant serves as a supplement not the substitute to our precious nature dentition. When treating periodontal patients, simply removing teeth sometime does not solve the core of the problem and it is risky to judge from the first impression without comprehensive assessment. This clinical case report demonstrated successful treatment for patient suffered from severe periodontal disease. The clinical parameters dramatically changed after controlled of inflammation and infection, and the final outcomes showed prognosis of teeth can be changed by proper treatment. A maintainable oral environment was established, together with a highly motivated and cooperative patient, supportive periodontal therapy is provided regularly to achieve the longevity and stability of healthy periodontium.
- Armitage, G. C. Development of a classification system for periodontal diseases and conditions. Annals of Periodontology 1999; 4: 1–6.
- Marsh, P.D. Microbial Ecology of Dental Plaque and Its Significance in Health and Disease. Advances in Dental Research 1994; 8: 263-271.
- Hart TC(1), Kornman KS. Genetic factors in the pathogenesis of periodontitis. Periodontol 2000 1997 Jun;14:202-15.
- Mariano et al, The role of immune system in the development of periodontal disease: a brief review odonto ciênc. 2010;25(3):300-305
- Matuliene G, Studer R, Lang NP, Schmidlin K, Pjetursson BE, Salvi GE, Brägger U, Zwahlen M.Significance of Periodontal Risk Assessment on the recurrence of periodontitis and tooth loss. J Clin Periodontol 2010; 37: 191–199.
- PapapanouPN and Wennstrom JL: The angular bony defect as indicator of further alveolar bone J Clin Periodontol 1991; 18: 317-322.
- Papapanou, PN, Tonetti, MS Diagnosis and epidemiology of periodontal osseous lesions. Periodontology2000. 2000; 22: pp. 8-21.
- Esposito M, Grusovin MG, Coulthard P, Worthington HV.Enamel matrix derivative (Emdogain) for periodontal tissue regeneration in intrabony defects. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD003875.
- Salvi GE, Mischler DC, Schmidlin K, Matuliene G, Pjetursson BE, Brägger U, Lang NP. Risk factors associated with the longevity of multi-rooted teeth. Long- term outcomes after active and supportive periodontal therapy. J Clin Periodontol. 2014Jul;41(7):701-7.
- Sanz M, Tonetti MS, Zabalegui I, Sicilia A, Blanco J, Rebelo H, Rasperini G, Merli M, Cortellini P and Suvan JE Treatment of intrabony defects with enamel matrix proteins or barrier membranes:results from a multicenter practice based clinical trial. J Periodontol. 2004;75: 726–33.
- Miron, R.J., Sculean, A., Cochran, D.L. et al, Twenty years of enamel matrix derivative: the past, the present and the future. J Clin Periodontol. 2016;43:668–683.
- Cortellini, P., Prato, G.P. & Tonetti, M.S. The simplified papilla preservation flap. A novel surgical approach for the management of soft tissues in regenerative procedures. International Journal of Periodontics and Restorative Dentistry. 1999a; 19: 589–599.
- Hamp, S.E., Nyman, S. & Lindhe, J. Periodontal treatment of multirooted teeth. Results after 5 years. Journal of Clinical Periodontology. 1975; 2: 126–135.
- Pontoriero, R., Lindhe, J., Nyman, S. et al. Guided tissue regeneration in degree II furcation involved mandibular molars. A clinical study. Journal of Clinical Periodontology 1988;15: 247–254.
- Cortellini, P. & Tonetti, M. Radiographic defect angle influences the outcome of GTR therapy in intrabony defects. Journal of Dental Research 1999;78: 381 abstract.
- Cortellini, P. & Tonetti, M. Evaluation of the effect of tooth vitality on regenerative outcomes in intrabony defects. Journal of Clinical Periodontology 2000b; 28: 672–679.
- Cortellini, P. & Tonetti M.S. Minimally invasive surgi- cal technique and enamel matrix derivative (EMD) in intra- bony defects: 2. Factors associated with healing outcomes. International Journal of Periodontics and Restorative Dentistry 2009a; 29: 256–265.
- Langer, B., Stein, S.D. & Wagenberg, B. An evaluation of root resection. A ten year study. Journal of Periodontology 1981; 52: 719–722.
- Lang, NP. & Tonetti, M. Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT). Oral Health Prev Dent 2003; 1: 7-16.