Treatment planning
The following treatment steps were discussed and established as the treatment plan:
- removal of all supragingival and clinically accessible subgingival plaque and calculus (closed approach);
- adjuvant antibiotic therapy based on the microbiological analysis results;
- repeated assessment and maintenance therapy as part of supportive periodontal therapy (SPT); and
- if necessary, surgical therapy (open approach).
Treatment progress
The first appointment included an informative and therapeutic discussion about the findings, diagnosis and risk factors related to periodontal disease. Detailed guidance was provided on topics such as nutrition, stress management and potential interactions with the patient’s high blood pressure medication. A mouth hygiene check, documented according to Lange’s approximal plaque index (60%) and sulcus bleeding index (50%), was also conducted, followed by instruction on home oral hygiene.
Finally, non-surgical periodontal therapy with corresponding antibiotic treatment according to the Van Winkelhoff1 schema 500 mg amoxicillin three times a day and 400 mg metronidazole three times a day for seven days) was performed. Additionally, antibacterial therapy in the form of a 0.2% chlorhexidine solution twice a day for seven days was recommended. To enhance the treatment’s success, a full-mouth disinfection was performed in one session for each visit of the periodontal therapy.
Follow-up examinations
The first follow-up examination showed a positive healing trend. No redness, swelling or pain was observed. At the second follow-up, slight probing at the gingival margin resulted in no bleeding. The appearance of the gingivae showed no abnormalities. Exact PPDs were planned to be measured for the first assessment about three months later. Subsequent appointments were made according to the SPT framework.
At the first SPT session, a periodontal evaluation was conducted, involving two PPD and two BOP measurements per tooth. A general improvement was observed, especially positive progress regarding tooth #13 (reduced from 12 mm to 6 mm distally), tooth #27 (reduced from 6 mm to 3 mm mesially), tooth #36 (reduced from 8 mm to 5 mm distally), tooth #33 (reduced from 8 mm to 5 mm mesially) and tooth #43 (reduced from 9 mm to 6 mm mesially). The mouth hygiene check (approximal plaque index according to Lange) showed a 20% improvement in oral hygiene. The sulcus bleeding index had also improved by 25%. Home oral hygiene instruction was given again. Positive progress regarding the gingiva was observed in both jaws. Subsequently, periodontal therapy was performed on teeth with PPD ≥ 4 mm, along with professional tooth cleaning for all teeth.
The patient reported no pain when biting, and there was no redness or swelling. The patient’s behaviour showed a positive trend in terms of oral hygiene and management of risk factors. According to the patient, dietary changes had been made, including daily consumption of fruits and vegetables and water as a thirst-quencher. A healthy diet, specifically one low in the glycaemic index and rich in omega-3 fatty acids, fibre, micronutrients and secondary plant compounds that reduce inflammation in the body, can positively influence host response.
The next SPT session included a re-evaluation of the periodontal status, a mouth hygiene check and home oral hygiene instruction. Except for a slight improvement in PPD (approximately 1 mm), all values remained stable. Subsequently, another periodontal therapy session was performed on all teeth with PPD ≥ 4 mm, along with professional tooth cleaning on these teeth.
During the semi-annual dental examination, a panoramic radiograph was taken to enable a comparison of bone structure. A significant improvement in bone density was observed, especially around teeth #13, 36, 33, 43 and 47, where severe vertical bone loss was initially present. Clinical improvements were also noted, including inflammation-free gingivae with slight recession (Figs. 5 & 6).
The third SPT session included a re-evaluation of periodontal status (PPD and BOP), another mouth hygiene check and home oral hygiene instruction. An improvement in the approximal plaque index of 60.0% to 33.0% and in the sulcus bleeding index of 25.0% to 12.5% was noted. The PPD profile also showed slight improvement in some areas of approximately 1 mm. Periodontal therapy was performed on all remaining teeth with PPD ≥ 4 mm, along with professional tooth cleaning for all teeth (Fig. 7).
To post a reply please login or register