Treatment of patients with severe periodontal disease

treatment plan

The following treatment steps were discussed and developed as a treatment plan:

  1. Removal of all supragingival and clinically palpable subgingival plaque and calculus (occlusive method);
  2. Adjuvant antibiotic treatment based on microbial analysis results;
  3. Repeat evaluation and maintenance treatment as part of supportive periodontal therapy (SPT); and
  4. If necessary, surgical treatment (open surgery) is performed.

treatment progress

The first appointment includes an informative and therapeutic discussion about periodontal disease-related findings, diagnosis, and risk factors. Detailed guidance is provided on topics such as nutrition, stress management, and potential interactions with patients' hypertension medications. An oral hygiene examination was also performed, with documentation of Langer's approximate plaque index (60%) and gingival sulcus bleeding index (50%), followed by home oral hygiene instruction.

Finally, non-surgical periodontal treatment is performed according to Van Winkelhoff criteria and accompanied by corresponding antibiotic treatment.1 Regimen: amoxicillin 500 mg three times a day; metronidazole 400 mg three times a day for 7 days). In addition, antimicrobial treatment with 0.2% chlorhexidine solution twice daily for 7 days is recommended. To increase the success rate of treatment, full mouth disinfection is performed at every periodontal treatment visit.

Follow-up examination

The first follow-up examination showed a positive healing trend. No redness, swelling or pain was observed. During the second follow-up, the gingival margin was lightly probed and there was no bleeding. There was no abnormality in the appearance of the gingiva. The precise PPD is planned to be measured at the first assessment approximately three months later. Subsequent appointments were made under the SPT framework.

During the first SPT session, a periodontal assessment was performed, including two PPD and two BOP measurements of each tooth. Overall improvement was observed, especially for tooth No. 13 (distal reduction from 12 mm to 6 mm), tooth No. 27 (mesial reduction from 6 mm to 3 mm), and tooth No. 36 (distal reduction from 8 mm to 5 mm ), tooth #33 (mesial reduction from 8 mm to 5 mm), and tooth #43 (mesial reduction from 9 mm to 6 mm). Oral hygiene examination (according to Lange's approximate plaque index) showed a 20% improvement in oral hygiene. The gingival sulcus bleeding index also improved by 25%. Home oral hygiene instruction again. Positive progress in the gingiva was observed in both jaws. Subsequently, periodontal treatment was performed on teeth with PPD ≥ 4 mm, and professional dental scaling was performed on all teeth.

The patient reported no pain from the bite and no redness or swelling. Patient behavior showed positive trends regarding oral hygiene and risk factor management. According to the patient, he has changed his eating habits to include consuming fruits and vegetables and water daily to quench his thirst. A healthy diet, particularly one that is low on the glycemic index and rich in omega-3 fatty acids, fiber, micronutrients, and secondary plant compounds that reduce inflammation in the body, can positively influence host responses.

The next SPT session includes re-evaluation of periodontal status, oral hygiene examination, and home oral hygiene instruction. All values ​​remain stable except for a slight improvement in PPD (approximately 1 mm). Subsequently, another periodontal treatment was performed on all teeth with PPD ≥ 4 mm, and these teeth were professionally cleaned.

During your semiannual dental exam, panoramic X-rays are taken to compare bone structure. Significant improvements in bone density were observed, particularly around teeth 13, 36, 33, 43, and 47, areas with initially severe vertical bone loss. Clinical improvement was also noted, including lack of inflammation and slight recession of the gingiva (Figures 5 and 6).

The third SPT session included a reassessment of periodontal status (PPD and BOP), another oral hygiene examination, and home oral hygiene instruction. The near-plaque index improved by 60.0% to 33.0%, and the sulcal bleeding index improved by 25.0% to 12.5%. The PPD profile also showed slight improvement of about 1 mm in some areas. Periodontal treatment was performed on all remaining teeth with PPD ≥ 4 mm, and all teeth were professionally cleaned (Figure 7).

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