Discuss
1. CAL
2. Periodontal Diagnosis:
Generalised Stage III Grade C periodontitis
Severity:
3-4mm greatest CAL 3 -4 mm for 9 teeth (17, 12, 11, 21, 33, 32, 45, 47)
5mm or more CAL on 6 more teeth (16, 37, 36, 41, 42, 46
PD of 9mm even noted on some teeth, with 7mm pockets being common
Horizontal and vertical bone loss >33%
Complexity: Stage III because CAL is >5mm on teeth highlighted in pink + Grade II mobility involvement
Grace C because %greatest bone loss / age in years = 50 / 26 so bone loss >1%
Differential diagnosis: generalised molar/ incisor Stage III Grade C periodontitis, periodontitis as a manifestation of systemic diseases (genetic), systemic diseases or conditions affecting the periodontal supporting tissues (neoplastic), traumatic occlusal forces?
3. Identify risk factors
Poor oral hygiene:
lack of proper toothbrushonly brushing once a day with horizontal scrubbing (WRONG)
Lack of interdental cleaning
family history of periodontal disease
Stress/ anxiety due to preparing for exams
tonsillectonomy so decreased immunity
Iron deficiency - burning oral mucosa
Mouth breather
Crowding and malposition of teeth, especially lower anterior teeth
Secondary problem - burning mouth sensation - possible risk factors include iron deficiency caused by atrophic glossitis/ stomatitis, exacerbated with ethanol content and overuse of Listerine, mouth breathing and potentially dry mouth may be identified as an additional risk factor.
4. Bone loss type and severity
General - Upper maxillary teeth horizontal bone loss, mandibular teeth mixed horizontal with vertical and furcation involvement
Tooth related -
17 furcation involvement and vertical defect
16 bone level at the level of furcation 16 not affected furcation
5. Prognosis for dentition:
Questionable - Poor
6. Prognosis per tooth:
7. Provide LA plan for debridement
Allergic to adrenalin so best to opt for prilocaine with felypressin 3%
Q1 & Q2: Greater palatine and nasopalatine block, infraorbital nerve block, or alternatively just buccal and palatal infiltrations
Q3 & Q4: IANB & Lingual n block, long buccal nerve block
8. Maintenance Plan
Review every 3 months for supragingival clean and OHI if poor OH
Review every 6 months if perio charting shows significant improvement
9. Treatment Plan
Periodontal screening, education (risk factors), OHI education (interdental cleaning + 2x tooth brushing with Bass technique), provide education related to Listerine (2x is sufficient), may be better to switch to CHX (0.2%)
Initial therapy 1: Supragingival scale & prophylaxis & OHI
Periodontal assessment : 6 point chart
Initial therapy 2:
Subgingival debridement Q1 & 4
wait 2 weeks
Subgingival scale Q2 & 3
Periodontal review: wait 1 month
Full mouth 6 point periodontal chart
Redebridement if necessary
Consultation with orthodontics - decision to exo 18, 28, 38, 42, 48
Surgical regenetative periodontal therapy (regeneration with Emdogain) of 37, 36, 46
Periodontal review
Orthodontic therapy with continuous 3 months program with continuous caries prevention, keep monitoring OH and recalibrating ID spaces
If improvement and periodontal health stabilises, schedule next appointment in 6 months time. If no improvement, schedule next appointment in 3 months time.
Comments