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Short Commentary: Generalized Advanced Periodontitis Judy Carroll, RDH

Generalized Advanced Periodontitis
Judy Carroll, RDH, aka "periopeak" presents a case involving Regenerative Periodontal Endoscopy with a patient who has long-time periodontal disease. A 45-year-old male patient came to see me for a consultation. He was well educated, had a Ph.D. and held more than 30 patents. He smoked for 25 years, had a family history of periodontal disease and had suffered with periodontal disease for more than 15 years. During that time he saw three periodontists and each time treatment was completed, he was told that his case was beyond treatment and that nearly all his teeth needed to be extracted. He was also seen by a prosthodontist who recommended extractions and a full upper denture and extractions and implants on the lower, saving just a few natural teeth. Not wanting to lose his teeth, he continued to look for help. It was at this time that he stopped smoking and came to me for a consultation for Regenerative Periodontal Endoscopy (RPE).

Mesial surface of tooth number six measures 15mm. 		He presented with generalized moderate plaque, localized moderate supragingival calculus and generalized heavy subgingival calculus. He had generalized severe redness and inflammation with 100 percent of sites bleeding upon gentle probing. Exudate was evident at many sites. Mobility was generalized II to III, and furcation involvement was evident on all molars, from Class I to III. Probing depths ranged from 8mm to 15mm. The diagnosis: generalized, chronic, advanced, adult periodontitis. The recommended treatment was Regenerative Periodontal Endoscopy. This synergistic protocol combines pretreatment systemic low dose doxycycline (LDD) followed by definitive subgingival deposit removal, and the placement of an enamel matrix protein to assist in healing and closure of the periodontal pockets.

Three months post op. 		He presented with generalized moderate plaque, localized moderate supragingival calculus and generalized heavy subgingival calculus. He had generalized severe redness and inflammation with 100 percent of sites bleeding upon gentle probing. Exudate was evident at many sites. Mobility was generalized II to III, and furcation involvement was evident on all molars, from Class I to III. Probing depths ranged from 8mm to 15mm. The diagnosis: generalized, chronic, advanced, adult periodontitis. The recommended treatment was Regenerative Periodontal Endoscopy. This synergistic protocol combines pretreatment systemic low dose doxycycline (LDD) followed by definitive subgingival deposit removal, and the placement of an enamel matrix protein to assist in healing and closure of the periodontal pockets.
  The patient was placed on 20mg of LDD two weeks prior to the start of treatment to reduce inflammation and bleeding thus allowing for better visualization when using the endoscope. No systemic or local antibiotics were used.

Treatment included two appointments one week apart, for full-mouth Perioscopy, two hours per side using local anesthesia. Subgingival instrumentation was completed with a bladed piezoceramic ultrasonic root instrumentation technique (using the Satelec P5 Newtron).

Following subgingival instrumentation assisted with perioscopy, root surfaces were coated with Emdogain, to enhance healing and regeneration. Oral hygiene instructions included the use of a Sonicare power toothbrush and dental floss.

Three months after treatment, the gingival tissues appear healthy, pink and tight with no bleeding upon probing. Probing depths now range from 2mm to 5mm.

It is now two years later and he has kept all his teeth and is very happy with the result. He continues to do very well and is periodontally stable. He continues to take LDD once daily, and has not smoked since his Perioscopy treatment. Full-mouth extraction and dentures were recommended prior to the RPE. At this time he has only one tooth (#19) being considered for extraction.

Definitive, regenerative periodontal therapy can be delivered by hygienists within today’s scope of practice. We have the technology and if patients knew about it, there would be demand for it.
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