Case 3

“Good Things Come in Pairs”

Larry Gelb, DDS
[email protected]

In 2012 a 64 year male presented for periodontal care. He had been referred many years earlier but had refused to schedule even an evaluation visit. He was fearful of the pain and disfigurement that he understood was associated with periodontal surgery. However, when his general dentist told him about LANAP and its benefits, he scheduled a comprehensive periodontal evaluation.
 
A full series of radiographs and periodontal probing revealed moderate to advanced generalized periodontitis with concomitant occlusal trauma. Sulcular inflammation with heavy deposits of sub-gingival calculus was noted. The remaining teeth in the maxilla included #4-#8 and #12 and #13. The missing teeth were replaced with a maxillary removable partial denture. When not wearing the partial denture, fremitus was noted on tooth #6. Also a buccal fistula in the attached gingivae was observed in the interproximal space between #27 and #28.
 
The deepest pockets and most dramatic and severe vertical bone loss was associated with #6 and #28. Treatment involved LANAP. First the right side was treated and two weeks later the left side. Post treatment radiographs and pocket probings were done 2 years later. During those two years, #7 sustained a horizontal fracture below the osseous crest and was extracted and a replacement tooth was added to the partial. All of the parameters, which included pocket depths, radiographic evidence of bone regeneration, and mobility showed great improvement.
 
The patient of course was very pleased with the result. He made it very clear that had an alternative to conventional periodontal surgery not been available, he would have been willing to lose all of his teeth, so great was the fear factor.

Case 1