Case 1

“Raising the Bar”

David Goteiner, D.D.S.

www.artofperio.com

A 22 year old female presented for evaluation of her periodontium generally, and specifically, the mandibular anterior segment. She had swelling and pain which had been present for approximately 3 days.Clinical and radiographic examination revealed significant loss of clinical attachment in the 24-25 area, with 90 percent bone loss. As well, the woman had a tongue piercing with a bar that corresponded to the area in question. Probings ranged from 8-12mm’s in that area. (see chart below). Coincidentally, she had a tattoo on the internal aspect of her lower lip. Medications included Vivanse, Abilify and Vibryd for ADD, eating disorders and depression, respectively.

It was decided to splint the teeth extra-coronally, and rather than flap the area, which would have no doubt resulted in loss of one or both of the incisors, LPT was performed. Under local anesthesia, a total of 673 joules were placed in contact with the tissue and an additional 183 j for biostimulation.

The healing progressed in an expected fashion, and the patient was given oral hygiene instructions and told to return for routine follow up. It is important to acknowledge that the lesion was caused by a traumatic “appliance”, and that given her age we do expect better healing than in someone who was at least a decade older. But what is remarkable about this case is that other than a slight blunting of the papilla 24-25, there was virtually no recession. Scaling and root planing alone would have resulted in significant loss of tissue volume. The ability to hold the clot coupled with the fixation of the teeth with splint undoubtedly contributed to the successful outcome of this case. The patient should be kept on a follow up schedule for at least the next 5 yrs.

Without the option for LANAP, the trauma caused form the placement and habitual force of the bar against the lingual aspect of these teeth, would have obviated the need for extraction, grafting and either implant or conventional tooth replacement. The difficulty of the achieving esthetic results in this zone further complicates the potential pitfalls of failure to heal. The LPT results far exceeded the expected results.

For those that are more visual- the case in pictures unfolds a follows:.

Initial Presentation: Pt had reported pain for 3 days prior to appointment.