Case 4
“Furcationing the way out”
Sunny Drake, DMD, MS
57 year old white male (JH) presents in good health for a comprehensive periodontal exam and full mouth set of films on 5/23/2013 after stating “I was told I had gum disease but it doesn’t bother me and now I have pus coming out of this tooth when I press on it”. Patient is pointing to tooth #19. #19 periodontally probed 12 mm directly on the buccal.
Patient admits that he doesn’t understand what all the “fuss” is about and because it didn’t hurt, so “why bother” and states “everybody tries to scare be about these numbers”.
We (my staff and I) spent an appropriate amount of time to explain to our patient why he needed treatment even though it “didn’t hurt” and possible outcomes as well as a realistic prognosis with furcation involvement and possible root fracture and other differential diagnosis’s. He was told that the prognosis was guarded and was very interested in the research that compared traditional periodontal therapy to the LANAP protocol.
He didn’t schedule, but called my office back in a few weeks and discussed his internet research he’d done on LANAP, and wanted to discuss his options further. Eventually, after about 30 minutes on the phone with me he scheduled only after my promise that I would extract the tooth for “free” if my therapy didn’t work. LANAP surgery was scheduled for 10/2/2013.
At the time of presentation for surgery my diagnosis was generalized slight with localized severe chronic periodontitis, bruxism, periodontal abscess on #19 and #12, and the differential dx fracture of #19. Bleeding on probing was greater than 50% of all sites.
LANAP was performed per MDT protocol, bite was adjusted, and our patient was advised to get and wear an occlusal guard. He refused to do so for almost one year. At his one year appointment, following the patient coming in every 3 months for periodontal maintenance at my office, I felt that even though he had significant improvement on all teeth, that the BOP was greatly reduced (less than 10%) and a remaining 5 mm PD on the buccal of #19. A revision was performed on 10/16/14 on only #19, and patient was kept on a 3 month recall. The final probe depths taken on 4/13/15 reveal a substantially health mouth, with an area on the distal of #15 that we have discussed performing a distal wedge, but tooth #19 no longer probes any deeper than 4 mm. Needless to say, the patient does not want me to “extract #19 for free”.
Sunny Drake