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Case 1

 

“If at first you don’t succeed”

By: George Vassos, D.M.D.
Diplomate, American Academy of Periodontology
Certified Instructor, IALD

This 39 year old female was referred to by her dentist in 2008 with periodontal bone loss in several areas of her mouth.  Tooth # 15 had the worst periodontal destruction with a 10mm+ pocket on the distal aspect. She was treated  in 2008 with conventional periodontal therapy which included oral hygiene instruction, subgingival scalings, osseous flap surgery and guided tissue regeneration including platelet derived growth factor around tooth # 15.  Complete occlusal adjustment and a maxillary bruxism appliance were also part of her periodontal treatment.  All areas of her mouth resolved with 2-4mm pocketing except for tooth # 15.  On her recall examination on 1/20/2011 a 10-12mm distal pocket was noted on tooth # 15.  A class I buccal furcation and a class II distal furcation were noted on tooth # 15.  2-3mm of gingival recession was noted on this tooth.  Buccal gingival width was 3mm.
 
Several treatment options were discussed with the patient:

  1. Continued periodontal cleanings every 2-3 months.
  2. Open flap guided tissue regeneration surgery – a second time.
  3. Extraction, sinus lift grafting and placement of a dental implant
  4. Use of a local delivery time released antibiotic
  5. Localized laser surgery around tooth # 15

 
Localized laser treatment was recommended and accepted by the patient because it offered the best chance of success in this case with a minimally invasive approach.  Localized laser surgery was completed on February 7, 2011 without complication following the LANAP full mouth protocol.  Healing was uneventful.  Post laser surgery prophylaxis was done on 3/28/11,  5/23/11 and 11/28/11.
 
A new radiograph of tooth # 15 was taken on 11/28/11.  The deepest pocket at that time was 4mm.  The radiograph of 11/28/11 clearly shows a dramatic increase in bone support around tooth # 15 and in the furcation area.  Although the radiograph of 11/28/11 has the palatal root aligned with the furcation area, the dramatic bone regeneration is undeniable.
 
This case clearly demonstrates the advantage of the LANAP protocol in areas where, in the past, there have been no good treatment options to save severely periodontally compromised teeth.

Pre-op  01/10/2011
12 mm pocket depth on distal #15 and class II DB furcation involvement.

10 month post-operative. 11/28/11.
Probing depth on distal of #`15 now only 4 mm.

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