Case 2
“Do you see what I see?”
By: Craig Hescheles, D.M.D.
LANAP trained 2008
Boynton Beach, Fl
A 72 year old female in good general health presented for examination. The patient complained of a loose tooth on her upper left side which hurt when she chewed. She also noted there to be regular bleeding and pus draining from the same area.
Tooth # 14 demonstrated grade III mobility with associated fremitus, grade III furcation invasion, buccal/palatal gingival recession of 1mm, and probing depths ranging from 6-15mm’s (15mm’s on the direct buccal aspect and 14mm’s on the disto-buccal and disto-palatal sites). Tooth # 14 was noted to have suppuration draining form a buccal fistula. The tooth tested positive for vitality. The diagnosis was noted to be generalized moderate with localized advanced Periodontitis: Tooth # 14 (with an associated periodontal abscess).
The prognosis of Tooth # 14 was deemed hopeless. Treatment options were discussed, including: LANAP with or without the extraction of Tooth # 14 and guided bone regeneration with possible future dental implant placement. Conventional periodontal surgery with bone grafting and GTR was discussed but not recommended due to my concerns that tooth # 14 would avulse during surgery. The patient was adamant about not having the tooth removed and desired LANAP therapy with the understanding that Tooth #14 would likely need to be extracted sometime in the future.
Full-mouth LANAP therapy was performed. The ULQ received: Ablation – 950 joules at 4 watts and 100µsec and Hemostasis – 385 joules at 4 watts and 550µsec. The fistula was drained using the Abscess Drainage setting: 35 joules at 4 watts and 150µsec. During occlusal equilibration, Tooth # 14 was taken almost entirely out of occlusion. Post operative treatment care included: antibiotics, anti-inflammatory medication, and Peridex mouth rinse. Healing was uneventful. The fistula was no longer present and the patient was not experiencing any pain at the one week follow-up visit. Tooth # 14 appeared to become stable within the first month following treatment. The patient was seen for routine recall care every three months until the first reevaluation one year after completing LANAP.
