Comprehensive periodontal treatment in generalized stage IV, grade C periodontitis: a clinical case report / Tratamento periodontal abrangente em periodontite generalizada estágio IV, grau C: relato de caso clínico

Generalized stage IV, grade C periodontitis results in rapid bone destruction in the periodontium and can lead to early tooth loss. Scaling and root planing (SRP) complemented by systemic antibiotics, access surgery, regenerative techniques and implant placement are among the treatments used for patients with this condition. The aim of this article is to report a comprehensive periodontal treatment in a 23-year-old male who was referred to the periodontology department due to complaints of tooth mobility and gum infections diagnosed with generalized stage IV, grade C periodontitis according to the clinical, systemic, and family history features observed. Thorough non-surgical periodontal treatment consisting of scaling and root planing was provided, followed by a series of regenerative periodontal surgeries including guided tissue regeneration (GTR) and guided bone regeneration(GBR) to manage advanced bone defects. Six months after periodontal therapy, all implants were inserted using a one-stage approach and Six months later, they were restored with porcelain fused to metal crowns. During the one and two-year follow-ups, the teeth and implants did not show any signs of instability, attachment loss or bone loss. This case report shows that within the limitations of this study a successful outcome can be achieved with an early diagnosis and treatment involving elimination of infectious microorganisms and meticulous long-term maintenance combined with regenerative techniques and implant placement to restore the masticatory function and improve the quality of life for the patient. However further investigation and clinical studies are required to confirm these results (AU)

A periodontite generalizada estágio IV, grau C resulta em rápida destruição óssea do periodonto, podendo levar à perda dentária precoce. Raspagem e aplainamento radicular (SRP) complementada com antibióticos sistêmicos, acessos cirúrgicos, técnicas regenerativas e colocação de implantes estão entre os tratamentos usados para essa condição. O objetivo deste artigo é relatar o tratamento periodontal abrangente de um paciente de 23 anos, que foi encaminhado ao departamento de periodontia com queixas de mobilidade dentária e infecções gengivais, diagnosticado com periodontite generalizada estágio IV, grau C de acordo com as características clínicas, sistêmicas e de histórico familiar observadas. O tratamento periodontal não cirúrgico completo de raspagem e aplainamento radicular foi realizado, seguido por cirurgias periodontais regenerativas, incluindo regeneração tecidual guiada (GTR) e regeneração óssea guiada (GBR) para tratar defeitos ósseos avançados. Seis meses após a terapia periodontal, todos os implantes foram inseridos através de abordagem de estágio único e, seis meses depois, foram restaurados com porcelana fundida às coroas de metal. Durante os acompanhamentos de um e dois anos, os dentes e implantes não mostraram quaisquer sinais de instabilidade, perda de inserção ou perda óssea. Este relato mostra que, dentro das limitações deste estudo, um resultado bem-sucedido pode ser alcançado a partir de diagnóstico precoce e tratamento envolvendo a eliminação de microrganismos e manutenção meticulosa à longo prazo, combinada com técnicas regenerativas e colocação de implantes para restaurar a função mastigatória e melhorar a qualidade de vida do paciente. No entanto, mais investigações e estudos clínicos são necessários para confirmar esses resultados (AU)

Evaluation of Periodontal Status after Orthodontic Treatment: A Pilot Study on Patients with Stage IV/Grade C periodontitis.

OBJECTIVE: To evaluate whether the periodontal status was affected in patients with stage IV/grade C periodontitis after orthodontic treatment. METHODS: Twenty-four patients with stage IV/grade C periodontitis who received combined periodontal and orthodontic treatment were included in this study. Probing depth (PD), bleeding on probing (BOP) and percentage of relative bone height (RBH%) were measured and calculated. Parameter changes before and after orthodontic treatment, and their differences between teeth adjacent to extraction sites (TAES) and teeth nonadjacent to extraction sites (TNES) were compared. Three-level analysis was performed to test the influential factors of PD and RBH% reduction after orthodontic treatment. RESULTS: No change of PD, BOP% and RBH% was detected after orthodontic treatment. No difference of PD, BOP% and RBH% was detected between TAES and TNES. BOP negative, excessive horizontal overlap, excessive vertical overlap, crowding, PD at T0 (the last periodontal visit before orthodontic treatment) and RBH% at T0 were positively associated with PD reduction after orthodontic treatment. Being female, excessive horizontal overlap, excessive vertical overlap, crowding, PD at T0 and RBH% at T0 were positively associated with a RBH% reduction. Space was negatively associated with a RBH% reduction. CONCLUSION: Periodontal stability can be obtained for patients with stage IV/grade C periodontitis after orthodontic treatment. Orthodontic treatment with extraction was safe for patients with severe periodontitis, however, attention should be given to TAES.