Clinical Cases in Periodontics

The patient’s chief complaint

Medical and dental history

Soft tissue and gingival examination

Periodontal charting

Radiographic interpretations

Periodontal diagnosis

ASA classification 1

Vital signs: blood pressure 130/80 mmHg

Medication: none

Supplement: daily multivitamin

Allergy: none

The patient brushed three times daily and flosses daily.

The patient had received routine dental prophylaxis at her general dental practitioner’s office. Recently, the patient underwent extraction of her mandibular left first and second molars due to severe periodontal disease, and she would like to replace them with dental implants.

The patient denied any smoking habit and had never smoked.

The patient’s father suffered from periodontal disease and ended up receiving complete maxillary and mandibular removable dentures.

Patient was extremely motivated for dental treatment.

Extraoral examination did not reveal any significant findings. Intraorally, generalized gingival edema and erythema were noted ( Figure 1.1.1), which were more pronounced on #3 buccal, #8 buccal, #8 palatal, interproximal papilla between #8 and #9, interproximal papilla between #9 and #10, buccal gingival margin and interproximal papillae in mandibular incisors; rolled buccal gingival margins were noted on #3 mesiobuccal and #8 mesiobuccal aspect.

A comprehensive periodontal examination ( Figure 1.1.2) revealed localized deep probing depths of 10–12 mm on tooth #3 mesial aspect with grade I mobility and grade II mesiopalatal furcation involvement. Tooth #14 exhibited localized deep probing depths of 7 mm on its distal aspect with grade II distopalatal furcation involvement. Teeth #2, #8, #10, and #15 also exhibited localized probing depths of 5 mm. Teeth #2 and #15 exhibited Class I mesiopalatal furcation involvement. Otherwise, the remaining dentitions exhibited generalized probing depths of 1–4 mm. There was generalized bleeding on probing. Furthermore, localized areas with gingival recession were noted in some posterior teeth.

Figure 1.1.1Complete series of intraoral photographs.

Figure 1.1.2Complete periodontal charting.

A full‐mouth series of intraoral radiographs revealed generalized horizontal bone loss ( Figure 1.1.3). There was localized moderate horizontal bone loss on teeth #2 and #15. Tooth #3 exhibited vertical bone loss on its mesial aspect while tooth #4 exhibited vertical bone loss on its distal aspect. An open interproximal contact was evident on #3 mesial aspect. Vertical ridge deficiency was noted on edentulous teeth #18, #19 and #30, areas with slight radiolucency indicating possible horizontal ridge deficiency as well.

According to the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions by the American Academy of Periodontology and the European Federation of Periodontology [1], the patient exhibited stage III grade C periodontitis (localized).

Figure 1.1.3Complete series of intraoral radiographs.

1 What is the significance of obtaining medical and dental history in treating a patient with periodontal conditions?

2 Aside from conventional parameters such as probing depth, recession, mobility and bleeding on probing, what are the additional parameters that should be obtained during a comprehensive periodontal evaluation?

3 How did we derive periodontal diagnosis for this case of interest?

4 What is the importance of conducting a comprehensive periodontal evaluation for a patient who needs a dental implant?

5 Aside from periodontal charting, are there any other clinical findings that clinicians should record during their routine comprehensive examinations?

Answers located at the end of the chapter.

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