Wiley-Blackwell's "Clinical Cases" series is designed to recognize the centrality of clinical cases to the profession by providing actual cases with an academic. By Nadeem Karimbux. ISBN ISBN Wiley- Blackwell's "Clinical circumstances" sequence is designed to acknowledge the. Get Download eBook Clinical Cases In Periodontics (Clinical Cases (Dentistry)) By Nadeem Karimbux [PDF EBOOK EPUB KINDLE].
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Article (PDF Available) in Journal of periodontal & implant science 40(5) Clinical photographs of case 2 patient after 1 year therapy. The aim of periodontal treatment is to control the infection in order to stop disease progression and to be able to maintain a healthy periodontium. Mechanical. Clinical Cases in Periodontics PDF Free Download | Clinical Cases in Periodontics by Nadeem Karimbux Wiley-Blackwell's "Clinical Cases" series is designed.
In the six month follow-up radiographic examination after non-surgical periodontal therapy, resolution of the bony defect was observed. Conclusions Non-surgical therapy combined with systemic antibiotics administration in GAgP patients is suggested to be an effective approach to enhance the periodontal health.
GAgP affects a minority of patients, but it is highly significant because it is characterized by severe destruction of the supporting apparatus of teeth in a relatively young subjects. Because of its less common occurrence, few studies have evaluated different treatment protocols for this condition.
Among those, one study [ 3 ] recently applied the principles of full-mouth non-surgical periodontal treatment and found further improvement in clinical parameters when systemically administered antibiotics were added.
It has been shown that successful treatment of GAgP is dependent on the reduction of specific pathogenic bacteria.
For example, the adjunctive use of metronidazole plus amoxicillin may control Aggregatibacter actionomycetemcomitans and Porphyromonas gingivalis more efficiently than single antibiotic regimens or mechanical therapy alone [ 4 ]. Its etiology is highly correlated to the presence of Aggregatibacter actionmycetencomitans [ 5 - 7 ] and host response defects [ 8 - 10 ] and is possibly related to a genetic inheritance [ 11 - 18 ].
There is no widely accepted treatment protocol for GAgP [ 19 ]. Treatment alternatives include scaling and root planing SRP alone or in conjunction with systemic antibiotics [ 20 - 22 ] as well as surgical [ 23 ] and interdisciplinary approaches [ 24 , 25 ], with adequate outcomes.
However, there are only a few reports [ 19 , 23 , 26 ] of long-term follow-up for these different treatments. Successful treatment of GAgP is considered to be dependent on early diagnosis, directing therapy towards elimination or suppression of the infecting microorganism and providing an environment conductive to long-term maintenance.
The purpose of this study was to evaluate the improvement of periodontal health of GAgP diagnosed patients treated with non-surgical periodontal therapy accompanying systemic antibiotics administration. Suppuration was registered at the maxillary right first molar and the mandibular left first molar. Gingival inflammation was observed.
The patient was in good general health, had never smoked, and did not take any medications. Familial aggregation of GAgP was denied. The complexity of this rehabilitating treatment depends on the effects produced by the periodontal disease. The objective of this article is to present the comprehensive treatment of a periodontal prosthetic patient providing dentistry students and professional dentists with some guidelines on the interdisciplinary treatment of a challenging case.
He admitted being asymptomatic but referred this as the reason for consulting: ''I was told I have periodontal problems and in my gums''. A complete clinical history was registered, and several diagnostic aids were performed, such as clinical photographs, periapical radiographic series figures 1 , 2 y 3 , and study models.
The principal findings include: the patient is systemically healthy, with family history of periodontal disease, high blood pressure, diabetes, and dental prosthesis; the functional analysis of the temporomandibular joint revealed a slight block by the end of oral opening followed by a dull noise and a sudden movement.
The patient has had history of articular noise and a joint block on maximum opening. He admits brushing his teeth daily at least twice a day and not using dental floss very often. It is important to point out the presence of lower anterior dental crowding as a local risk factor that favors bacterial plaque accumulation20, 21 figure 1.
The radiographic analysis showed generalized bone loss in both vertical and horizontal directions, and a significant periapical lesion on tooth 12 figura 2. DIAGNOSIS Systemic: healthy Dental: occlusal active caries on 47, faulty dental restoration on 12, dental attrition on lower anterior teeth and abnormal teeth position lower anterior crowding. Pulpal: necrotic pulp on 12 with chronic suppurative apical periodontitis.
The patient does not present systemic diseases, and quit smoking sixteen years ago. Individual prognosis is poor for teeth 23, 33, and 34 because bone loss has affected two thirds of dental root; it is also poor for tooth 12 due to necrotic pulp and extensive apical periodontitis, and for 46, 47, and 48 due to significant insertion loss and bifurcation degree II types a and b. Once diagnosis and prognosis had been established, a treatment plan was designed on April 24th with approval by the patient who signed an informed consent before initiating treatment.
TREATMENT Several clinical procedures were performed during the hygienic phase in order to stop periodontal infection and to teach the patient how to maintain good oral hygiene; this included: patient's motivation and education on oral health, supragingival periodontal preparation with scalers and curettes, dental prophylaxis with toothbrush and prophylactic paste, simple extraction for teeth with bad periodontal prognosis: 16, 17, 18, 26, 27, 28 figure 4 , removal of active caries on 47, pulpal debriding and endodontics of tooth 12, subgingival periodontal preparation to entire mouth total mouth disinfection 28 which included: non-surgical scaling and root planing with curettes and sonic-scaler machine to remove subgingival irritants and disorganize adhered and non-adhered bacterial flora.
It also included mouth wash with emphasis on the back of the tongue and tonsils with a 0. This hygienic phase finished with the installation of an upper esthetic plate due to the extraction of maxillary molars figura 6.
Reassessment was performed eight weeks after periodontal disinfection—the required period for healing of periodontal tissues—. The results obtained so far were satisfactory: considerable reduction of inflammation and gingival bleeding, absence of suppuration, improvement of oral hygiene, reduction of periodontal probing, bone regeneration, and cortication of alveolar crest on affected areas.
AINEs was prescribed during three days as well as 0. Postsurgical evaluation was performed eight days later; the periodontal suture was removed and healing process was observed; no signs of infection were found figure Once periodontal healing was completed eight weeks ,29 new probing was performed and no periodontal pockets were found, nor other signs or symptoms of periodontal disease.
Once periodontitis had been controlled and maxillary edentulism classified as Kennedy class I topographic classification of edentulism figure , several prosthetic treatment options were suggested to replace missing teeth; these options ranged from using implants to adapting an acrylic metal removable partial prosthesis, but due to the patient's biological conditions, such as little maturation time of periodontal tissue,29 poor oral hygiene history, and scarce economic resources, the second alternative was chosen.
Type III plaster models were obtained, as well as occlusal records and tests on semi-adjustable articulator and parallelometer. Based on this analysis, a partially removable prosthesis with bilateral distal extension was planned; this required a careful design since characteristics of the residual ridge and base movement during its functioning would determine the occlusal efficacy of the prothesis.