Case Study #3




     24 year old white male. Medical history: Health- WNL. ASA II due to tobacco smoking for 10 years. Heavy case value. Generalized Type II probing depths 4-5 mm, localized Type III probing depths 6-7 mm.  Moderate bone loss. Severe bleeding up to the probing. Generalized pink fibrotic gingiva with soft and flaccid papillae.  Red marginal gingiva with moderate inflammation on posterior teeth.Generalized subgingival calculus on all teeth.  Full mouth series film exposed and confirmed localized horizontal and vertical bone loss in all teeth about 3-4mm from the CEJ (Moderate Periodontitis).  This patient was selected for Arestin treatment.  Belong exposed FMS and Periodontal charting alongside with treatment plan which included place of Arestin.


Visit 1: Complete all assessments. OHI: recommended Modified Bass technique with soft brush. Instructed how to properly use waxed floss “C” method. Ultrasonic and hand scaled # 25-# 27 teeth.

Visit 2: Reviewed OHI, recommended power tooth brush. Re-evaluate scaled previously teeth. Scaled LR quadrant with ultrasonic and hand instruments. Administered 1 carpule of 2% Lidocaine with 1:100,000 Epinephrine for patient comfort. Qualified for Arestin.

Visit 3: Reviewed OHI, patient is using Power Oral – B Vitality tooth brush. I recommended interdental Tip Gum Stimulator to help reshape the interproximal papillae. Re-evaluate scaled LR, tissue response was positive, less bleeding upon exploring and less inflammation. There was pocket reduction in localized areas Arestin was placed.  Verbal and written post-up instructions was provided. Scaled UR quadrant with local anesthetic for patient comfort.

Visit 4: Reviewed OHI, recommended use tongue scraper. Re-evaluate UR,LR quadrats. Ultrasonic and hands scaling UL quadrant with local anesthetic. Placed Arestin on local area of UR quadrant. Post -up reviewed and explained to patient.

Visit 5: Reviewed OHI. Re- evaluate UL quadrant, generalized gingiva looks pale pink with pointed papillae. Light bleeding.  Ultrasonic and hands scaling LL quadrant with local anesthetic. Polished with fine tooth paste.  Applied 5% NAF varnish treatment. Arestin was placed on UL teeth.

Visit 6: Limit Focus visit. Re-evaluation of areas where the Arestin was placed. Tissue response was positive and probing depths where Arestin was placed reduced by 1-2mm. Tissue appeared more firm and resilient, with no bleeding upon probing. Patient was put on a 3-month recare.

After this successful Arestin treatment, I discussed with my patient how his compliance with home care will play a big role in maintaining the status of his oral health. My patient was very pleased with his results, which left him feeling motivated to keep up the good work and healthy mouth.