Case Studies

CASE 1

27 year old male, no systemic condition. Non-smoker. Patient was classified as a heavy case type/perio type II; localized supra-gingival calculus in anterior mandible lingual aspect and generalized subgingival calculus.

Slightly red and erythematous tissue with generalized chronic moderate marginal inflammation. Slightly blunted papilla; slightly rolled gingival margins.  Recession(1mm) on #2,3,14,15,18,19,30. Early signs of furcation involvement #2,3,14,15,18,19,30. The probing depths were 2-6mm with localized areas of 4-6mm in the posterior regions and there was moderate bleeding upon probing.  Classified as Type II slight periodontitis.

Recommended FMS to evaluate bone loss  and periodontal progression.  Radiographs revealed slight bone loss #5M, #16MD, #19M; no caries detected radiographically. Radiographs confirmed the clinical periodontal pocket depths; they revealed early signs of bone loss (about 10%) in the posterior regions.

Taking into account of the patient’s periodontal case value and his compliance with the overall treatment and home care regimen, Arestin treatment was recommended for this patient.

Below is a comparison of the probing depths 0f 10 placement sites before Arestin and post-Arestin treatment.

Site	Initial reading	post-Arestin reading
#2MB	5mm	5mm
#2ML	5mm	5mm
#3MB	5mm	4mm
#3ML	5mm	5mm
#3DL	5mm	5mm
#4DB	5mm	3mm
#4ML	6mm	4mm
#15DL	6mm	5mm
#30ML	6mm	5mm
#30DL	6mm	3mm

I was satisfied with the Arestin treatment outcome. Out of the 10 treatment sites, 6 sites showed a reduction in pocket depths in a range of 1-3mm. It accounted for a 60% success rate for this particular case. The 4 sites that did not show any improvement were #2MB-5mm, #2ML-5mm, #3ML-5mm, #3DL-5mm. I suspected the reason to be the following: the fact that these sites were more toward posterior and lingual might have made it more difficult for the patient to access and perform oral hygiene. I concluded that the patient’s compliance and appropriate home care would be a big contributing factor to a successful Arestin treatment outcome.
CASE 2

 

 

29 year old Asian female with a history of type I diabetes, which was diagnosed in 1998. Patient is trying to become pregnant and carries an insulin pump since February 2013. Patient was classified as Heavy case value/perio type II. I introduced to the patient the correlation between diabetes and dental health. I informed the patient that she is at high risk of periodontal disease due to her condition, and meticulous home care and professional dental hygiene care are crucial. Indeed patient’s diabetic condition had a huge impact on the entire treatment. Tissue healing was impacted and extremely slow.

CASE 3

66 year old male with a history of hypertension and type 2 diabetes. Taking amlodipine 5mg, aspirin 81mg, glibenclamide 2.5mg for the past 10 years. Non-smoker; quit smoking about 20 years ago. BP: 153/79, pulse 72. Heavy case value/perio type IV, probing depths 2-9mm. Severe extrinsic staining present due to diet. Generalized severe attrition. Oral hygiene instructions given(Modified Bass and interproximal brush). Full mouth scaling with hand and ultrasonic instrumentation, followed by air polishing with Prophy Jet to remove the extrinsic staining. Exposed full-mouth radiographs which revealed tooth #18 has periapical abcess. Referral given to patient for #18 evaluation and periodontal evaluation.