Yu Wang
| Yu Wang |
Kadri Kadri, Yu Wang
Periodontics, University of Pennsylvania, School of Dental Medicine
Introduction
Stage III periodontitis often requires surgical treatments to reduce pocket depth, eliminate negative bony architecture and ultimately regain stable periodontium. In deep intrabony defects, resective osseous surgery might be forced to remove a significant amount of supporting bone, resulting in compromised outcomes. Combining resective surgery and biologics in regenerative therapy can enhance periodontal regeneration and clinical outcomes.
Methods
A 68-year-old male patient with a history of diabetes, hypertension, and arthritis was referred to the periodontics clinic due to residual deep pockets after non-surgical treatment. Stage III, Grade B periodontitis was diagnosed. Combined osseous surgery and regenerative therapy with mineralized cancellous bone allograft (Puros) and enamel matrix derivative (Emdogain) was planned for the upper right quadrant. Medical clearance was obtained with HbA1c 6.7 and RBS level 135 mg/dl on the day of the surgery. Bone sounding was recorded after local anesthesia; sulcular incision at buccal and submarginal incision at palatal was made from mesial of tooth #4 to distal of #2 with distal wedge incision at tooth #2 distal. The submarginal incision was done from line angle to line angle to preserve the papillae. A full-thickness flap was reflected. Granulation tissue was removed, and scaling/root planing was completed with hand instruments. Three-wall intrabony defect was detected on the distal of tooth #3, with crater defects found in between teeth #3 and #4. Thick bony ledges on the buccal and palatal aspects were noticed. Osteoplasty and ostectomy were performed. Root conditioned with EDTA, then Emdogain was applied on the root surfaces and mixed with the 0.5cc bone graft to apply to the bony defects. Palatal flap was thinned, and primary closure was achieved by single interrupted sutures with PTFE and chromic gut sutures. Post-op instruction was provided to the patient. We are fortunate to have pre-op and 6 months post-op CBCT due to the need to evaluate the sinus lift procedure for the upper left side.
Results
The six-month post-op clinical and radiograph evaluations reveal successful treatment outcomes. 3D radiographic bone fill was significant in the intrabony defects from the post-op CBCT.
Conclusion
This case report provides evidence that combined resective and regenerative therapy with biologics could be a viable treatment modality for severe periodontitis in diabetes patients with enhanced healing and promising clinical outcomes.