There was no systemic disease but she had a family history of periodontitis.
The original presenting x-rays and photographs are included.
The decision was made to treat her nonsurgically since surgical procedures would result in a great deal of recession and increased mobility which was already severe.
Metronidazole was prescribed. The patient underwent a series of perioscopic scalings using the dental endoscope to ensure all calculus was removed.
There was a marked reduction in probing depth to the point at which we decided we would retain the maxillary teeth. The reduction in probing depths was partially due to recession, as it reduced inflammation and on the palatal aspect of the upper anteriors along epithelial attachment. Pocket depth did remain on isolated teeth and will be dealt with over time.
In other areas of her mouth, hopeless teeth were extracted and implant dentistry was performed where individual teeth were missing. The patient was highly motivated to use a water irrigator twice a day and was meticulous with her oral hygiene.
After periodontal health was achieved, there was still significant mobility and a great deal of recession as noted by the post-treatment photographs.
The dentist she had seen felt that he would get a better cosmetic result with direct bonding but requested that she undergo Invisalign orthodontics prior in order to rotate the teeth into a better position.
The teeth were rotated but mobility became very severe due to the extreme loss of bone especially on the lateral incisors.
We elected to change aligners every 3-4 weeks to allow the slight turning of the teeth to occur without the teeth exfoliating.
Ultimately the teeth were aligned and a lingual retainer was placed. Lo and behold, there was no mobility of the teeth once splinted together despite the bone loss. Radiographs showed good healing in terms of crestal bone. Pocket depth was reduced to the 3-5 mm. range compared to the 7-10 mm. range that she presented with. There was recession due to complete removal of calculus and healing.
Included are the photographs of the bonding that was done.
This case does demonstrate alternatives to full-mouth extractions and implants particularly in a patient who has a high propensity for periodontal disease and for whom the extraction of these remaining teeth would result in a great deal of pink porcelain being necessary to hide the length of the implants.
I will send up follow-up x-rays and photos over time.
As always, I appreciate your feedback. I understand this represents just one approach among viable alternatives.
Victor M. Sternberg, D.M.D.
Dental Office of:
Victor M. Sternberg, D.M.D., PC
Westchester Center of Periodontal and Implant Excellence
141 North State Road
Briarcliff Manor, NY 10510