This patient presented with severe inflammatory periodontitis around her upper anterior teeth. This was an 80-year-old woman who had been seen by a specialty prosthetic practice for many years. Many of her teeth had been restored and restored very well.
She was referred to me because of the severe inflammatory hyperplasia of her upper anterior teeth. The initial photo shows the amount of inflammation she presented in her upper anterior teeth which resulted in the actual opening of a diastema between the 2 central incisors. The x-ray with the point clearly shows the defect 8 mm. deep between the two central incisors.
All of her blood tests came back normal. At that point, the hygienist spent 2 visits with her scaling and root planing the upper anterior teeth and the lower left cuspid/bicuspid area.
The results speak for themselves. The photograph shows the diastema closed spontaneously; the pocket completely closed on its own resulting in a 3 mm. sulcus without bleeding and the nature of the tissue is self-evident.
The patient came in with a-9 mm. pocket on a central incisor. She had been advised by another periodontist to have the tooth removed and an implant placed. Implants have become the go-to when teeth have periodontal disease. Periodontal treatment is getting put on the back burner because of the enormous influence of implant dentistry. Subject to another conversation.
- did not want to lose her tooth
- did not mind the space between her teeth
- was informed by me that if she had the tooth removed and an implant placed, there would be several steps to build up the bone and she would be without a tooth for awhile before the implant could be placed and restored.
In addition, because the pocket was located on the mesial aspect of the tooth, readily accessible on a single-rooted tooth, we elected to have the patient undergo several visits of scaling and root planing and using a perioscopic device to make sure all the calculus was off.
The preoperative x-ray shows the deep defect. The five-year follow-up x-ray of this tooth shows not only elimination of the pocket to 3 mm. but regeneration of much if not all of the bone on the mesial aspect of the tooth.
Particularly on single-rooted teeth, if you can effectively remove all the calculus and get the patient to be effective, not just going through the paces, but be truly effective with removing plaque on a daily basis, these kind of results are not unusual but are predictable.
One final note: There have been a number of studies done comparing the use of lasers during scaling vs. with scaling alone. Looking at over 50 articles, the conclusion of the review indicated there is no current evidence to show that laser treatment in addition to scaling and root planing improves the outcomes in a way that is clinically and statistically significant.
Also, a long-term, peer-tested, evidence-based study looking at the efficacy of scaling alone vs. using Arestin or an antibiotic placed subgingivally in pockets after scaling, showed no significant long-term improvements in the outcomes.
Whether it be implants, whether it be lasers or whether it be local antibiotics, much of dentistry is now being driven by companies, not by clinical evidence and clinical instructors.
The two cases I presented did not involve any of those things except an old fashioned curette, a sharpening stone and a competent hygienist.
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