Class II Generalized Periodontitis and Rheumatoid Arthritis Requesting Implant Placement

The Challenge:

To establish periodontal remission by addressing the clinical manifestations of periodontal disease and altering the oral flora in order to lower the incidence of periodontal disease relapse. Bacterial management will eliminate a source of total body inflammation and increase success of implant placement.

The Background:

• Age: 66
• Sex: Male
• Medical History: Rheumatoid arthritis, takes Lisinopril
• Last Dental Exam: 05/16/2019
• Home Care: Brushing twice a day and sporadic flossing
• Chief Complaint: Missing tooth #19 and interested in dental implant
• Clinical Assessment: Class II generalized periodontitis with localized Class III periodontitis. Generalized bleeding on probing and localized bulbous and erythematous tissue on buccal aspect of tooth #5 due to excess material on Class V restoration.
• Periodontal Assessment: Upon probing and completion of periodontal assessment, this case was classified as Class II generalized periodontitis with localized Class III periodontitis due to pocket measurement on mesial of #14.

Additional Comments: Patient indicates he visits the dentist every six months and reports no previous periodontal treatment.

The Solution:

• Date of Pre MyPerioPath^® (pre-therapy test): 05/16/2019
• Periodontal Therapy: Patient was scheduled for full mouth debridement and localized curettage on periodontal pocket sites. This procedure was performed for 3 consecutive weeks and pockets were stabilized to measurements 2-3mm.
• Systemic Antibiotic Use: A script of Amoxicillin 500mg, 3 times a day for 7 days was prescribed even though all bacteria were under reference lines.
• Home Care Instruction: Perio Protect^™ trays were recommended for use twice a day with Perio Gel^® for 15 minutes each application for 3 weeks, then every other day until 3 month follow-up. Oral hygiene instructions on how to brush and floss correctly were reinforced.
• Date of MyPerioProgress^® (post-therapy test): 09/03/2019

The Result:

Clinically there was 100% pocket size reduction on pockets greater than 3mm. All periodontal pockets stabilized and zero bleeding on probing was observed. There was a 79% reduction in periodontal pathogen (burden) load 3 months and 18 days after treatment started. These current results are likely associated with a decrease in both oral and systemic inflammation. Having clinical improvement is always our goal and was achieved in this case. The significance of having the pre and post therapy MyPerioPath results gives me an objective measurement to things I can’t visually see. With the reduction of bacterial load, I now know the environment for surgical placement of an implant has less risk for failure due to periodontal pathogens. I utilize this test as a pre-surgical work up, just like a medical doctor uses blood work before their hip/knee/valve replacements surgeries.

About the Author:

Dr. Patricia Lugo is a Puertorriquena oral surgeon who studied her doctorate degree at University of Puerto Rico Medical Sciences Campus and has been practicing for more than 10 years in the private sector. Her passion is practicing Complete Health Dentistry, dentistry that links oral health with systemic health. She works with her husband, Dr. Edwin Rodriguez, prosthodontist, on providing optimal health to patients with complex oral rehabilitations.