Cases reported "Periodontal Pocket"

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1/45. Effective periodontal treatment in a patient with type IIA von Willebrand's disease: report of a case.

    von Willebrand's disease (vWD) is one of the most common hereditary hemorrhagic disorders. A mild to moderate deficiency of factor viii and von willebrand factor (vWf) often is associated with gingival bleeding. In this case report, the periodontal treatment of a patient with vWD is described. A 45-year-old woman with type IIA vWD was referred for periodontal therapy because of an episode of gingival hemorrhage and percussion pain of teeth #18 and #47. The periodontal findings included probing depths ranging from 2 to 6 mm, horizontal bone loss, and Class II furcation involvement of tooth #46. After consultation with a hematologist, apically positioned flap surgery and hemisection were performed on tooth #46 following completion of oral hygiene instruction, scaling and root planing, and endodontic therapy. The patient was given 500 units of factor viii including vWf multimer 30 minutes before surgery. After healing of the periodontal tissue, prosthodontic treatment was undertaken on the posterior mandibular sextants. At follow-up, the probing depths ranged from 2 to 3 mm, and gingival bleeding on probing was minimal. The patient's children all had vWD. They had mild to moderate periodontitis with probing depths ranging from 2 to 5 mm and gingival bleeding on probing. With the combined efforts of the periodontist and hematologist, effective periodontal treatment can be provided to patients with von Willebrand's disease.
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2/45. Radiographic bone fill following debridement of a periodontal abscess. A case report.

    A periodontal abscess often develops in association with deepened periodontal pockets. Traditional management is by establishing drainage and prescribing antibiotics. This is usually followed by surgical pocket reduction. This case report discusses the remarkable healing of a periodontal abscess by establishing drainage alone without resorting to surgical pocket reduction. A 42-year-old white male presented with swollen gingivae associated with the mesiolingual of tooth #23. Increased probing depth and suppuration were evident. Radiographic bone loss on mesial #23 was present. A diagnosis of periodontal abscess was established. The abscess was drained through the orifice of the pocket. The patient failed to return for follow-up as instructed. A year later, the patient came back. Clinical evaluation showed healthy gingival tissues with probing depth of 3 mm on the mesiolingual of tooth #23. Radiographic evaluation showed bone fill of the osseous defect on the mesial of #23. The results of this case suggest that sufficient time should be allowed for healing prior to surgical pocket reduction.
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3/45. Long-term follow-up of periodontitis in a patient with chediak-higashi syndrome. A case report.

    chediak-higashi syndrome (CHS) is an extremely rare hereditary disease characterized by leukocyte dysfunction. We report on a 21-year-old woman who presented at the age 9 years with CHS and serious periodontal tissue destruction around erupted teeth. The patient had received systemic, radiographic, immunological, microbial, and clinical periodontal examinations since childhood. The chemotactic activity of neutrophils in the Boyden chamber assay was 22% of the control, and leukocyte bactericidal activity was one-third of the control. actinobacillus actinomycetemcomitans, porphyromonas gingivalis, and prevotella intermedia were isolated from periodontal pockets. Periodontal treatment including oral hygiene was provided, followed by professional tooth cleaning from the age of 12 to 21 years. However, the mobility of teeth and the inflammation of periodontal tissue progressed. This CHS patient presented with periodontal disease of extremely early onset, which was resistant to periodontal treatment.
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4/45. Early tooth loss due to cyclic neutropenia: long-term follow-up of one patient.

    In young patients with abnormal loosening of teeth and periodontal breakdown, dental professionals should consider a wide range of etiological factors/diseases, analyze differential diagnoses, and make appropriate referrals. The long-term oral and dental follow-up of a female patient diagnosed in early infancy with cyclic neutropenia is reviewed, and recommendations for care are discussed.
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5/45. Periodontal regeneration of a class II furcation defect utilizing a bioabsorbable barrier in a human. A case study with histology.

    This case report describes human histologic data of periodontal regeneration following guided tissue regeneration therapy (GTR) with a bioabsorbable barrier composed of polylactic acid. The tooth that was examined was part of a previously published study of the clinical effects of GTR therapy without the use of bone or bone substitutes on Class II furcation defects. Twenty-five months following the surgical procedure, the tooth was extracted for non-periodontal reasons. During this extraction, the bone within the furcation that was treated in the study was luxated with the tooth. At the completion of the study (month 12), the furcation's vertical probing depth had decreased by 2 mm with a 2 mm gain in clinical attachment. The horizontal furcation measurement decreased by 3 mm. Following extraction, the tooth was prepared for light microscopy and sectioned in the mesial-distal plane. Reference notches were not placed in the tooth at the time of surgery as there were no plans to perform histologic analysis in the study. However, using the buccal root prominences and what we interpreted to be root planing marks on the cementum, we were able to demonstrate that complete periodontal regeneration occurred on the root surface that was exposed to the pocket environment prior to surgery. New alveolar bone, cementum, and periodontal ligament were consistently observed throughout the furcation in the areas that demonstrated clinical attachment gain and a decrease in horizontal probing depth. This case report adds to the accumulating evidence of histologic periodontal regeneration following guided tissue regeneration with bioabsorbable polylactic acid barriers.
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6/45. Palatal radicular multigrooves associated with severe periodontal defects in maxillary central incisors.

    BACKGROUND: This case report describes a rare condition of palatal radicular multigrooves on teeth 11 and 21 with severe periodontal defects and the findings at 3-year follow-up. METHOD: Radiculoplasty using hand curettes and rotary burs were used to remove the multigrooves on the root surfaces and change the wrinkled root form to the relatively flat and smooth normal root morphology. Minor tooth movement and frenotomy were performed for a diastema between teeth 11 and 21. Supportive periodontal therapy started immediately after completion of the active treatment. RESULTS: Improved healthy periodontal tissues and adequate plaque control have been maintained.
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7/45. Combined mechanical and antibiotic periodontal therapy in a case of Papillon-Lefevre syndrome.

    BACKGROUND: Papillon Lefevre syndrome (PLS) is a rare entity and, as such, it is almost impossible to evaluate an effective therapy in a randomized controlled study. The amount of success reported after therapy for prepubertal periodontitis (PP) in PLS is highly variable from case to case. The goal of this case report is to evaluate the effects of a combined mechanical and antibiotic periodontal therapy regimen in the management of PLS. methods: A male patient was diagnosed as suffering from PP associated with PLS at the age of 7 years. He showed hyperkeratosis of the palms and soles, as well as advanced periodontal disease already affecting permanent teeth with maximal probing depth and vertical attachment loss of 12 mm and 11 mm, respectively. Subgingival debridement was performed with simultaneous administration of oral 250 mg amoxicillin 3 times daily and 250 mg metronidazole twice daily for one week. Clinical parameters were assessed and subgingival plaque was collected from all teeth prior to therapy and 7 and 26 months after treatment. Selective cultures for A. actinomycetemcomitans were incubated for each individual tooth and DNA probe analysis was performed for various periodontal pathogens. RESULTS: Prior to combined mechanical and antibiotic treatment, all teeth but one harbored actinobacillus actinomycetemcomitans subgingivally. However, at 7 and 26 months after therapy A. actinomycetemcomitans could be detected neither by culture nor by dna probes. Clinical parameters improved markedly and teeth erupting after therapy did not exhibit attachment loss of more than 1.5 mm during the observation period. CONCLUSIONS: Eradication (suppression beneath detection levels) of A. actinomycetemcomitans seems to play a significant role in the successful treatment of localized prepubertal periodontitis in PLS.
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8/45. Subperiosteal connective tissue grafts for pocket reduction and preservation of gingival esthetics: a case report.

    BACKGROUND: Clinical studies and recent histological evidence following mucogingival surgery for the treatment of gingival recession have documented that when closely adapted to a previously exposed root surface, connective tissue is capable of forming a new attachment. Despite these findings, no clinical tests have been conducted to examine the ability of connective tissue to reduce probing depth (PD) and increase clinical attachment levels (CAL) when it is implanted into periodontal osseous defects. The purpose of this paper is to report the clinical results on a patient following 2 subperiosteal connective tissue grafts. methods: Subperiosteal connective tissue grafts were placed in 2 sites of periodontal bone loss and deep pocketing in one patient. Following flap reflection and root preparation, a connective tissue graft 1.5 to 2.0 mm in thickness was draped and sutured over each osseous defect and then completely covered by the external flap. RESULTS: Ten months following subperiosteal connective tissue grafting, tooth #7 had 4 mm of CAL gain. Tooth #10 had 3 mm of CAL gain 8 months postoperatively. Both teeth had 1 mm gain in gingival recession. Both teeth probed 3 mm postoperatively. CONCLUSIONS: When connective tissue was grafted into 2 periodontal osseous defects, there were significant reductions in probing depth and gains in CAL. There was minimal postoperative gingival recession. The new clinical attachment gain remained stable for 8 to 10 months following subperiosteal connective tissue grafting.
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9/45. Endodontic infection caused by localized aggressive periodontitis: a case report and bacteriologic evaluation.

    A rare case of a periodontally induced endodontic lesion in a systemically healthy subject of 28 years is described. The patient, having presented with severe attachment loss on the palatal and distal aspects of his maxillary right second premolar, was diagnosed with localized aggressive periodontitis. He had never received periodontal treatment. The tooth was nonvital and showed all signs of symptomatic apical periodontitis. It was also free of any restoration. All clinical findings clearly suggested that the endodontic problem was caused by the aggressive periodontal disease. Bacteriologic screening of the pocket and the root canal, by using "checkerboard" DNA-DNA hybridization analysis, revealed diverse flora in the periodontal lesion. The sample obtained from the root canal exhibited DNA from a limited number of species, including black-pigmented anaerobic rods. No bacterial DNA was found in the root canal that was not also recovered from the periodontal pocket.
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10/45. Treatment of a palatal-gingival groove using enamel matrix derivative.

    This case report demonstrates the treatment of a severe palatal-gingival groove on a maxillary lateral incisor. Periodontal surgery for tissue preservation and esthetics included odontoplasty, citric acid application, and the placement of porcine enamel matrix protein. At intervals up to 15 months postoperatively, the site remained free of signs of clinical inflammation and revealed a stable decrease of 8 mm to 9 mm in probing depth. This surgical procedure improved the long-term prognosis for this tooth from poor to excellent.
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