DTUK1110

W hen deciding how to deal with a periodon- tally compromised tooth in a clinical situation, there are a number of factors to take into consideration. These not only include the prognosis of both the affected tooth and ad- jacent teeth, but also the peri- odontal stability of the rest of the mouth, all of which play an important factor in deciding whether to treat the tooth or to go ahead with the placement of implants. Other vital factors to remember are the patient’s bone dimensions, their financial re- strictions, and any cosmetic im- plications of treatment. Early treatment It is widely accepted among den- tists that teeth affected by peri- odontal disease are unreliable in the long-term, meaning that if implant therapy is a considera- tion, it should be carried out as early as possible. Implant therapy is regar- ded as a safe and reliable met- hod in the treatment of com- plete and partial endentulism, however, it is also associated with technical and/or biologi- cal complications, such as peri- implantitis. This significant and not infrequent complication can result in bone and implant loss, and seems to be more prev- alent in periodontally compro- mised patients. In my view, treatment de- cisions should be based upon scientific evidence. However, there is a lack of data to act as a guideline for our choice of strat- egy, and we are all guilty of be- ing biased by our own clinical experience! Our common sense will often lead us to deal with clinical issues only within our ‘comfort zone’. The following article presents a case that presented with extremely severe general- ised chronic periodontal disease that clearly needed restorative treatment and periodontal man- agement. The case has been fol- lowed for eight years, which is a reasonable time to evaluate its long-term outcomes. The Case This patient was a 47-year-old male in good general health. He complained of tooth mobil- ity (particularly tooth 11), which had triggered his visit to the den- tist. As a temporary measure, his dentist had splinted the tooth (Fig 1). Upon examination, dramatic bone loss could be seen (Fig 2) with deep pockets and bleeding on probing (BOP) in all areas. No previous periodontal treatment was reported other than occa- sional ‘scaling and polishing’, and his oral hygiene was fair. The perio-implant interface Periodontal therapy not only promotes good oral health, it is also the cornerstone for excellent cosmetic dentistry, says Dr Jose Zurdo 19ClinicalApril 26-May 2, 2010United Kingdom Edition ESTETICA E80 Rise above the rest with KaVo. • Outstanding ergonomics and attractive, highly functional designs. • Innovation at its best. • State of the art technology reliability and functionality at amazingly low prices. From as little as £286* per month excl VAT KaVo Dental Limited · Raans Road, Amersham, Bucks HP6 6JL Tel. 01494 733000 · Fax 01494 431168 · mail: sales@kavo.com · www.kavo.com Contact your local KaVo or Gendex supplier for more details! *Finance is subject to status and for business purposes only. KaVo – Dental Excellence Estetica A4 SELECTED:Layout 1 25/2/09 13:42 Page 1 ‘There is a lack of data to act as a guideline for our choice of strategy’ page 20DTà Fig1