DTUK1110

After lengthy discussions about the patient’s prognosis and treatment options, his wish to avoid removable prosthesis was made quite clear, although his cosmetic demands were low. Extensive implant treatment was beyond the patient’s financial means, but he would consider short arch dentition. A full clinical examination was carried out to evaluate the extent and severity of the dis- ease (pockets, bleeding, mobil- ity, etc). Initial periodontal ther- apy included the removal of the ‘hopeless’ remaining molars and tooth 11 (root resection). All re- maining single-rooted teeth, regarded initially as having a ‘questionable’ prognosis, were subject to a course of non-surgi- cal periodontal therapy. Despite the im- pressive radiograph- ic appearance of dra- matically advanced bone loss, the general mobility following initial therapy was degree 1 and all teeth were functionally sta- ble. Generally, bleed- ing and pockets im- proved substantially, however a number of sites in the lower jaw still presented deep pockets that responded well to periodontal surgeries (Fig 3). Once full per- iodontal stability was obtained (absence of pockets >4mm, neg- ligible presence of BOP, good OH and physiological mobility), a strict maintenance programme was designed to prevent reoccurrence of the dis- ease (Fig 4 & 5). Subsequently, an implant was installed at 11 with si- multaneous connective tissue graft to improve the quality of the soft tissue seal (Fig 6 & 7). The implant was restored three months later with a ceme- nted porcelain-bonded crown over a cast-to abutment (Fig 8). The patient has been follo- wed for eight years without any significant change to his periodontal and perio-implant condition (Fig 9). The only relevant observation was the deterioration of the conve- ntional fillings present in the anterior region that were getting old and needed replacement. Points for discussion This case illustrates the potential of structured periodontal ther- apy (conventional non-surgical therapy plus localised correc- tive surgical treatment and long- term care) to change the progno- sis of very compromised teeth in a highly motivated patient. The prognosis of teeth is not only dependent on the amount of bone that has been lost – and more importantly, what is left – but also the ability to prevent further bone loss. Both the pa- tient’s wishes and local or ana- tomical factors will influence the dentist’s chances of controlling the disease. Despite this, it is very well documented that in the majo- rity of cases periodontal ther- apy can be quite predictable. The feeling of inevitability that spreads among patients, and the sense that the battle has already been lost, is in many cases, unjustified. Although often overlooked, periodontal tissues cannot be ig- nored. As patients become more knowledgeable and discern- ing, it is increasingly important to update our skills in this area of treatment and provide a first class service for all. DT About the author José Zurdo has extensive experi- ence of general and specialist practice. After graduating in Medicine (Bilbao, 1983) and General Dentistry (Barce- lona, 1986) he com- pleted a Masters in Implantology (NYUCD, 1995), a Preceptorship in Periodontics (Hou- ston, 1999) and an MSc in Periodontics at the University of Gothenburg (2002) with the approval of the European Fed- eration of Periodontology. The Swedish Board of Health and Welfare recog- nised him as a Specialist in Clinical Periodontology in 2002. José currently runs popular, hands-on periodontal courses and study groups for all den- tists interested in extending their skills in this area. He is running courses at the DARE training centre in Manches- ter. Please contact Suzanne@daretobe- dental.com or call 0161 830 7300 for more information. April 26-May 2, 2010United Kingdom Edition FenderMate® is a trademark registered by Directa AB. Registered Design and Patent pending. Form Contact Point Flexible wing exerts pressure for maintained separation and cervical adaption Inserts like a wedge Tight cervical marginal adaptation prevents overhangs World’s Fastest Composite Matrix? 3108-1001©DirectaAB Matrix Distributed in the UK by Trycare, Tel. 01274-88 10 44 More Designs by Dentists www.directadental.com FenderMate tryKit for only £ 9.00* (value £ 26.00) *Redeemable against your next purchase of FenderMate. Promotion code DP02 to be mentioned on order. page 19DTß ‘it is increasingly important to update our skills in this area of treatment and provide a first class service for all’ Fig2 Fig3 Fig4 Fig5 Fig8 Fig9 Fig6 Fig7