International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 06 Issue 12, June, 2014

Pages: 64-71

Date of Publication: 23-Jun-2014


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AESTHETIC INTERDISCIPLINARY MANAGEMENT OF AGGRESSIVE PERIODONTITIS - A CASE REPORT

Author: Priyanka K. Cholan, P. Ragavi, P. Rajapriya, Mangaiyarkarasi Subramanian

Category: Healthcare

Abstract:Aggressive periodontitis is a type of periodontal disease and is further classified based on their etiology and pathogenesis as: Localized aggressive periodontitis (LAP) and Generalized aggressive periodontitis (GAP). GAP is characterized by generalized interproximal loss of attachmentinvolving at least three permanent teeth other than firstmolars and incisors. This case report describes the periodontal and the aesthetic management of a patient with generalized aggressive periodontitis.

Keywords: Aggressive periodontitis, flap surgery, implants, smile correction

Full Text:

INTRODUCTION

Aggressive periodontitis, as the name implies is a type of periodontitis where there is rapid destruction of periodontal ligament and alveolar bone which occurs in otherwise systemically to healthy individuals of a younger age group but older patients maybe rarely involved in it1,2 . Its etiology is highly correlated due to the presence of Aggregatibacteractionmycetemcomitans3 and host response defects and also possibly related to a genetic inheritance4 .Though there is no widely accepted treatment protocol for Generalised Aggressive periodontitis, this article presents the clinical management of the periodontal and esthetic aspects of a patient with aggressive periodontitis and smile designing for the same. Clinical relevance to interdisciplinary dentistry A multidisciplinary approach to provide improved aesthetics and function. A combinational approach by a team of periodontist, endodontist and prosthodontist helped in the periodontal and esthetic management of a patient with aggressive periodontitis. Management included full mouth flap debridement, implant placement and fixed prosthesis and aesthetic management of protruded teeth and facial profile.

CASE REPORT

A 24 year old female patient reported to the Department of Periodontics with the chief complaint of forwardly placed teethwith spacing which has increased over the years and bleeding gums for the past 6-7 years. The patient noticed the flaring of anterior teeth few years before, after which she noticed it to be gradually increasing and associated with intermittent episodes of gingival bleeding. There were no related complaints other than a cosmetic concern from the patient. Her medical history appeared non-contributory, as she was not taking any medication, referred no allergies, and had no history of episodic illness or orofacial trauma. Familial history reveals brother with mobile anterior teeth and periodontally compromised dentition. Clinical oral examination, showedgeneralised gingival recessionassociated with deep periodontal pockets as shown in tables I, II, III and IVwith Millers grade I mobility in 11,12,21,22,26,23,24,36,37,38,47 and Millers grade III mobility in 31,41,32 and 42 (Figure 1). The panoramic X-ray (Figure 2) and full mouth IOPAs revealed generalized moderate to severe bone loss which was a combination of both horizontal and vertical bone loss and the severity of bone loss in correlation to the age of the patient suggested a rapid rate of disease progression. The patient was referred for a complete medicalevaluation to rule out any underlying systemic disease. Her complete blood count was within normal limits, including basal glucose and creatinine levels. Absolute monocyte and neutrophil counts were slightly elevated. Due to the age of the patient, familial history, the severity of bone loss, the lack of a detectable systemic disease and rapid rate of disease progression, the diagnosis of Generalized Aggressive Periodontitis was made.Treatment plan was categorized under the following phases including non-surgical phase, surgical phase, restorative phaseand maintenance phase. The major challenges faced in treating this particular case were, compromised periodontal status with advanced attachment and bone loss, gingival recession, unaesthetic gingival display, proclined upper incisors and spacing between the teeth. The treatment options proposed wereorthognathic surgery, orthodontic treatment, rehabilitation with implants and endodontic treatment. The patient was reluctant for orthodontic treatment and orthognathic surgery, due to the prolonged duration of treatment and major surgery associated fear and anxiety. Hence a full mouth periodontal management with extraction of hopeless prognosis teeth and rehabilitation with implants with aesthetic endodontic correction was planned.

CASE DISCUSSION

The periodontal management included supragingival and subgingival scalingand root surface debridementand the patient was motivated for better plaque control. Full mouth disinfection with chlorhexidine gelsupplemented with systemic antimicrobial therapy was followed for a period of 8 days. The patient was recalled after 2 weeks for evaluation of the response to treatment5,6 . Persistent high bacterial counts and the presence of periodontal pathogens at surgery adversely affect clinical attachment level gains, meticulous initial therapy and good oral hygiene are considered to be prerequisites for successful periodontal surgery7 . In the surgical phase,a quadrant-wise full mouth flap debridement (Figure 3)was done with bone grafting in relation to upper and lower molar regions. Extraction of hopeless prognosis teeth 31, 32, 41, 42 were done with immediate implant placement. Life care implants 2.8×10 mmwas placed in relation to 32, 42 region (Figure 4)and temporary crowns were given.A postsurgical evaluation done 3 weeks later showed satisfactory healing and probing depths within normal limits. The patient was put on regular recall appointments for evaluation of the gingival and periodontal status and maintenance therapy. Since the patient was concerned about the esthetic appearance of the anterior teeth, she was advised to undergo aesthetic endodontic management. Targets to be achieved in Aesthetic management include: 1. Correction of labial proclination and spacing, which was done stepwise by targeting the required outcome of diastema closure 2. Reduction of theproclined upper incisors 3. Reduction of excessive incisal exposure 4. Rectification of the smile line8 In order to appropriately execute the treatment plan, proper pre-operative photographs were taken

(Figure 5) and awax mock up was done on the study cast (figure 6).9,10Duplication of the wax mock uphelped in both evaluating the possible treatment outcome and aided in providing the patient an understanding of the probable outcome of the treatment. It also helped in obtaining the template to provide proper temporaries during treatment course 9,11. Due to the excessive proclination, the tooth preparation in upper incisors would result in pulpal exposure which indeed led to the intentional root canal treatment for 11, 12, 21 and 22. The tooth preparation was done for full veneer crown in upper incisors 11, 12, 21 and 22 (figure 6). During the tooth preparation the proclination had to be reduced and the incisal height had to be decreased, so the tooth preparation was done more on the labial aspect. The incisal reduction was done excessively to reduce the crown height and the preparation margins were done above DEJ(dentinoenameljunction) inorder to reduce the excessive incisal exposure. The temporaries were given with the help of the available template for the upper incisors, the treatment outcome was evaluated and the high points, mainly canine recountouring was done for 33 and further adjustments were made on the temporaries. Following this an impression was taken with the temporaries which acted as a guide for the final porcelain fused metal crowns. Since the periodontal status was compromised, the full veneer crownsfor 11, 12, 21 and 22 were done as a single unit which acted as a splint supporting the mobile teeth. The permanent crowns were then luted in place with type 2 GIC (figure 7). This case was followed upto two years to evaluate any relapse or further bone resorption is related to rehabilitation of teeth resulted in full satisfaction.

CONCLUSION

Even though the occurrence of aggressive periodontitis is much lower than the chronic Periodontitis, the management ofaggressive periodontitis is more demanding compared to that of chronic periodontitis because of its strong geneticpredisposition as an unmodifiable risk factor. In the present scenario the key to a wholesome management of aggressive periodontitis lies in the early diagnosis of the disease process, rigorous treatment modalities and scrupulous life- long maintenance therapy.

References:

REFERENCES

1. Armitage G C. Development of a classification system for periodontal diseases and conditions.AnnPeriodontol 1999;4:1-6.

2. American Academy of Periodontology, “Parameter on aggressive periodontitis,” Journal of Periodontology, 2000:71(5): 867– 869.

3. Fine DH, Markowitz K, Furgang D, Fairlie K, Ferrandiz J, Nasri C, et al. Aggregatibacteractinomycetemcomitans and its relationship to initiation of localized aggressive periodontitis: longitudinal cohort study of initially healthy adolescents. J ClinMicrobiol 2007;45:3859-69.

4. Kinane DF, Shiba H, Hart TC. The genetic basis of periodontitis. Periodontol 2000 2005;39:91-117.

5. M. G. Jorgensen and J. Slots, “Practical antimicrobial periodontal therapy,” Compendium of Continuing Education inDentistry, 2000;21(2):111–124.

6. Roshna Tand Nandakumar K. Generalized aggressive periodontitis and its treatment options:case reports and review of the literature. Case reports in medicine October 2012, Article ID 535321. 

7. Jung M H, Park J W, Suh J Y and Lee J M. Clinical case report on treatment of generalized aggressive periodontitis. J Periodontal Implant Sci 2010;40:249-253.

8. Goldstein RE. Esthetics in Dentistry.Philadelphia, PA: JB Lippincott Co 1976:7.

9. Davis N C. Smile Design. Dent Clin N Am 2007;51:299-318

10. Bhuvaneswaran M. Principles of smile design.J Conserv Dent 2010;13:225-32

11. Harry F. Albers. Tooth - colored restoratives: Principles and Techniques, Ninth edition.

12. Goldstein RE. Esthetics in Dentistry.Philadelphia, PA: JB Lippincott Co 1976:7.

13. Chalifoux PR. Anterior porcelain veneers, three-quarter crowns, and full crowns. Contemporary Esthetics and Restorative Practice. 1998;2(1):52-61.

14. Kinsel R P, Capoferri D.Full crowns in the esthetic zone.Dental Dialogue 2005; Volume 5(4). 15. Abbott SJ. Metal-ceramic restorations. Adv Dent Res. 2003;17:55-60.

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


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A Study by Humaira Tahir et al. entitled "Comparison of First Analgesic Demand after Major Surgeries of Obstetrics and Gynecology between Pre-Emptive Versus Intra-Operative Groups by Using Intravenous Paracetamol: A Cross-Sectional Study" is awarded Best Article for Vol 14 issue 14
A Study by Monica K. entitled "Risk Predictors for Lymphoma Development in Sjogren Syndrome - A Systematic Review" is awarded Best Article for Vol 14 issue 13
A Study by Mokhtar M Sh et al. entitled "Prevalence of Hospital Mortality of Critically Ill Elderly Patients" is awarded Best Article for Vol 14 issue 12
A Study by Vidya S. Bhat et al. entitled "Effect of an Indigenous Cleanser on the Microbial Biofilm on Acrylic Denture Base - A Pilot Study" is awarded Best Article for Vol 14 issue 11
A Study by Pandya S. et al. entitled "Acute and 28-Day Repeated Dose Subacute Toxicological Evaluation of Coroprotect Tablet in Rodents" is awarded Best Article for Vol 14 issue 10
A Study by Muhammad Zaki et al. entitled "Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study" is awarded Best Article for Vol 14 issue 09
A Study by Vinita S & Ayushi S entitled "Role of Colour Doppler and Transvaginal Sonography for diagnosis of endometrial pathology in women presenting with Abnormal Uterine Bleeding" is awarded Best Article for Vol 14 issue 08
A Study by Prabhu A et al. entitled "Awareness of Common Eye Conditions among the ASHA (Accredited Social Health Activist) Workers in the Rural Communities of Udupi District- A Pilot Study" is awarded Best Article for Vol 14 issue 07
A Study by Divya MP et al. entitled "Non-Echoplanar Diffusion-Weighted Imaging and 3D Fiesta Magnetic Resonance Imaging Sequences with High Resolution Computed Tomography Temporal Bone in Assessment and Predicting the Outcome of Chronic Suppurative Otitis Media with Cholesteatoma" is awarded Best Article for Vol 14 issue 06
A Study by Zahoor Illahi Soomro et al. entitled "Functional Outcomes of Fracture Distal Radius after Fixation with Two Different Plates: A Retrospective Comparative Study" is awarded Best Article for Vol 14 issue 05
A Study by Ajai KG & Athira KN entitled "Patients’ Gratification Towards Service Delivery Among Government Hospitals with Particular Orientation Towards Primary Health Centres" is awarded Best Article for Vol 14 issue 04
A Study by Mbungu Mulaila AP et al. entitled "Ovarian Pregnancy in Kindu City, D.R. Congo - A Case Report" is awarded Best Article for Vol 14 issue 03
A Study by Maryam MJ et al. entitled "Evaluation Serum Chemerin and Visfatin Levels with Rheumatoid Arthritis: Possible Diagnostic Biomarkers" is awarded Best Article for Vol 14 issue 02
A Study by Shanthan KR et al. entitled "Comparison of Ultrasound Guided Versus Nerve Stimulator Guided Technique of Supraclavicular Brachial Plexus Block in Patients Undergoing Upper Limb Surgeries" is awarded Best Article for Vol 14 issue 01
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A Study by Manoj KP et al. entitled "A Randomized Comparative Clinical Trial to Know the Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block Against Multimodal Analgesia for Postoperative Analgesia Following Caesarean Section" is awarded Best Article Award of Vol 13 issue 23
A Study by Karimova II et al. entitled "Changes in the Activity of Intestinal Carbohydrases in Alloxan-Induced Diabetic Rats and Their Correction with Prenalon" is awarded Best Article of Vol 13 issue 22
A Study by Ashish B Roge et al. entitled "Development, Validation of RP-HPLC Method and GC MS Analysis of Desloratadine HCL and It’s Degradation Products" is awarded Best Article of Vol 13 issue 21
A Study by Isha Gaurav et al. entitled "Association of ABO Blood Group with Oral Cancer and Precancer – A Case-control Study" is awarded Best Article for Vol 13 issue 20
A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
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A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
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A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
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A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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