minocycline and Furcation-Defects

Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. Baseline examination revealed generalized plaque deposition and gingival inflammation. Thirty-nine percent of the sites had a probing depth (PD) of 4-6 mm and 2% a PD of ≥7 mm; 63% exhibited bleeding on probing (BOP). Radiographic examination revealed vertical bone loss in the molars and horizontal bone loss in other teeth. Microbiological examination of subgingival plaque revealed the presence of Aggregatibacter actinomycetemcomitans and Tannerella forsythia. Oral health-related quality of life was assessed as a measure of patient-reported outcome. Based on a clinical diagnosis of generalized aggressive periodontitis, initial periodontal therapy and adjunct antimicrobial therapy were implemented. After reducing inflammation and subgingival bacteria, open flap debridement was performed for teeth with a PD of ≥4 mm. Reevaluation showed no sites with a PD of ≥5 mm, a minimal level of BOP, and a marked reduction in the level of the targeted periodontal pathogens. The patient's oral health-related quality of life was slightly worsened during supportive periodontal therapy (SPT). Implementation of adjunct antimicrobial therapy targeting periodontal pathogens and subsequent periodontal surgery resulted in improvement in periodontal and microbiological parameters. This improvement has been adequately maintained over a 2-year period. However, additional care is necessary to further improve the patient's oral health-related quality of life during SPT.

Topics: Adult; Aggregatibacter actinomycetemcomitans; Aggressive Periodontitis; Aluminum Compounds; Alveolar Bone Loss; Anti-Bacterial Agents; Chemotherapy, Adjuvant; Cuspid; Dental Enamel Proteins; Dental Plaque; Dental Plaque Index; Dentin Sensitivity; Female; Fluorides; Furcation Defects; Gingival Recession; Gingivitis; Gram-Negative Bacterial Infections; Humans; Malocclusion; Minocycline; Molar; Oral Hygiene; Pasteurellaceae Infections; Patient Care Planning; Periodontal Debridement; Periodontal Index; Periodontal Pocket; Quality of Life; Silicon Compounds; Tannerella forsythia; Tokyo; Treatment Refusal

This case report demonstrates orthodontic and regenerative combined therapy in a 49-year-old male whose right maxillary premolar furcation had a bony defect with poor biologic width resulting from extensive subgingival caries. In these advanced interdisciplinary cases, crown lengthening with periodontal surgery alone does not solve the complex clinical problems. We believe that a combined orthodontic and periodontal regenerative combination therapy offers the best option for achieving a predictable outcome.. First, regenerative therapy by open debridement with a bioabsorbable synthetic bone graft, bioabsorbable membrane, and minocycline root conditioning was carried out. Eight weeks after initial surgery, orthodontic extrusion was initiated.. Radiographs and reentry documentation suggest that the furcation defect associated with poor biologic width was successfully treated.. This case report demonstrates that orthodontic-regenerative combined therapy can resolve complex clinical problems and enhance predictability.

Topics: Absorbable Implants; Bone Regeneration; Bone Substitutes; Crown Lengthening; Furcation Defects; Glass; Guided Tissue Regeneration, Periodontal; Humans; Male; Maxilla; Membranes, Artificial; Middle Aged; Minocycline; Molar; Oral Surgical Procedures; Patient Care Team; Surgical Flaps; Tooth Movement Techniques