Periodontal Infection: Case Study

May 29, 2023
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By: Dr. Jennifer Bell, DDS, FAGD, FICD

Have you ever had a patient with a periodontal infection?

Here is a case study of my experience with it.

patient information with periodontal infection

Periodontal Infection Patient Information:

  • The patient presented with CC of mobile lower #25
  • The patient reported mild pain but managing with NSAIDs
  • The patient is concerned that the lower tooth is going to fall out
  • There is localized swelling
  • No malaise, diffuse swelling, or pyrexia
periodontal infection

Periodontal Infection: Initial Patient Exam

Because radiolucency extended circumferentially around the apex of #25, the clinician suspected a periodontal/endodontic combination lesion.

periodontal infection next steps

Next Steps

Endodontic Origination:

  • Must complete vitality testing to include CO2, percussion, palpation, and EPT if possible to confirm the diagnosis.

Periodontal Origination:

  • Must complete periodontal probing, bleeding assessment, and radiographic analysis if possible.
  • Also not purulence or exudate to help determine the origin of the infection.
results

Results of Exams

The patient’s tooth tested vital with CO2 and EPT so the origin of the infection was determined to be periodontal in nature.

periodontal infection treatment options

Periodontal Infection Treatment Options

Extract the Tooth

  • Graft site
  • Periodontal splint using the natural tooth as pontic

Extract the Tooth

  • Graft site
  • Use essix or a flipper as a temporary pontic solution

Extract the Tooth

  • Graft site
  • No immediate temporization

Periodontal Surgery

  • Periodontal surgery of the area to attempt to save the tooth and consider orthodontics in the future to move the tooth back into the arch form.
    • LANAP
    • Traditional Bone guided regeneration surgery
treatment decision

Patient’s Treatment Decision

The patient elected to remove the tooth and use the natural tooth as pontic to include periodontal splinting of lower anterior teeth while we worked to stabilize her generalized periodontal condition.

periodontal infection treatment outcome

Periodontal Infection Treatment Outcome

  • Gross debridement of the calculus was completed in the area to improve the bonding of the splint.
  • Extraction of #25 completed.
  • Gross debridement of the socket to remove all granulation tissue and return the area to sound bone.
  • Placement of cortical/cancellous synthetic bone graft complete and sutured to primary closure.
  • Removed the root of #25 to fit back into the edentulous space.
  • Orthodontic wire and flowable composite bonded to the linguals of lower anterior teeth and pontic was added.

Up Next: Fractured Tooth Case Study

Dr. Jennifer Bell, DDS, FAGD, FICD

Dr. Jennifer Bell, DDS, FAGD, FICD

Dr. Jennifer Bell is a native of Lexington, North Carolina. She earned her undergraduate and dental graduate degrees from the University of North Carolina at Chapel Hill. Upon graduation, she completed the Advanced Education in General Dentistry program at the Veterans Administration Medical Center in Fayetteville, NC. In 2010, Dr. Bell along with her business partner started a general dentistry practice in Holly Springs, NC. They opened their second practice in Angier, NC in 2017. Their practices treat all ages and complexity of cases. Her main interests include rehabilitation cases, complex prosthodontic cases, laser dentistry, and sleep disorders. Dr. Bell has earned a fellowship from the Academy of General Dentistry (AGD) where she has served the North Carolina state chapter as president, committee chair, national delegate, and most recently as executive director. In addition to her work with the AGD, Dr. Bell is an active member in the American Dental Association, the North Carolina Dental Society, American Academy of Dental Sleep Medicine and a fellow in the International College of Dentists. In March 2018, she completed and graduated from the Kois Continuum in Seattle, WA. Outside of dentistry, Dr. Bell is active with Kiwanis International and other local philanthropic organizations in her community. Dr. Jennifer Bell is an innovative and fresh voice in the world of dentistry. She brings a unique perspective on digital innovation, practice management, team building, and leadership development through an engaging and interactive style. Dr. Bell is a frequent contributor to leading dental publications, speaks on a variety of relevant and timely topics, and co-hosts a popular, weekly dental industry podcast. Dr. Bell and her husband Brian reside in Holly Springs, NC with their three children.

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