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