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Case Study
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Solving a Complex Periodontal Case via Interdisciplinary Care

Learning Objectives: 

Upon completing a review of this case study, the reader should:

  • Understand the importance of interdisciplinary approaches to modern dentistry
  • Understand how conservative interdisciplinary methods might be preferable in some cases

 

In most developed countries of the world, the dental IQ of the average patient has increased considerably over the last decades and they expect dental solutions that restore function as well as health, aesthetics, and self-esteem. Dentistry itself has evolved from the aggressive and resective procedures of the past which, by contemporary standards, can seem imprecise and invasive. There is now ample evidence that periodontal disease can be reversed in the majority of instances, and that teeth—with proper maintenance—can be maintained for many years in health, function, and comfort, even when severely affected. The origins of periodontitis – which is defined as inflammation and infection of the ligaments and bones that support the teeth – and the role of the known risk factors are much better understood. Innovative surgical approaches allow periodontists to regain support and restore tissue in affected areas. Additionally, the development and success of osseointegrated implants anchored directly into bone have facilitated the restorative aspects of treatment. 

To address the aesthetic expectations of today’s patient, the clinician should consider moderate-to-severe periodontitis more frequently, and understand how it impacts to the desired outcome—particularly in the aesthetic zone. Hence, orthodontics must be included in the treatment plan. Once primarily associated with adolescent patients, orthodontic treatment has become common among a significant proportion of adults. 

Consequently, dentistry needs to develop an interdisciplinary approach to treatment for such cases and put together a dental team that includes specialists as well as auxiliaries with similar philosophies and skills. The participating practitioners need to convey the benefits of embarking on a comprehensive, extensive, time consuming, and occasionally expensive treatment to the patient. Once completed, however, satisfaction with the results combined with improved self-esteem and a positive response from others will make the cost and process worthwhile for the patient. 

This extensive and comprehensive multidisciplinary treatment has permitted the resolution of a severely compromised patient with a conservative approach. All of the patient’s teeth were maintained, and the health of the remaining periodontium was preserved. The patient was pleased with the aesthetics achieved and thankful for the services provided by the members of the restorative team. Function, stability, and aesthetics have been achieved, and the patient’s self-esteem has been reaffirmed. 

 

*Private practice, Pamplona, Navarra, Spain.

  

Related Reading: 

  1. Chace R, Low SB. Survival characteristics of periodontally-involved teeth: A 40-year study. J Periodontol 1993;64:701-705. 
  2. Wojcik MS, DeVore CH, Beck FM, et al. Retained “hopeless” teeth: Lack of effect periodontally-treated teeth have on the proximal periodontium of adjacent teeth 8-years later. J Periodontol 1992;63:663-666. 
  3. Kokich VG. Managing complex orthodontic problems: The use of implants for anchorage. Semin Orthod 1996;2:153-160. 
  4. Melsen B, Agerbaek N, Eriksen J, Terp S. New attachment through periodontal treatment and orthodontic intrusion. Am J Orthod Dentofacial Orthop 1988;94:104-116. 
  5. Salama H, Salama M. The role of orthodontic extrusive remodeling in the enhancement of soft and hard tissue profiles prior to implant placement: A systematic approach to the management of extraction site defects. J Periodont Rest Dent 1993;13:313-333.  
  6. Wennström J, Lindhe J, Sinclair F, el al. Some periodontal tissue reactions to orthodontic tooth movement in monkeys. J Clin Periodontol 1987;14:121-129. 
  7. Sada-Garralda V, Caffesse RG. Enfoque ortodóncico en el tratamiento multidisciplinario de pacientes adultos. Su relacion con la periodoncia. Revista del Consejo de Odontólogos y Estomatólogos de España 2003;8(6):673-684. 
  8. Sada-Garralda V, Caffesse RG. Enfoque ortodóncico en el tratamiento multidisciplinario de pacientes adultos. Su relación con implantes y prostodoncia. Revista del Consejo de Odontólogos y Estomatólogos de España 2004;9(2):195-207. 
  9. Smalley WM. Implants for tooth movement: Determining implant location and orientation. J Esthet Dent 1995;7:62-72. 
  10. Tarnow D, Magner A, Fletcher P. The effect of the distance from the contact point to the crest of bone on the presence or absence of the interproximal dental papilla. J Periodontol 1992;63:995-996. 
  11. Magne P, Perrond R, Hodges JS, Belser U. Clinical performance of novel-design porcelain veneers for the recovery of coronal volume and length. Int J Periodont Rest Dent 2000;20:441-457. 
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