Periodontal Regenerative Therapy with Enamel Matrix Derivative and Autogenous Bone Graft in Patient with Chronic Periodontitis: An 18-month Follow-up Report.

Abstract

We report a case of generalized chronic periodontitis requiring periodontal treatment including regenerative therapy. The patient was a 57-year-old who man presented with the chief complaint of gingival swelling and mobile teeth in the right maxillary molar region. An initial examination revealed 55.3% of sites with a probing depth of ≥4 mm and 24.0% with bleeding on probing. Radiographic examination revealed vertical bone resorption in teeth #16, 17, 25, 26, 37, and 45; horizontal resorption was also noted in other areas. Based on a clinical diagnosis of severe chronic periodontitis, initial periodontal therapy consisting of plaque control, scaling and root planing, and caries treatment was performed. Both #16 and 17 were extracted due to bone resorption extending as far as the root apex. A removable partial denture was placed for #16 and 17, and a provisional restoration for #25 and 26. Surgical periodontal therapy was subsequently performed at selected sites. Periodontal regenerative therapy using enamel matrix derivative (EMD) with autogenous bone graft (ABG) was performed on #25 and 26. Other sites with residual periodontal pockets (#31, 32, 33, 36, 37, and 41) were treated by open flap debridement. Following reevaluation, full metal crowns (#25 and 26) and the removable partial denture were placed for #16, 17, 46, and 47. After further reevaluation, the patient was placed on supportive periodontal therapy (SPT). Periodontal regenerative therapy using EMD with ABG resulted in improvement in vertical bone resorption. This improvement has been adequately maintained over an 18-month period. The patient has continued to have some minor problems in occlusal contact and guidance following active therapy, however. Therefore, additional care will be necessary to maintain stable periodontal conditions during SPT.