A case of generalized periodontitis who was successfully treated using a psychological approach followed up for 11 years

Abstract

: We report the case of a patient with periodontitis complicated by occlusal trauma who re-ceived initial therapy using a psychological approach, which was reinforced at every follow-up visit, regenerative therapy with enamel matrix derivative (EMD) and autogenous bone, and supportive periodontal therapy (SPT), and has been followed up for 11 years. The patient, a 55-year-old woman, visited the dental office complaining of inter-dental spaces in the anterior teeth. Examination revealed the following: bleeding on probing (BOP): 97%; probing depth (PD): 7 mm or more in 9 teeth; vertical bone resorption in the maxillary anterior teeth. Tooth mobility was ob-served for many teeth and the patient reported having a habit of clenching her teeth while working. We diagnosed the patient as having periodontitis with inflammation and occlusal trauma. Focusing on removal of the cause for periodontal treatment, we adopted a psychological approach for the initial therapy, a motivational approach, followed by Otaniʼs guidance and cognitive behavioral therapy for bruxism, and counseling about work-related stress reduction. After re-evaluation, periodontal surgery and oral rehabilitation were carried out, and an occlusal splint was provided as a countermeasure for bruxism, and self-implicit therapy under Ikedaʼs guidance as an-other psychological treatment. We have recalled the patient every 3 months after the transition to SPT, the psychological treatment was strengthened at every visit, and 11 years have passed favorably. From these results, introduction of a psychological approach to periodontal treatment seems ef-fective in improving the patientʼs motivation for treatment and enhancing the effects of treatment.