A 59-year-old, non-smoking female patient was referred to me for periodontal evaluation. Her medical condition includes high blood pressure controlled with medications including bisoprolol fumarate, chlorothiazide, and vitamin D. She is allergic to lisinopril. The patient was never previously diagnosed with periodontal disease. She was undergoing Invisalign treatment and noticed mobility on her lower left teeth. The Invisalign treatment was paused, and she was referred to our office.
Tooth #18 had a 7mm probing depth on the mesiobuccal aspect and 6mm on the mesiolingual aspect. There was a clinical probing depth of 9mm on the distobuccal and distolingual aspects of tooth #19. Distal of tooth #19 had a vertical defect and exhibited class II buccal furcation, grade I mobility, and bleeding on probing.
Localized LAR (laser-assisted regeneration) treatment using the LANAP protocol steps was conducted using the PerioLase® MVP-7™ dental laser. The settings used were: 1) ablation – 4.0W/100μs/200mj/20Hz – 257J and 2) hemostasis –4.0W/650μs/200mj/20Hz – 45J. An occlusal adjustment was performed on tooth #19. Post-op antibiotics were prescribed.
The patient returned for a follow-up visit after two weeks. Additional instructions were provided on how to brush and keep the area clean. Periodontal maintenance cleanings were conducted post-op at three months and at six months. The clinical probing depth on the distobuccal aspect of tooth #19 was now 4mm (previously 9mm) with no bleeding on probing. The tooth now had no mobility. Tooth #19 now has a class I furcation (previously was class II). The rest of the areas probed were 3-4 mm.
The patient was extremely happy she did not lose tooth #19! She was scheduled for three-month recall appointments and will be able to resume her Invisalign treatment.
Rupa Hamal, DMD, MS, MPH
A practicing periodontist since 2002, Dr. Rupa Hamal is a Diplomate to the American Board of Periodontology and was formerly Assistant Clinical Professor
at the College of Dentistry, The Ohio State University. She earned her Doctor of Dental Medicine from the University of Pennsylvania, Certificate of Periodontics
and Master of Public Health from The Ohio State University, and Master of Science from the University of Alabama at Birmingham.
She has extensive experience with periodontal surgery, dental implants, extractions, laser surgery, and treatment of medically compromised patients. Dr. Hamal is a member of Omicron Kappa Upsilon and practices at Premier Periodontics and Implant Dentistry in Gahanna, OH.