Perio Pockets

This is not a “Terminal Dentition.”‍

It is interesting to see the increase in patients being advised that Periodontitis is not treatable or that treatment is somehow expensive and ongoing maintenance is difficult/unachievable. These patients are usually advised to receive implant treatment as an alternative.

This patient first presented in 2016 at the age of 33 years. He was a former smoker (quit two years prior to the initial presentation). He presented with generalised deep pocketing and advanced loss of attachment.

Radiographic assessment showed generalised moderate to advanced bone loss with most teeth showing bone loss to more than 50% of the root length. Given the established loss of attachment in relation to his relatively young age, this patient was diagnosed with generalised aggressive periodontitis. According to the 2017 Classification of Periodontal Disease, he would be Stage III, Grade C Periodontitis.

The patient was managed with non-surgical periodontal debridement. Two months later, he presented with an encouraging reduction in periodontal probing depth (PPD). There were 85% sites with PPD 1-3mm, 15% sites with PPD 4-5mm and no sites with residual PPD > 6mm. The patient showed excellent plaque control measures and his bleeding on probing score was 1%. The patient has been placed on a six-monthly periodontal maintenance program with the periodontist. He also sees his general dentist once annually. The OPG images dated 2016 and 2023 show stable bone levels with no evidence of further bone loss.

The patient had orthodontic treatment between 2018-2020 to address the flaring and spacing of his teeth, which was a cosmetic concern to him (orthodontic treatment done by Dr Frank Furfaro).

Long-term evidence shows that we, as dental clinicians, are not accurate at determining the prognosis of periodontally compromised teeth (McGuire 1996). We may also be hasty at labelling such teeth as “hopeless”. The threshold at which we decide to extract teeth due to periodontal disease may be too low (Splieth 2002). There is no evidence on the other hand that dental implants have longer survival or less complications or better cost compared to periodontally treated teeth.

I conclude with these two quotes:

"The belief of implants yielding a better long-term prognosis has now clearly been rejected in several comparative studies and systematic reviews”.
‍Giannobile 2016

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“In no way does the longevity of oral implants surpass that of natural teeth even of those that are compromised for periodontal reasons”.
Holm-Pederson 2007

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