Treatment of Stage III Grade C Periodontitis With Smoking Cessation Care and Periodontal Surgery Including Regenerative Therapy: A Case Report With a Two-Year Follow-Up

TL;DR

A 41-year-old man with severe periodontitis improved significantly after a two-year treatment combining smoking cessation and surgical periodontal care.

Contribution

This case report demonstrates the effectiveness of integrating smoking cessation and regenerative periodontal surgery in treating severe periodontitis.

Findings

The patient achieved smoking cessation and showed periodontal stability over two years.

Periodontal therapy significantly improved the patient's oral health-related quality of life.

Regenerative treatments like rhFGF-2 and GTR helped reduce periodontal pockets and improve bone support.

Abstract

We report a case of generalized chronic periodontitis requiring periodontal treatment, including smoking cessation care and surgical procedures. With a chief complaint of swelling and pain in the gingiva around #47, a 41-year-old man visited the Tokyo Dental College Suidobashi Hospital. The patient had been smoking cigarettes for 31 years. The initial periodontal examination identified a probing depth (PD) of ≥4 mm in 72.6% of sites and bleeding on probing (BOP) in 45.2% of sites. Radiographic examination demonstrated bone resorption extending to the root apex in #37 and 47, angular bone resorption in #17 and 24, furcation radiolucency in #17, 27, 37, and 47, and horizontal resorption in other areas. Following the clinical diagnosis of stage III grade C periodontitis, non-surgical therapy consisting of smoking cessation care, plaque control, scaling and root planing (SRP), and placement of occlusal splint was performed. Teeth #37 and 47 were extracted due to bone resorption extending to the root apex. The patient had achieved smoking cessation by the end of the non-surgical therapy. Subsequently, surgical periodontal treatment was performed at the selected site. Periodontal regenerative therapy using recombinant human fibroblast growth factor (rhFGF)-2 was carried out for #14 and 24. Guided tissue regeneration (GTR) was implemented for #17. Open flap debridement was performed in #16, 23, 25, 26, and 27 to facilitate the reduction of periodontal pockets. Following periodontal re-evaluation, supportive periodontal therapy (SPT) was initiated. The patient maintained smoking cessation after the non-surgical therapy, and periodontal stability was observed over a two-year period. Periodontal therapy contributed to a marked improvement in the patient’s oral health-related quality of life.

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