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Dr. Pierpaolo Cortellini - What would you do?

A clinical question by Dr. Pierpaolo Cortellini (http://www.tangramodis.it/corsi_frame_centrale.php here’s the info about the new Perio-IT 11 Periodontology and Dental Implantology Training Course). Today we show you the first part of the case with the initial situation, the situation after cause-related therapy and the periapical X-ray. Starting from tomorrow we will focus on 4 specific clinical situations related to this patient and you’ll decide the additional surgical treatment!
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Let's focus on four clinical situations and decide the additional surgical treatment: extraction, flap surgery, resective surgery, regenerative surgery? Fig. 2. - Teeth #27-28. 360° pockets, from 9mm to 13mm, furcation involvements and degree II mobility. Tooth #28 is necrotic.

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Fig. 5. Tooth # 36. Pocket 6mm deep on the distal side associated with an intrabony defect. Normal mobility. No furcation involvement.

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Fig. 4. Tooth # 16. Pocket 7mm deep on the distal side associated with 5mm recession. Degree II distal furcation and degree I vestibular furcation. Degree I mobility.

Fig. 3. Teeth #47 and 46. Periodontal probing: from 4mm to 6mm associated with a bone crater. No teeth mobility. No furcation involvement.

Clinical question: what kind of surgery after cause-related therapy? Fig. 1. 62 years old patient. Generalized moderate to severe chronic periodontal disease, non-smoker, no family history of periodontitis, good systemic health, very poor oral hygiene (FMPS 78%, FMBS 85%, 99 pockets 5mm or deeper). Cause-related therapy.Significant improvement after cause-related therapy (FMPS 5%, FMBS 8%, 18 residual pockets 5mm or deeper)The periapical X-ray status shows the main problems of the patient