By: Victor M. Sternberg, D.M.D.
June 13, 2022
Twenty-one years ago a patient presented with severe periodontitis as you can see on the radiographs.
At that time she was a woman 41 years old. She wanted desperately to hold on to her teeth and was willing to commit to whatever regimen of oral hygiene and frequent maintenance that would be necessary. One could have easily made a case for taking out all the maxillary posterior teeth. If she wanted permanent restoration she would require sinus lifts bilaterally and multiple implants. In the mandible there certainly was the need for periodontal surgery and/or even extraction of tooth #30 and perhaps also tooth #18. Periodontal surgery was performed in 2001.
However, the patient's commitment to frequent maintenance and meticulous oral hygiene has now resulted, twenty-on years later, with the maintenance of every tooth she started with having an even better radiographic profile.
In addition, periodic cultures were done and when the bacterial flora was of concern we provided appropriate targeted systemic antibiotics.
Food For Thought - You need to have the right patient with a significant commitment.
Also to be considered, given this patient's propensity to develop severe periodontitis, there was no guarantee that implants would not develop severe peri-implantitis.
Another case, where implants were placed in NYC 10 years prior to her visit here. She had a history of severe periodontitis.
After one year of maintenance the implants became unstable.
They were all easily removed. Obviously this is not the norm, but implants are not bulletproof. When peri-implantitis becomes evident they are more challenging to treat than teeth.
Food For Thought - Maintaining teeth in a state of health had been the mission of dentistry.
As always I appreciate your feedback.
Victor M. Sternberg, D.M.D.
By Westchester Center for Periodontal & Implant Excellence
February 7, 2023