A protocol for achieving periodontal reattachment
B Y JUDY CARROLL, RDH, AND HOWARD M. NOTGARNIE, RDH, EDD
regeneration consists of two histologically identifiable improvements—cementum and connec-tive-tissue growth—and two
clinically identifiable improvements—bone growth and coronal
migration of the epithelial attachment.
7 Although SRP is often done
in preparation for surgery,
enhancing nonsurgical techniques
with a periodontal endoscope might
further improve outcomes while
decreasing costs and morbidity
when the surgical option can be
This case report documents a
nonsurgical protocol to achieve
reattachment of periodontal tissues
that had been lost to periodontitis.
The patient was 45 years old with at
least one known family member having
periodontitis. He had a normal level of
C-reactive protein ( 2.0 mg/L), slight
elevation of blood pressure (146/87
mmHg), low-density lipoproteins (130
mg/dL), and slight deficiencies of vitamin D and thyroxin. He used an appliance to control bruxism and had a
history of orthodontic treatment, although malocclusion was still present.
A periodontist had recommended
extraction of teeth Nos. 18 and 31,
which had vertical defects on the distal
surfaces (see Figure 1). On both teeth,
recession was less than 1 mm on all
surfaces, and pocket depths were at
least 7 mm on the buccal and distal
Chronic periodontitis is the most
common form of periodontitis, and
aggressive periodontitis causes rapid destruction of the supporting
structures of the teeth.
1 The chronic,
inflammatory nature of periodontitis is a likely mechanism that makes
it a risk factor for cardiovascular
3 and cancers
of the skin, breast, lung, esophagus,
4 From 2009 through
2012, periodontitis was present in
46% of US adults and severe peri-
odontitis in 8.9% of US adults.
mographic characteristics showing
an increased risk for periodontitis
were male, nonwhite, poor, unedu-
cated, and elderly.
5 Treatment of
periodontitis has been scaling and
root planing (SRP), surgical inter-
vention, and the use of chemother-
apeutic and biologic agents.
Traditional SRP followed by peri-
odontal surgery can save teeth and
regenerate periodontal structures
supporting those teeth.
Figure 1: Pre-treatment radiographs