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    1. Dental Hygiene
    2. Clinical Hygiene

    Case study: use of perioscopy and LANAP for treatment of advanced periodontal disease

    Aug. 1, 2012
    A case study conducted by Suzanne Newkirk, RDH, and Robert Gottlieb, DDS, presents the findings for a patient with advanced periodontal disease that indicated a combination treatment plan of perioscopy and LANAP.

    Case #3 depicts a patient with extremely advanced periodontal disease with a history of FM osseous surgery 25 years previously.
    His PreViser Risk analysis and clinical findings dictate a surgical treatment plan.

    Case #3:
    Perioscopy by Suzanne Newkirk, RDH
    LANAP surgery by Dr. Robert Gottlieb
    Male age 70
    No social habits
    Medical History:
    Arthritis, high cholesterol, gastroesophageal reflux disease (GERD)
    Medications:
    Motrin (OTC) as needed for arthritis, Simvastatin daily for cholesterol, Omeprazole for GERD as needed
    Chief Complaint: Has had periodontal disease his entire adult life
    PreViser Risk Analysis:
    Risk Score 4
    Disease State 99

    Periodontal Clinical Findings
    •Advanced periodontal inflammation
    • Moderate to advanced sulcular bleeding and suppuration
    •Many advanced pockets >6mm
    • Missing teeth; 1,16,17,19,25,32

    •Local Factors •Supragingival calculus - slight to moderate deposits •Subgingival calculus – moderate to heavy deposits in the deepest pocketsDiagnosis •Generalized advanced chronic periodontitisRecommended treatment plan: • Improved oral hygiene. • Scaling and root planing with Perioscopy in conjunction with LANAP surgery • Evaluation for future extractions and implants due to the very guarded prognosis of teeth #’s: 2,3,18, and 26 • Occlusal therapy • Possible orthodontic therapy • 3 month supportive periodontal maintenance in the periodontal office for a minimum of 1 yearUR Pre Tx
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    Pockets 4-9mm Class ll furcation involvement in both molars, possible endo abscess #3, (tooth is asymptomatic)

    LR Pre Tx
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    Pockets: 4-8mm

    LA Pre-Tx
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    Pockets 5-8mm.
    Severe bone loss #26, 8mm DF, 5mm straight facial, +2 mobility

    UL Pre Tx
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    Pockets 4-7mm Possible periapical abscess #15

    LL Pre Tx
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    PC 4-12mm, Class lll buccal and lingual furcation
    Possible endodontic abscess #18

    Treatment 5/12/2011 FM Perioscopy with local anesthetic FM LANAP ➢ Surgical Procedure •Bone sounding was performed on all teeth included in this procedure •Occlusal adjustment has been performed resulting in reduction in centric prematurities1 year post Perioscopy/LANAP treatment:
    UR Quadrant
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    Pockets 2-4mm, no BOP

    LR Quadrant
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    Pockets 2-4mm, no BOP

    UL Quadrant

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    Pockets 2-4mm, no BOP

    LL Quadrant
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    Photos and x-rays 13 months post treatment:
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    #27M, now 2mm reduced from 6mm, tissue tight and firm
    #26 DF, now 2mm from 8mm

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    #26 F now 2mm. All tissue is light pink, tight and firm.
    Bone fill #26 and 27,no mobility

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    #18 buccal reflected in a mirror. Now probes 2mm reduced from 9mm

    1 year post treatment Conclusion:
    A full set of radiographs taken 13 months post therapy show bone fill in the deepest pockets, with generalized pocket reductions of up to 7mm.
    #3 was referred for endodontic evaluation.
    #’s 15 and 18 show no signs of endodontic involvement, #15 tests vital.

    This patient now has a periodontally stable dentition for the first time in his adult life and is very happy with the outcome of his therapy.

    Suzanne Newkirk Fo
    Suzanne Newkirk, RDH, graduated from the University of Alaska, Anchorage, in 1981 and has dedicated the last 31 years to excellence in clinical dental hygiene and periodontics. Suzanne is a periodontal therapist, dental hygiene coach and mentor. She is also a Perioscopy instructor and speaker and is listed on the Seattle Study Club Speakers Bureau List. Ms. Newkirk is a member of the American Dental Hygienists' Association and Georgia State Dental Hygienists' Association.
    Bob Gottlieb Fo
    Dr. Bob Gottlieb received his Certificate in Periodontics from the University of Washington. Practicing for 35 years, he was voted one of Seattle’s Best Dentists. Dr. Gottlieb mentors and directs numerous study clubs, as well as lectures extensively in California and Washington. To read another article in RDH eVillage FOCUS from Suzanne Newkirk and Robert Gottlieb, go to article.