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

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

Case #2 is a patient with moderate periodontal disease, but the clinical findings of early furcation involvement, localized vertical bone loss in molar teeth and an intermediate risk analysis indicate a combination treatment plan of Perioscopy and Laser Assisted New Attachment Procedure (LANAP).

Case #2
Perioscopy by Suzanne Newkirk, RDH
LANAP by Robert Gottlieb, DDS

Female, age 61
No social habits
Medical History:
Hypertension, dry eyes
Hydrochlorothiazide (HCTZ) for hypertension
Ophthalmic cyclosporine (Restasis) eye drops for dry eyes
OTC Calcium citrate
PreViser Risk Analysis:
Risk Score 3
Disease State 15

Diagnosis and Etiology:
Moderate periodontitis
Associated occlusal traumatism from a deep overbite and anterior spacing
Bruxism with associated TMJ discomfort
Generalized pocket depths of 4-6 mm in posterior teeth, generalized BOP
Ill-fitting posterior crowns are a plaque and food trap which are contributing factors in posterior inflammation and pocketing

TX plan:
•Improved personal oral hygiene
•FM perioscopy and LANAP
Occlusal therapy
•Orthodontic referral
Restorative treatment plan to replace poorly fitting crowns post orthodontia
•3 month periodontal maintenance


UR/LR Pre Tx

Pockets 4-7mm, generalized posterior BOP

UR/LR Pre Tx
UR/LR Pre Tx (reflected in a mirror and Cantilever bridges #’s 2/3, 30/31
The tissues around the posterior crowns are almost bluish in color
(above left)UL/LL Pre Tx:

Pockets 4-6mm, gen posterior BOP

UL/LL Pre Tx

UL/LL Pre Tx reflected in a mirror

TX FM Perioscopy with local anesthetic FM LANAP Surgical Procedure •bone sounding was performed on all teeth included in this procedure •occlusal adjustment performed resulting in reduction in centric prematurities •Orthodontic referral for anterior spacing •3 month periodontal maintenance14 months post Treatment

Pocket reductions of up to 4mm

The patient now has a stable dentition and has moved forward with Invisalign orthodontia to correct the overbite and spacing in her anterior teeth.
The posterior crowns still present a challenge to keep clean and will be scheduled for replacement post orthodontic treatment.
She is enrolled in periodontal supportive therapy every 3 months.

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.
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.