A multidisciplinary approach to the diagnosis and treatment of early-onset periodontitis: a case report.
BACKGROUND
The diagnosis and treatment of early-onset forms of periodontitis (EOP) represent a major challenge to periodontists. In this case report, we describe a multidisciplinary approach for the treatment of a patient with severe generalized juvenile periodontitis (GJP). Our approach incorporates clinical laboratory evaluation with conventional concepts of periodontal pathogenesis and therapeutics to diagnose and effectively treat EOP.


METHODS
The 17-year-old female patient presented with clinical and radiographic evidence of severe attachment loss. Microbiological testing showed the presence of known periodontal pathogens including Actinobacillus actinomycetemcomitans, Prevotella intermedia, and Porphyromonas gingivalis. Routine immunological tests did not reveal any of the functional defects thought to play a role in the pathogenesis of EOP After initiation of therapy, which consisted of scaling and root planing, supplemented with administration of systemic antibiotics, a reduction in probing depth and gain in clinical attachment could be demonstrated. Microbiological testing was used to monitor the composition of the periodontal microbiota and to adjust antimicrobial therapy accordingly.


RESULTS
Using a non-surgical approach to treatment, except for 2 root amputations performed without flap reflection, we have been able to stabilize this patient's periodontal condition over the course of a 2-year follow-up period.


CONCLUSIONS
This treatment strategy provides an efficacious alternative to more aggressive forms of therapy and should therefore be considered for the treatment of patients with severe EOP.
Worch
K P
KP
Department of Periodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, USA. worch@uni-muenster.de
Listgarten
M A
MA
Korostoff
J M
JM
D000293:Adolescent; D016976:Aggregatibacter actinomycetemcomitans / Q000145:classification; D010520:Aggressive Periodontitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D012534:Dental Scaling; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D017823:Furcation Defects / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D010348:Patient Care Team; D010406:Penicillins / Q000627:therapeutic use; D017622:Periodontal Attachment Loss / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D010514:Periodontal Pocket / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D016966:Porphyromonas gingivalis / Q000145:classification; D018713:Prevotella intermedia / Q000145:classification; D012390:Root Canal Therapy; D016745:Root Planing; D014092:Tooth Root / Q000601:surgery; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010406:Penicillins; D008795:Metronidazole; D000658:Amoxicillin