title: Periodontitis associated with plasminogen deficiency: a case report.
abstract: BACKGROUND
  Plasminogen deficiency is a rare autosomal recessive disease, which is associated with aggressive periodontitis and gingival enlargement. Previously described treatments of plasminogen deficiency associated periodontitis have shown limited success. This is the first case report indicating a successful therapy approach consisting of a non-surgical supra- and subgingival debridement in combination with an adjunctive systemic antibiotic therapy and a strict supportive periodontal regimen over an observation period of 4 years.
  
  
  METHODS
  The intraoral examination of a 17-year-old Turkish female with severe plasminogen deficiency revealed generalized increased pocket probing depths ranging from 6 to 9 mm, bleeding on probing over 30%, generalized tooth mobility, and gingival hyperplasia. Alveolar bone loss ranged from 30% to 50%. Clinical attachment loss corresponded to pocket probing depths. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Prevotella nigrescens and Eikenella corrodens have been detected by realtime polymerase chain reaction. Periodontal treatment consisted of full mouth disinfection and adjunctive systemic administration of amoxicillin (500 mg tid) and metronidazole (400 mg tid). A strict supportive periodontal therapy regimen every three month in terms of supra- and subgingival debridement was rendered. The reported therapy has significantly improved periodontal health and arrested disease progression. Intraoral examination at the end of the observation period 3.5 years after non-surgical periodontal therapy showed generalized decreased pocket probing depths ranging from 1 to 6 mm, bleeding on probing lower 30%, and tooth mobility class I and II. Furthermore, microbiological analysis shows the absence of Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola after therapy.
  
  
  CONCLUSIONS
  Adjunctive antibiotic treatment may alter the oral microbiome and thus, the inflammatory response of periodontal disease associated to plasminogen deficiency and diminishes the risk of pseudomembrane formation and progressive attachment loss. This case report indicates that patients with plasminogen deficiency may benefit from non-surgical periodontal treatment in combination with an adjunctive antibiotic therapy and a strict supportive periodontal therapy regimen.
authors.affiliation: Section of Periodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany. sarah.neering@med.uni-duesseldorf.de.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Neering
authors.affiliation: Section of Periodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany. sabine.adyani-fard@med.uni-duesseldorf.de.
authors.forename: Sabine
authors.initials: S
authors.lastname: Adyani-Fard
authors.affiliation: Section of Periodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany. astrid.klocke@med.uni-duesseldorf.de.
authors.forename: Astrid
authors.initials: A
authors.lastname: Klocke
authors.affiliation: Department of Operative Dentistry Center for Dentistry and Oral Medicine (Carolinum), Goethe University Frankfurt, Theodor-Stern-Kai 7, D-60598, Frankfurt, Germany. ruettermann@em.uni-frankfurt.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rüttermann
authors.affiliation: Dean Faculty of Dentistry, Prince Philip Dental Hospital, 34 Hospital Road, Sai Ying Pun, Hong Kong. flemmig@hku.hk.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Flemmig
authors.affiliation: Section of Periodontics, Heinrich-Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany. beikler@med.uni-duesseldorf.de.|Department of Periodontics, University of Washington, 1959 NE Pacific St B307, Seattle, WA, 98195, USA. beikler@med.uni-duesseldorf.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Beikler
mesh_terms: D000293:Adolescent; D016301:Alveolar Bone Loss / Q000209:etiology / Q000628:therapy; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D003231:Conjunctivitis / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005884:Gingival Hemorrhage / Q000209:etiology / Q000628:therapy; D005885:Gingival Hyperplasia / Q000209:etiology / Q000628:therapy; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D017622:Periodontal Attachment Loss / Q000209:etiology / Q000628:therapy; D057747:Periodontal Debridement / Q000379:methods; D010514:Periodontal Pocket / Q000209:etiology / Q000628:therapy; D010518:Periodontitis / Q000209:etiology* / Q000628:therapy; D010958:Plasminogen / Q000172:deficiency*; D012873:Skin Diseases, Genetic / Q000150:complications*; D014086:Tooth Mobility / Q000209:etiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D000658:Amoxicillin; D010958:Plasminogen