id="ulink_b5dad0cf-8e62-568c-99fd-8a34894cc9c4">1 Examination and Diagnosis
1 Case 1: Examination and DocumentationTae H. Kwon, DDS, MMSc, Howard H. Yen, DMD, and Liran Levin, DMD, FRCD(C), FIADT, FICD
2 Case 2: Dental Plaque‐Induced GingivitisNadeem Karimbux, DMD, MMSc, Ningyuan Sun, B.D.S, Ph.D and Satheesh Elangovan, BDS, DSc, DMSc
3 Case 3: Non‐Plaque‐Induced Gingivitis17N. Joseph Laborde III, DDS, MMSc and Mark A. Lerman, DMD
4 Case 4: Gingival EnlargementT. Howard Howell, DDS, Maria Dona, DMD, MSD, DMSc, and Thomas T. Nguyen, DMD, MSc, FRCD(C)
5 Case 5: Aggressive PeriodontitisNadeem Karimbux, DMD, MMSc and Martin Ming‐Jen Fu, BDS, MS, DMsc
6 Case 6: Chronic PeriodontitisFlavia Teles, DDS, MS, DMSc, Ricardo Teles †, DDS, DMSc, Magda Feres, DDS, MSc, PhD, Belen Retamal‐Valdes, DDS, MSc, PhD, and Vinicius Souza Rodrigues, DDS, SDD, DMSc
7 Case 7: Local Anatomic Factors Contributing to Periodontal DiseaseDaniel Kuan‐te Ho, DMD, DMSc, MSc and David M. Kim, DDS, DMSc
8 Case 8: Oral–Systemic Links57Lorenzo Mordini, DDS, MS, Carlos Parra, DDS, and Po Lee, DDS
9 Case 9: Developments in DiagnosticsAruna Ramesh, BDS, MS, DMD and Hugo Campos, DDS, DMD
† Deceased
Case 1 Examination and Documentation
CASE STORY
A 44‐year‐old Caucasian female presented with chief concern “I have pain on my upper left molar, which has gradually increased. I would like to fix my gum diseases. I would like to receive dental implants to replace my missing teeth also.”
LEARNING GOALS AND OBJECTIVES
The patient’s chief complaint
Medical and dental history
Soft tissue and gingival examination
Periodontal charting
Radiographic interpretations
Periodontal diagnosis
Medical History
ASA classification 1
Vital signs: blood pressure 130/80 mmHg
Medication: none
Supplement: daily multivitamin
Allergy: none
Dental History
The patient brushed three times daily and flosses daily.
The patient had received routine dental prophylaxis at her general dental practitioner’s office. Recently, the patient underwent extraction of her mandibular left first and second molars due to severe periodontal disease, and she would like to replace them with dental implants.
The patient denied any smoking habit and had never smoked.
The patient’s father suffered from periodontal disease and ended up receiving complete maxillary and mandibular removable dentures.
Patient was extremely motivated for dental treatment.
Soft Tissue and Gingival Examination
Extraoral examination did not reveal any significant findings. Intraorally, generalized gingival edema and erythema were noted (Figure 1.1.1), which were more pronounced on #3 buccal, #8 buccal, #8 palatal, interproximal papilla between #8 and #9, interproximal papilla between #9 and #10, buccal gingival margin and interproximal papillae in mandibular incisors; rolled buccal gingival margins were noted on #3 mesiobuccal and #8 mesiobuccal aspect.
Comprehensive Periodontal Examination
A comprehensive periodontal examination (Figure 1.1.2) revealed localized deep probing depths of 10–12 mm on tooth #3 mesial aspect with grade I mobility and grade II mesiopalatal furcation involvement. Tooth #14 exhibited localized deep probing depths of 7 mm on its distal aspect with grade II distopalatal furcation involvement. Teeth #2, #8, #10, and #15 also exhibited localized probing depths of 5 mm. Teeth #2 and #15 exhibited Class I mesiopalatal furcation involvement. Otherwise, the remaining dentitions exhibited generalized probing depths of 1–4 mm. There was generalized bleeding on probing. Furthermore, localized areas with gingival recession were noted in some posterior teeth.
Figure 1.1.1 Complete series of intraoral photographs.
Figure 1.1.2 Complete periodontal charting.
Radiographic Examination
A full‐mouth series of intraoral radiographs revealed generalized horizontal bone loss (Figure 1.1.3). There was localized moderate horizontal bone loss on teeth #2 and #15. Tooth #3 exhibited vertical bone loss on its mesial aspect while tooth #4 exhibited vertical bone loss on its distal aspect. An open interproximal contact was evident on #3 mesial aspect. Vertical ridge deficiency was noted on edentulous teeth #18, #19 and #30, areas with slight radiolucency indicating possible horizontal ridge deficiency as well.
Diagnosis
According to the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions by the American Academy of Periodontology and the European Federation of Periodontology [1], the patient exhibited stage III grade C periodontitis (localized).
Figure 1.1.3 Complete series of intraoral radiographs.