Treating severe periodontitis with staged load applied implant restoration: A case report

Table 1 Comparison of periodontal disease cases

Case	Patient summary	Patient history	Intraoral examination	Radiological features	Final diagnosis
Combined periodontal and implant treatment of a patient with chronic periodontitis and severe alveolar bone loss	A 41-yr-old female whose upper front teeth were loose	Denied having systemic disease. The teeth have been filled with restorations at a different hospital	Teeth #21, #26, and #27 were missing and the patient had a deep overbite. The gap length of the missing teeth, located at the upper front part of the jaw, was 10 mm. The width of the alveolar ridge was 4 mm	Teeth #21, #26, and #27 were missing. In the area of tooth #21, the alveolar bone was absorbed. The entire alveolar bone was absorbed horizontally from 1/3 to 1/2 the depth of the root length	Moderate chronic periodontitis; severe prosthesis; dentition defect
Implant treatment of a case of severe chronic periodontitis	A non-smoking 51-yr-old female who only has a few maxillary teeth	Denied having systemic disease, drug allergies, and any infectious disease	Supragingival calculus was found in the mandibular anterior segment and pathologic tooth migration was found in teeth #11 and #12. Teeth #11, #12, and #21 exhibited class III mobility. Tooth #46 had a class III furcation lesion. Sixty-one percent of the teeth had a deep PPD of over 4 mm; 61% had BOP; and all teeth scored 101% on O’Leary’s plaque control record	In teeth #14, #16, #26, and #46, periodontal tissue destruction occurred. Horizontal bone resorption depth was 3 to 5 mm and, vertical bone resorption depth was 4 to 6 mm	Generalized moderate to severe chronic periodontitis
Treating severe periodontitis with staged load applied implant restoration	A 49-yr-old female who was missing most of her teeth and wanted implants immediately	Denied having systemic disease, drug allergies, and any infectious disease	The patient was missing the majority of her teeth and had gingival atrophy and severe alveolar ridge atrophy. There was a long PFM bridge on teeth #11-14 and #21-24	Alveolar bone was absorbed to 1/3 of the root apex; the bond width of the maxillary anterior region was approximately 3 mm; the labial bone was absorbed; and the bone height in both posterior areas w approximately 2 mm	Dentition defect; Severe periodontitis

PPD: Periodontal probing depth; BOP: Bleeding on probing.

Table 2 The cases comparison of periodontal disease treatments

Case	Treatment step 1	Treatment step 2	Treatment step 3	Treatment step 4	Prognosis and follow-up
Combined periodontal and implant treatment of a patient with chronic periodontitis and severe alveolar bone loss	Basic periodontal treatment (non-surgical) and reassessment	In the area of tooth #21, conducted GBR tissue increment surgery and dental implantation simultaneously	Temporary restoration on the implant was made for gum shaping	Removed bad prosthesis in the area of tooth #11; permanent restorations were made	Received good feedback from patient; new therapy idea combined implantation, periodontal and restorations. This patient only has a limited number of bone defects
Implant treatment of a case of severe chronic periodontitis	Initial periodontal treatment: Oral hygiene instruction; scaling and root planning; tooth extraction (teeth #11, #12, #16, #21, #22, and #27); partial denture therapy (teeth #12-22); root canal treatment and hemisection (tooth #46); Occlusal adjustment (teeth #13 and #23)	Oral functional rehabilitation treatment: Implant prosthesis (in the areas of teeth #12, #16, #22, #36, and #41)	Temporary restoration: During the 5-mo relief period, a partial denture was placed in the maxillary anterior region	Permanent restoration: All custom abutments and porcelain fused to metal crowns were retained	The screw was restored after cleaning and occlusal adjustment. The patient’s oral hygiene has been well maintained. There has not been any recurrence nor has the patient's periodontal disease worsened among other natural teeth
Treating severe periodontitis with staged load applied implant restoration	First load-bearing stage: Removed the remaining teeth in the jaw; conducted immediate All-on-6 implant restoration and immediate loading	Second load-bearing stage: Inserted four temporary Osstem mini implants; performed immediate loading, maxillary GBR technique, and lateral maxillary sinus lifting on both sides	Third load-bearing stage: Four temporary implants were removed, and eight permanent implants were placed; performed immediate loading	Fourth load-bearing stage: The resin bridge was segmented for gingival repair	Restored with custom abutments and the zirconium crown-bridge prosthesis

GBR: Guided bone regeneration.