450
strict periodontal maintenance recall. She is satisfied to maintain
her upper anterior teeth status quo as of now. She is aware of
the long-term guarded prognosis of #11, 21 and the need for
replacement of these teeth if and when signs and symptoms pre-
sent in the future.
PC268
Interdisciplinary treatment of aggressive
periodontitis in a patient with class III
hyperdivergence: perio-, ortho-, prosthodontics –
10 year case report
C. Bruckmann, M. M€
uller
Vienna/Austria
Background: Aggressive periodontitis is characterized by a
non-contributory medical history and rapid attachment loss. If
untreated before orthodontic therapy, it may adversely influence
its results.
A 23 year old student was referred for recession coverage on
#21. Recession had started during camouflage treatment for
Class III malocclusion. It turned out as symptom of severe
localized AP.
Clinical Procedure: At intake in 2007 severe bone loss in #21
and PPD up to 9 mm in the molar and incisor areas (BoP+)
were present. Orthodontic Tx was discontinued and non-surgi-
cal perio treatment with adjunctive antibiosis was performed.
After reevaluation regenerative flap procedures were carried in
remaining molar defects and SPT initiated. Prognosis for #21
remained poor.
2009 the patient wanted to continue orthodontic treatment. The
plan was changed to a combined orthodontic/orthognathic
approach which foresaw bimaxillary advancement and orthodontic
extrusion of #21 to create a better implant site. At extraction of
#21, a socket seal preservation (free epithelial + subepithelial con-
nective tissue graft) was carried out to enhance future esthetics,
Miller Class III recessions in the lower jaw were stabilized with a
free gingival graft. In 2011, ortho treatment was finished and the
result retained (splint in upper, bonded retainer in lower jaw).
For a non-invasive/cheaper prosthodontic approach to replace
#21, the site was prepared for an ovate pontic and a resin provi-
sional was adapted. Finally, a one-wing composite Maryland
bridge was incorporated.
Outcomes: From 2012 to 2016, stable esthetic and periodontal
results were maintained through regular SPT (3 times/year). We
saw the patient again in autumn 2017 after a round-the-world trip
with limited access to dental hygiene. Further, the bridge had
come lose and been fixed in a slightly different position. Never-
theless, only #26 showed 2 sites with 5 mm PPD (BoP) with
furcation class I. Personal oral hygiene and SPT were reinstalled.
PC269
Laser assisted excision of an excessive-sized gingival
pyogenic granuloma. Report of a case
D. Andreadis, I. Lazaridi, E. Anagnostou, A. Poulopoulos
Thessaloniki/Greece
Background: The pyogenic granuloma is considered as a non-
neoplastic, exuberant, reactive lesion due to local irritation-
trauma (calculus, bacterial plaque, caries or restorations) with
E-Poster | Clinical Report Presentation
predilection for the gingiva. A 71-year-old Caucasian female
(with diabetes and hypertension under treatment) presented with
a painless, solid, lobulated gingival overgrowth (5-months dura-
tion) of the right maxilla.
Clinical Procedure: The lesion was located at the marginal,
buccal gingiva of the maxillary right molars. The relevant teeth
had medium mobility and covered by metal-ceramic crowns for
partial denture with irregular margins. The lesion’s diameter was
more than 2 cm and was covered by red-purple-colored mucosa
with local ulceration and it was easily bleeding automatically. A
periapical radiograph revealed no osseous involvement. Total
surgical excision of the lesion was performed with an 840 nm
diode laser and then hyaluronate gel and overlying periodontal
dressing was placed and left in situ. Microscopically, high vascu-
lar proliferation and inflammatory granulomatous tissue with
infiltration of lymphocytes, plasma cells and neutrophils, and
areas of fibrous connective tissue, as well were seen. The lesion
was covered by ulcerated stratified squamous epithelium without
atypia. After 2 weeks a complete healing was observed, but the
patient denied replacing the dental restoration. During the 4-
month follow-up, a reduction of the teeth mobility was observed
but a minor recurrence of gingival lesion was seen.
Outcomes: Pyogenic granuloma is commonly found at the gin-
giva as a response to traumatic factors. The diagnosis is always
confirmed by histological examination and a radiograph is help-
ful to exclude osseous involvement. It is critical to excise these
lesions with proper but not extended surgical management for
the maintenance of gingival tissue and from this point of view
the use of diode laser is preferable. In addition, the correction
or replacement of relevant dental restorations is crucial in order
to avoid recurrence as in our case.
PC270
Last chance for the tooth
M. Chalupova, B. Valentova, M. Budınova
Plzen/Czech Republic
Background: Repeated application of calcium hydroxide into the
root canals was used for preserving the tooth. This procedure was
offered to the patients as an alternative to the tooth extraction.
Teeth with II or III grade of mobility and periodontal pocket
depth more than 8 mm were indicated to this procedure.
Clinical Procedure: Ten teeth (in 7 patients) were treated
according to operating protocol approved by endodontists and
periodontologist. In every case, periodontal pockets depth and
clinical attachment loss (CAL) were measured and preoperative
apical X-ray was taken. Root canals were treated with endodon-
tic rotary instrument system, usually till ISO 30, and standard
irrigation protocol was used (2.5% NaOCl and 17% EDTA).
Calcium hydroxide (Calxyd) was applied to the full working
length and the tooth was closed with glass ionomer cement
(GIC). This process was repeated in 7-,14- and 30-day interval.
After the first endodontic section, deep scaling was processed.
In the 4th endo-section, canals were obturated with sealer
(MM-Seal) and single gutta-percha cone (6% conicity). X-ray
control was taken immediately after canal obturation and teeth
were usually stabilised with semi-flexible splint (Dentapreg).
After 3 months, periodontal pocket depth and CAL was evalu-
ated and bone excess was measured on control X-ray.
Outcomes: After this procedure, physiological or I grade
mobility was measured in every tooth. Periodontal pocket depth
and CAL decreased and the bone excess was measurable on X-
ray.
© 2018 The Authors.
© 2018 European Federation of Periodontology