A new patient enters your practice with generalized periodontitis. The comprehensive exam reveals generalized, moderate bone loss, gingival recession, and pocket probing depths of 4-6mm throughout the mouth. Tissues around the upper posteriors and around every tooth on the lower arch are bleeding on probing, with extensive heavy bleeding in the lower anteriors. The patient understands the need for immediate treatment and long-term maintenance care. What do you recommend?
This case scenario is more common than ever as patients who have avoided dental care during the long recession are now returning to dental offices. When the patient above entered Dr. Greg Gist’s practice in Southlake, Texas on January 28, 2013, it had been more than four years since his last dental exam. Dr. Gist’s protocol, outlined below, resulted in long-term successful treatment as well as an Orkos Award honoring his excellence in treatment for gum disease with this case study report.
Following the comprehensive exam on January 28, Dr. Gist began the first of four debridement and scaling procedures. After mechanical therapy, he delivered prescription periodontal trays (Perio Trays®, Perio Protect LLC, St. Louis, MO) to the patient to be used twice a day for 10 minutes to deliver 1.7% hydrogen peroxide gel (Perio Gel®, QNT Anderson, Bismarck, ND) and 3 drops of an antibiotic (Vibramycin®, Pfizer, NY, NY) deep into periodontal pockets.
At the end of March, approximately 2 months after the initial visit, the patient exhibited three sites that were bleeding on probing, and pocket probing depths measuring more than 3mm were just 7%, down from 100% at pretreatment. A periodontal maintenance visit on June 26, 2013 confirmed the improvements with no bleeding on probing. At the patient’s most recent dental appointment on September 9, 2014, inflammation remained under control with no bleeding on probing exhibited. All pocket probing depths measured 3mm or less. Recession had also decreased with reported improvements in the lamina dura.
Dr. Gist attributes the long-term success of this case study to his focus on both the destructive symptoms and bacterial causes of the disease. “So much medicine today focuses on what has happened, not how to fix a problem. I am concerned with comprehensive treatment and prevention that addresses the sources of disease.”
The prescription tray delivery used for this patient, and for many in his practice, has been described by Dr. Gist as his ‘secret weapon’ and ‘therapeutic silver bullet’ for effective biofilm treatment. “The unique way in which the trays are fabricated,” Dr. Gist explains, “enables us to force the medication deep into the periodontal pockets where most of the bacteria reside and where most patients have a problem cleaning.” The simplicity of this treatment system is also relevant. According to Dr. Gist, ”The prescription tray is so easy for our patients to use that it allows patients to have a high degree of compliance, especially when patients are educated to the incredible systemic and lifestyle benefits of keeping their mouths infection free.”
Dr. Gist prescribes the Perio Tray® for more than just periodontal disease. “We have developed a pre-operative treatment regimen that gets our patients ready to be restored, and a post-operative regimen that protects my patient’s investment in their health after their restorative work is complete. We have actually built a niche Perio Protect Practice within our Restorative / Cosmetic Practice that is improving our patients’ health.”