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PERIO - Periodontal Practice Today
PERIO - Periodontal Practice Today 5 (2008), No. 4     4. June 2009
PERIO - Periodontal Practice Today 5 (2008), No. 4  (04.06.2009)

Page 251-258

Therapy of hopeless teeth - a case of long-term tooth preservation in a patient with generalised aggressive periodontitis
Pelka, Matthias / Petschelt, Anselm
Background and aim: Aggressive periodontitis is a critical disease with a poor prognosis for long-term tooth preservation. Extractions of several 'hopeless teeth' are often necessary with subsequent extensive prosthetic reconstruction. The authors aimed to determine whether or not the preservation of 'hopeless teeth' can stabilise periodontal conditions over time.
Case report: A 32-year-old female was first examined in the authors' department in 1993 with the diagnosis of generalised severe aggressive periodontitis. Her external treatment plan included several tooth extractions, bone augmentations, implants, and an extensive prosthetic reconstruction. In accordance with the patient's choice, all hopeless teeth were preserved. Non-surgical treatment was performed on all teeth, surgical treatment was performed on teeth without regenerative potential and with pockets over 6 mm, and surgical regenerative treatment with non-bioresorbable expanded polytetrafluoroethylene (ePTFE) membranes was performed on sites with regenerative potential. After surgical therapy, supportive treatment was carried out four times a year to date. Due to the teeth preservation treatments, no prosthetic treatment was necessary, but a gingiva mask was used for the wide exposed roots of the maxillary anterior teeth.
Results and conclusions: This case shows that periodontal stabilisation and long-term preservation of even hopeless teeth is possible. The radiographic re-evaluation in 2007 showed bone gain at sites treated with ePTFE membranes and small bone gain or stabilisation of the bone level in all other treated sites. The treatment increased the bone level of the hopeless teeth and these teeth have been preserved for 14 years.

Keywords: aggressive periodontitis, hopeless tooth, tooth preservation