Hope for hopeless teeth - three-year interdisciplinary management of stage IV grade C periodontitis: A case report.

BACKGROUND: Advanced periodontitis associated with infrabony defects often requires surgical intervention when nonsurgical periodontal therapy proves to be insufficient. Combination regenerative therapy, including guided tissue regeneration, has been shown to facilitate periodontal regeneration and improve clinical outcomes in a predictable manner. METHODS: A 57-year-old female presented to the Division of Periodontology at Harvard School of Dental Medicine with complaints of tooth mobility and gingival bleeding. Comprehensive periodontal and radiographic examinations were performed to determine disease severity and extent. Initial periodontal therapy included patient education, oral hygiene instructions, nonsurgical scaling and root planing, and occlusal adjustment. Due to persistent deep periodontal pockets and infrabony defects, full-mouth osseous surgery and open flap debridement, combined with regenerative therapy using bone grafts and biologic agents, were subsequently performed. The patient was enrolled in supportive periodontal therapy at 3-month intervals thereafter. RESULTS: At the 1-year follow-up, significant clinical improvements were observed, including reductions in probing depths, furcation involvement, and tooth mobility. Radiographic evaluation demonstrated bone fill at infrabony defect sites treated with combination regenerative therapy. These outcomes were maintained over a 3-year follow-up period with strict supportive periodontal therapy during orthodontic treatment. CONCLUSIONS: Within the limitations of a single case report, this case highlights the potential effectiveness of surgical periodontal therapy combined with regenerative techniques in the interdisciplinary management of generalized stage IV, grade C periodontitis with infrabony defects. KEY POINTS: Surgery periodontal therapy with guided tissue regeneration led to radiographic bone fill, reduced probing depths, and improvements in tooth mobility and furcation involvement, even in a severe stage IV grade C case. Success was strongly associated with strict supportive periodontal therapy and good oral hygiene adherence. Advanced periodontitis can have predictable long-term outcomes with proper interdisciplinary treatment and maintenance. PLAIN LANGUAGE SUMMARY: This case demonstrates successful interdisciplinary ortho-perio management of stage IV, grade C periodontitis with infrabony defects using surgical periodontal therapy and regenerative techniques. Significant reduction in probing depths, decreased tooth mobility and furcation involvement, and radiographic bone fill were observed following treatment. Favorable outcomes were maintained over a 3-year follow-up with supportive periodontal therapy.