A large breed dog presented for a periodontal cleaning. During a periodontal examination how many surfaces of the tooth should be evaluated with a periodontal probe?
Answer:
Minimally 6 surfaces should be probed (mesial-buccal, buccal, distal-buccal, distal-lingual, lingual, mesial-lingual) by walking, not dragging, the periodontal probe around the tooth.
Question:
During the periodontal examination a 12 mm+ distal-lingual periodontal pocket is identified. What is the next diagnostic step?
Answer:
Intraoral Radiography
Question:
What is the radiographic interpretation and diagnosis?
Answer:
There is widening of the distal periodontal ligament space of tooth the right mandibular first molar (tooth 409) associated with vertical bone loss estimated to be approximately 75% (stage 4 periodontal disease). Vertical bone loss results in an intrabony periodontal pocket.
Treatment options for tooth 409 include:
- Guided tissue regeneration of tooth 409
- Hemisection of the distal root of tooth 409 with root canal treatment of the mesial root.
- Surgical Extraction.
This tooth has significant vertical bone loss, although no evidence of periapical lucency. I think!!! This tooth needs to be scaled well and curette the root completely. How about filling the pocket with doxirobe or consil? Follow up in 2-3 months with radiographs.
Hi Kim,
Doxyrobe can be used to create a membrane to prevent epithelial downgrowth and may be placed on top of the bone graft prior to closure. You are correct in that curettage and root planing is the first step. This must be complete with no debris present. A mucoperiosteal flap is needed to visualize the defect adequately.
Brett