Step by step Dr. Steffen Rieger M.Sc., Germany, shows the treatment of a generalized, severe, chronic periodontitis with adjunctive photodynamic therapy - a painless and side effect free supportive method to eliminate pathogen microorganisms. A 53-year old patient presents with a clinical attachment loss of more than 5 mm on approximately 50 % of all measured sites. Radiographic documentation reveals a generalized horizontal and a multiple vertical bone loss to the lower third of the root.
Microbiological diagnostic indicates the periodontal pathogenic bacteria Aggregatibacter actinomycetemcomitans in elevated levels. The therapy is performed with scaling and root planning in a Full Mouth Disinfection. Because the patient refuses to take adjunctive antibiotics, Rieger combines the Full Mouth Scaling with an antimicrobial photodynamic therapy using the Helbo system. In addition he gives chlorhexidine rinsing solution and gel for two weeks for use at home. The first reevaluation shows a significant reduction of the probing depth and a complete elimination of Aggregatibacter actinomycetemcomitans.
Nevertheless all teeth which are affected by higher probing depth or furcation involvement are treated surgical to get periodontal stability. Degranulation and flap operations are performed with Emdogain and BioOss for the regenerative approach. Rieger is improving the aesthetic situation with a reconstructive therapy and shape correction of the two central incisors in the upper jaw with all-ceramic crowns. The patient becomes part of the periodontal recall-system. In the end the combined conservative and surgical treatment is approaching a stable healing outcome without signs of inflammation. For an introduction to photodynamic therapy see Dr. Rieger's lectures and interview, too.