This 59 year old patient received twice yearly cleanings by her general practioner and no history of previous periodontal treatment. Her chief complaint was that her bridge (#’s 9-11) “keeps losing gum tissue” and the patient “felt it was ugly”. This was the third bridge that had been placed. A comprehensive periodontal examination revealed periodontal probing depths of 4- 9mm, with associated generalized bleeding on probing. Localized Class I mobility and recession of 1-3 mm was noted throughout the dentition. Radiographic bone loss around the bridge was noted and a diagnosis of generalized AAP case type III-IV (moderate to severe) periodontal disease was made.

The patient was initially recommended full mouth laser surgery (Laser Assisted New Attachment Procedure), implant placement in the edentulous area #10 and crown lengthening, but the patient declined all surgical options. A non-surgical treatment plan of ultrasonic endoscopic debridement was made and the patient was prescribed azithromycin (250mg x 6), 2 to be taken the day of treatment, then 1 per day until gone. Endoscopic debridement with adjunctive non-surgical laser pocket disinfection was completed in 2 visits under local anesthesia. Periodontal maintenance was provided every 3 months to include full mouth periodontal charting, instrumentation and polish. Bridge replacement of #’s 7-9 was coordinated with the referring general dentist

3 years post ultrasonic endoscopic debridement the patient is maintaining a generalized favorable clinical outcome. Periodontal charting reveals overall improvement with generalized decreased probing depths and radiographic bone repair is evident on the bridge abutments #’s 9 and 11.

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