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07/19/15
Periodontics II
Final Part II Case Study: Mr. Karns
1. Mr. Karns will need to understand that he has bone loss in the area where he wants an implant
in place of tooth number three. Also, he would need to stop smoking in order for an implant to
be successful.
2. Although Mr. Karns brushes his teeth twice daily, he does not present for regular dental visits,
nor does he use mouth rinse or floss regularly even though he knows he needs to. Since he
knows of certain things he should do, but does not do them shows that Mr. Karns is not selfmotivated and may not be receptive to suggestions made by the dental team for improvement.
The patient also smokes, so there will need to be extra attention given in a respectful way to
tobacco cessation for the patient to achieve optimal oral health.
3. The fact that Mr. Karns smokes is a definite concern for the dental team consider while proving
treatment. Also Mr. Karns is currently taking two medications: Zocor and Nifedipine. Zocor can
cause muscle dysfunction due to the lipid therapy. This may make brushing or chewing more
difficult for the patient. Nifedipine may cause gingival hyperplasia. These medications would be
something to consider when determining treatment for Mr. Karn.
4. Gingival erythema are evident in certain areas of Mr. Karns’ dentition such as the lingual of the
right and left posteriors. Mr. Karns has generalized marginal inflammation with blunted and
glossy gingiva. There is an absence of redness and severe swelling which is most likely due to
how often the patient smokes.
5. There are plaque deposits present as well has obvious calculus deposits present throughout the
patient’s dentition and some staining.
6. The patient may need to have surgical periodontal therapy in order to thoroughly clean the
exposed furcations.
7. Yes. There are many sites of attachment loss present documented on Mr. Karns’ periodontal
chart. For example, the distofacial and distolingual of tooth number 31 has a probe depth of
7mm from the gingival margin. Because the gingival margin is usually around 1mm apical to, or
above, the cementoenamel junction, there is actually about 8mm of actual attachment loss at
this specific site. This is just one of many sites of attachment loss throughout Mr. Karns
dentition.
8. Mr. Karns’ radiographs show much subgingival calculus deposits throughout the mouth as well
as many furcation sites and alveolar bone loss.
9. Furcations evident on Mr. Karns’ radiographs indicate alveolar bone loss present.
10. I would characterize Mr. Karns’ periodontal condition as severe chronic periodontitis. The
clinical and radiographic findings indicate, deep probing depths, attachment loss, alveolar bone
loss on many teeth, gingival inflammation, bleeding upon probing.
11. Apt 1- OHI providing correct brushing technique and a perio toothpick aid
-begin the SRP procedure with quadrant 1 and 4 NSPT along with local anesthesia (PSA, MSA,
GP and NP for quadrant 1) and (IA, LB, M, and infiltration if needed in quadrant 4).
- Use the blended approach using right and left swerve tips for posteriors and the standard
swerve tip for the anterior teeth.
- Hand scaling using Graceys (G11/12, G13/14) and the Columbia and S204 for posterior teeth
and the Nevi and Gracey ½ for the anterior teeth.
- Arestin may be delivered locally in pockets over 6mm after NSPT
Apt 2 –Continue SRP procedure with NSPT in quadrants 2 and 3 along with local anesthesia (PSA,
MSA, GP and NP for quadrant 2) and (IA, LB, M, and infiltration if needed in quadrant 3).
- Use the blended approach using the right and left swerve tips for the posterior teeth and
standard swerve tip for the anteriors.
- Hand scaling using the Gracey ½ the Nevi for the anterior teeth and Graceys (G11/12, G13/14)
the Columbia, the barnhart and S204 for posterior teeth.
- Arestin may be delivered locally in pockets over 6mm after NSPT
Apt 3- 4 to 6 weeks after completion of the NSPT, Re-eval of probing depths, attachment loss and
gingival health. Determine the successfulness of the therapy.
This step by step may also be scheduled by the completion of each sextant which may be necessary but
is at the discretion of the dental hygienist. This could take as many as 6 appointments if it took one
appointment per sextant.
12. Mr. Karns should be given accurate information about his periodontal diagnosis, about the
recommended periodontal therapy, the cost of recommended therapy. It is also important for
the patient to understand the available alternatives to the recommended therapy, as well as
what can happen without the needed therapy.
13. Mr. Karns needs to be aware that if the NSPT is unsuccessful in treating his disease, he may
possibly need surgical periodontal therapy in order to thoroughly clean his furcations and the
depth of his perio pockets to promote successful healing of his periodontium.
14. After the completion of Mr. Karns’ NSPT, he will need to come back every three months for
periodontal maintenance possibly for the rest of his life. If he shows up regularly to visits and his
homecare improves drastically and he responds positively to the NSPT, he may possibly be
referred for a six month recall in the distant future.