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Periodontosis: Treatment Results in 15-Year-Old Girl
CLIN IC A L
REPO RTS
Periodontosis: treatment results in 15-year-old girl H. W illiam Hoge, D D S, M S Dan B. Kirkham, D D S, M S
E x traction o f th e m a n d ib u la r in ciso rs a n d th e m a x illa r y s e c o n d p r e m o la r s in a 1 5 -y ea r-o ld g irl w as p a r t o f th e trea tm en t to stop b o n e loss. F ollow -u p trea tm en t in c lu d e d reta in in g th e m a x illa r y in ciso rs a n d m a x illa r y a n d m a n d ib u la r fir s t m o lars.
T
he e x a c t c h a r a c te r is tic s of periodontosis, even its very existence, have been controversial since the dis ease was first cited by G ottlieb in 1 923.1 It seems to be generally agreed that periodontosis is a disease process of the periodontium of adolescents re sulting in rapid bone loss around spe cific permanent teeth.2 The onset of periodontosis does not seem to be related to systemic disease or nutritional deficiency, nor does the etiology of periodontosis have the same relationship to plaque, calculus, occlusion, or restorative factors that periodontitis has. Periodontosis often follows a familial pattern and occurs more often in females.3,4 Clinically, periodontosis is charac terized by a normal-appearing superfi cial gingiva with localized areas of pocket depth and accompanying bone loss often affecting first molars and in cisors. The patterns of bone loss show
bilateral symmetry and may involve both incisors and first molars; the in cisor and first molar may be affected separately.5 Although the etiology of periodon tosis has been obscure, recent investi gations have suggested that gramnegative microorganisms may be in volved in the pathogenesis of this un usual form of alveolar bone destruc tion.6 Treatment of periodontosis has been hindered because of its uncertain eti ology. As a result, many therapeutic measures are described in the litera ture. Techniques that have been dis cussed include dental transplants,7 orthodontic-periodontic approach,8 osseous implants,9 selective extraction in more severe cases, and chemother apeutic maintenance regimens using tetracycline. The following report presents clin i cal and radiographic findings concern ing flap surgical management in a pa tient with symptoms of periodontosis.
a n d m a n d ib u la r fir s t m o la rs a n d in c is o r s . L in g u a l fu rc a tio n s w e re d e te c ta b le in th e m a n d ib u la r fir s t m o la rs. P e r ia p ic a l ra d io g ra p h s s h o w e d fo r m a tio n o f la rg e a n g u la r c ra te rs o n th e m e s ia l a s p e c ts o f a ll fo u r fir s t m o la rs (F ig 1 , 2 ) a n d o n th e in te r p ro x im a l a s p e c ts o f th e m a x il la ry (F ig 3) a n d m a n d ib u la r in c is o r s (F ig 4 ). B e c a u s e o f e x te n s iv e b o n e lo s s , th e m a n d ib u la r i n c is o r s w e r e e x t r a c te d a n d r e p la c e d w ith a p ro v is io n a l p a rtia l d e n tu re . T h e m a x illa r y s e c o n d p re m o la r s w e re e x tr a c te d b e c a u s e o f u n r e s to r a b le c a rie s . D e s p ite e x te n s iv e b o n e lo s s , th e d e c is io n w a s m a d e to re ta in a n d tr e a t m a x illa r y in c is o r s a n d m a x illa r y a n d m a n d ib u la r firs t m o la rs.
Treatment I n it ia l th e r a p y in c lu d e d s u b g in g iv a l d e b rid e m e n t a n d ro o t p la n in g , a s little c a l c u lu s w a s p re se n t. T h e p a t ie n t w a s in s tr u c t e d
in th e
m e th o d s o f p la q u e r e m o v a l, su b g in g iv a l flo s s in g , a n d in th e m o d ifie d B a s s te c h n iq u e o f b ru s h in g w ith a m u ltitu fte d so ft n y lo n b ru sh . N o o c c lu s a l a d ju s tm e n t w as d o n e , a s n o p r e m a tu r itie s c o u ld b e d e te c te d .
R e p o rt o f c a s e
S u r g ic a l tr e a tm e n t w a s th e n p e rfo rm e d
A 1 5 -y e a r-o ld b la c k g irl w a s re fe r re d to a p e rio d o n ta l s p e c ia lis t b e c a u s e o f so re , lo o s e m a n d ib u la r in c is o r s . H er m e d ic a l h is to ry w a s n o n c o n trib u to ry . C lin ic a l e x a m in a tio n d is c lo s e d c o m p le te d e n t itio n
in g o o d
a lig n m e n t w ith a C la ss I o c c lu s io n . C a rie s a ffe c te d e x te n s iv e a re a s o n m a x illa r y s e c o n d p re m o la r s a n d s e c o n d m o la rs. T h e g in g iv a w a s firm a n d stip p le d , a n d n o v is ib le s ig n s o f in f la m m a t io n w e r e p r e s e n t. P e rio d o n ta l p ro b in g d is c lo s e d d e e p p o c k ets o f 7 , 8 , a n d 9 m m o f d e p th in m a x illa r y
o n a ll fir s t m o la r a n d m a x illa r y in c is o r a re a s. E le v a te d m u c o p e r io s te a l fla p s w e re c re a te d u s in g a s c a llo p e d in te r n a l b e v e le d in c is io n . A ll g r a n u lo m a to u s a n d fib ro u sa p p e a rin g so ft tis s u e w a s re m o v e d fro m th e a re a o f th e le s io n . N o o s te o p la s ty o f o s se o u s g ra ftin g w a s d o n e , h o w e v e r. T h e fla p s w e re r e a p p r o x im a te d , p r im a r ily w it h n o . 4 .0 p o ly g ly c o lic a c id s u tu r e s . F in a lly , a p e r io d o n ta l d r e s s in g w as p la c e d , an d p h e n o x y m e th y l K p e n i c il l i n , 2 5 0 m g fo u r tim e s a d ay , w as p re s c rib e d fo r th e f ir s t fiv e p o s to p e ra tiv e d ay s.
JADA, Vol. 101, November 1980 ■ 795
CLIN IC A L
REPO RTS
F ig 1 ■ P re tre a tm e n t p e ria p ic a l ra d io g ra p h o f m a n d ib u la r rig h t first m o la r sh ow in g ex te n siv e a re a o f a n g u la r o sseo u s d e stru ctio n . S im ila r are a s
F ig 2 ■ P re tre a tm e n t p e ria p ic a l ra d io g ra p h o f m a x illa r y rig h t fir s t m o la r w ith a n g u la r o sseo u s d efect a n d ca rio u s seco n d p rem o la r.
w e re p resen t in m a x illa ry an d m a n d ib u la r left firs t m o lars.
T h e p a tie n t re tu r n e d in a w e e k to h a v e th e s u r g ic a l d r e s s in g re m o v e d a n d to r e c e iv e o ra l p h y s io th e r a p y in s tr u c tio n . E v e ry t h r e e m o n t h s th e r e a f t e r t h e p a t ie n t r e tu rn e d fo r ré é v a lu a tio n . A t th e fir s t th re e m o n th e v a lu a tio n a p p o in tm e n t (F ig 5), d e f in it e im p ro v e m e n t w as s e e n in r e s p o n s e to th e ra p y . T h e p e r io d o n ta l s u lc a l d e p th h a d d e c r e a s e d to 4 m m ; th e lin g u a l fu r c a tio n s c o u ld n o t b e p ro b e d , an d th e ra d io g ra p h s h o w e d a p p a r e n t r e o r g a n iz a tio n o f th e o s se o u s t is s u e o n th e m e s ia l a s p e c t o f th e fo u r m a n d ib u la r fir s t m o la rs. A t s ix m o n th s , u n m is ta k a b le e v id e n c e o f o s s e o u s r e g e n e ra tio n a n d fo r m a tio n o f a n e w la m in a d u ra w a s s e e n o n th e m a n d ib u la r firs t m o la rs a n d m a x illa r y in c is o r s (F ig 6 -8 ). P e r io d ic e v a lu a tio n fo r th r e e y e a rs h a s v e rifie d th e s ta b ility o f th is p a t ie n t’s d e n ti F ig 3 ■ P re tre a tm e n t ra d io g ra p h o f m a x illa ry
tio n to s u r g e r y a n d p o s to p e r a tiv e tr e a t m en t.
in c is o r a re a w ith d iffu se re s o rp tio n o f cre s ta l bone.
Discussion The techniques used in this case were not unusual. The initial preparatory
F ig 5 ■ T h ree -m o n th p o sto p e ra tiv e ra d io g ra p h o f m a n d ib u la r rig h t first m o la r w ith a p p a re n t o s seo u s re o rg a n iz a tio n in p ro ce ss.
F ig 4 ■ R a d io g ra p h o f m a n d ib u la r in c is o r a re a sh o w in g ex ten siv e a lv e o la r b o n e d estru ctio n .
796 ■ JADA, Vol. 101, November 1980
procedures we used are accepted app r o a c h e s to a m a n a g e m e n t o f periodontitis, and the surgical proce dure is a basic technique for the treat ment of periodontal disease. The re sponse to treatment, however, was un expected and encouraging. This case gave us a chance to study th e sy m p to m s o f an ex a m p le of periodontosis and to evaluate through postoperative followup the response to conventional periodontal therapy. Th e postop erativ e rad iog rap h ic changes in osseous appearance and clinical improvement suggest that, in this case, the progression of the bone loss has at least been arrested. The prognosis for the involved first molars and incisors remains questionable; the unpredictable nature of the disease could result in resumption of bone loss. However, the case does show that periodontosis may respond to therapy, and, therefore, conventional forms of
CLIN IC A L
REPO RTS
Fig 6 ■ Three-year post operative radiograph of mandibular right first molar with partial elimi nation of osseous defect visible and reformation of crestal lamina dura (ar row).
Fig 8 ■ Three-year postoperative radiograph of maxillary anterior area with suggestion of in creased osseous density between maxillary cen tral and lateral incisors.
'3 k
Fig 7 ■ Three-year post operative radiograph of maxillary left first molar shows increased crestal radiopacity (arrow).
1 . G o t t l i e b , B . D ie d i f f u s e a t r o p h i e d e s alv eo la r-k n o ch e n s. Z Sto m a to l 2 1 :1 9 5 , 1 9 2 3 . 2. B a e r, P .N ., and B e n ja m in , S .D . P erio d o n ta l d isease in ch ild re n and a d o lesce n ts. P h ila d e l p h ia, J. B. L ip p in c o tt Co., 1 9 7 4 , pp 1 3 9 -1 6 9 . 3. K irk h am , D .B. P e rio d o n to sis— g en era l d is c u ss io n and report o f fa m ilia l ca ses. J W ise D ent A sso c 5 3 (8 ):3 4 7 -3 4 9 , 1 9 7 7 . 4 . B e n ja m in , S.D ., and B a er, P.N . F a m ilia l p a t tern s o f ad v an ced a lv eo la r b o n e lo ss an d a d o le s c e n c e (p eriod on to sis). J P erio d o n to l 5 :8 2 , 1 9 6 7 . 5 . V o g e l, R .I ., a n d D e a s y , M .J. J u v e n i l e p e rio d o n titis (p erio d o n to sis); cu rre n t co n cep ts. JAD A 9 7 (5 ):8 4 3 -8 4 6 , 1 9 7 8 . 6 . N ew m an, M .A ., and o th ers. S tu d ies o f th e
periodontal treatment should be con sidered in this unusual disease.
Summary
lam in a dura was seen on the ra diographs. This example showed that an instance of periodontosis may re spond to this type of therapy.
m ic r o b io lo g y o f p e rio d o n to s is . ) P e rio d o n to l 4 7 :3 7 3 -3 7 9 , 1 9 7 6 . 7. B aer, P .N ., and G am ble, J.W . A u tog en eou s d en tal tran sp lan ts as a m etho d o f treatin g th e os seo u s d efects in p erio d o n to sis. O ral S u rg 2 2 :4 0 5 , 1966. 8 . G o ld ste in , M .C ., and F ritz , M .E . T rea tm en t o f p erio d o n to sis by co m b in ed o rth o d o n tic and
This case report describes the treat ment of a patient with periodontosis. Surgical treatment was used on all first molar and m axillary incisor areas. Mucoperiosteal flaps were made, and, at six months, evidence of osseous re g en eratio n and form ation of new
Drs. H oge and K irkham are a ssista n t c lin ic a l p ro fe s s o rs , d e p a rtm e n t o f p e rio d o n tic s , M ar q u ette D en tal S c h o o l, M ilw a u k ee, and are in the p riv ate p ra ctice o f p e rio d o n tics. A d dress requests fo r rep rin ts to Dr. H oge, 6 9 4 4 N Port W ash ing to n
p e rio d o n ta l a p p ro a ch : rep o rt o f a ca se . JA D A 9 3 (5 ):9 8 5 -9 9 0 , 1 9 7 6 . 9 . D em arco, T .J., an d S o le tta , L.J. T h e u se o f au to gen eo u s h ip m arrow in th e trea tm en t o f ju v e n ile p e rio d o n titis. J P erio d o n to l 4 1 :6 8 3 ,1 9 7 0 .
Rd, M ilw au k ee, 5 3 2 1 7 .
Hoge-Kirkham : PERIODONTOSIS ■ 797
REPO RTS
Periodontosis: treatment results in 15-year-old girl H. W illiam Hoge, D D S, M S Dan B. Kirkham, D D S, M S
E x traction o f th e m a n d ib u la r in ciso rs a n d th e m a x illa r y s e c o n d p r e m o la r s in a 1 5 -y ea r-o ld g irl w as p a r t o f th e trea tm en t to stop b o n e loss. F ollow -u p trea tm en t in c lu d e d reta in in g th e m a x illa r y in ciso rs a n d m a x illa r y a n d m a n d ib u la r fir s t m o lars.
T
he e x a c t c h a r a c te r is tic s of periodontosis, even its very existence, have been controversial since the dis ease was first cited by G ottlieb in 1 923.1 It seems to be generally agreed that periodontosis is a disease process of the periodontium of adolescents re sulting in rapid bone loss around spe cific permanent teeth.2 The onset of periodontosis does not seem to be related to systemic disease or nutritional deficiency, nor does the etiology of periodontosis have the same relationship to plaque, calculus, occlusion, or restorative factors that periodontitis has. Periodontosis often follows a familial pattern and occurs more often in females.3,4 Clinically, periodontosis is charac terized by a normal-appearing superfi cial gingiva with localized areas of pocket depth and accompanying bone loss often affecting first molars and in cisors. The patterns of bone loss show
bilateral symmetry and may involve both incisors and first molars; the in cisor and first molar may be affected separately.5 Although the etiology of periodon tosis has been obscure, recent investi gations have suggested that gramnegative microorganisms may be in volved in the pathogenesis of this un usual form of alveolar bone destruc tion.6 Treatment of periodontosis has been hindered because of its uncertain eti ology. As a result, many therapeutic measures are described in the litera ture. Techniques that have been dis cussed include dental transplants,7 orthodontic-periodontic approach,8 osseous implants,9 selective extraction in more severe cases, and chemother apeutic maintenance regimens using tetracycline. The following report presents clin i cal and radiographic findings concern ing flap surgical management in a pa tient with symptoms of periodontosis.
a n d m a n d ib u la r fir s t m o la rs a n d in c is o r s . L in g u a l fu rc a tio n s w e re d e te c ta b le in th e m a n d ib u la r fir s t m o la rs. P e r ia p ic a l ra d io g ra p h s s h o w e d fo r m a tio n o f la rg e a n g u la r c ra te rs o n th e m e s ia l a s p e c ts o f a ll fo u r fir s t m o la rs (F ig 1 , 2 ) a n d o n th e in te r p ro x im a l a s p e c ts o f th e m a x il la ry (F ig 3) a n d m a n d ib u la r in c is o r s (F ig 4 ). B e c a u s e o f e x te n s iv e b o n e lo s s , th e m a n d ib u la r i n c is o r s w e r e e x t r a c te d a n d r e p la c e d w ith a p ro v is io n a l p a rtia l d e n tu re . T h e m a x illa r y s e c o n d p re m o la r s w e re e x tr a c te d b e c a u s e o f u n r e s to r a b le c a rie s . D e s p ite e x te n s iv e b o n e lo s s , th e d e c is io n w a s m a d e to re ta in a n d tr e a t m a x illa r y in c is o r s a n d m a x illa r y a n d m a n d ib u la r firs t m o la rs.
Treatment I n it ia l th e r a p y in c lu d e d s u b g in g iv a l d e b rid e m e n t a n d ro o t p la n in g , a s little c a l c u lu s w a s p re se n t. T h e p a t ie n t w a s in s tr u c t e d
in th e
m e th o d s o f p la q u e r e m o v a l, su b g in g iv a l flo s s in g , a n d in th e m o d ifie d B a s s te c h n iq u e o f b ru s h in g w ith a m u ltitu fte d so ft n y lo n b ru sh . N o o c c lu s a l a d ju s tm e n t w as d o n e , a s n o p r e m a tu r itie s c o u ld b e d e te c te d .
R e p o rt o f c a s e
S u r g ic a l tr e a tm e n t w a s th e n p e rfo rm e d
A 1 5 -y e a r-o ld b la c k g irl w a s re fe r re d to a p e rio d o n ta l s p e c ia lis t b e c a u s e o f so re , lo o s e m a n d ib u la r in c is o r s . H er m e d ic a l h is to ry w a s n o n c o n trib u to ry . C lin ic a l e x a m in a tio n d is c lo s e d c o m p le te d e n t itio n
in g o o d
a lig n m e n t w ith a C la ss I o c c lu s io n . C a rie s a ffe c te d e x te n s iv e a re a s o n m a x illa r y s e c o n d p re m o la r s a n d s e c o n d m o la rs. T h e g in g iv a w a s firm a n d stip p le d , a n d n o v is ib le s ig n s o f in f la m m a t io n w e r e p r e s e n t. P e rio d o n ta l p ro b in g d is c lo s e d d e e p p o c k ets o f 7 , 8 , a n d 9 m m o f d e p th in m a x illa r y
o n a ll fir s t m o la r a n d m a x illa r y in c is o r a re a s. E le v a te d m u c o p e r io s te a l fla p s w e re c re a te d u s in g a s c a llo p e d in te r n a l b e v e le d in c is io n . A ll g r a n u lo m a to u s a n d fib ro u sa p p e a rin g so ft tis s u e w a s re m o v e d fro m th e a re a o f th e le s io n . N o o s te o p la s ty o f o s se o u s g ra ftin g w a s d o n e , h o w e v e r. T h e fla p s w e re r e a p p r o x im a te d , p r im a r ily w it h n o . 4 .0 p o ly g ly c o lic a c id s u tu r e s . F in a lly , a p e r io d o n ta l d r e s s in g w as p la c e d , an d p h e n o x y m e th y l K p e n i c il l i n , 2 5 0 m g fo u r tim e s a d ay , w as p re s c rib e d fo r th e f ir s t fiv e p o s to p e ra tiv e d ay s.
JADA, Vol. 101, November 1980 ■ 795
CLIN IC A L
REPO RTS
F ig 1 ■ P re tre a tm e n t p e ria p ic a l ra d io g ra p h o f m a n d ib u la r rig h t first m o la r sh ow in g ex te n siv e a re a o f a n g u la r o sseo u s d e stru ctio n . S im ila r are a s
F ig 2 ■ P re tre a tm e n t p e ria p ic a l ra d io g ra p h o f m a x illa r y rig h t fir s t m o la r w ith a n g u la r o sseo u s d efect a n d ca rio u s seco n d p rem o la r.
w e re p resen t in m a x illa ry an d m a n d ib u la r left firs t m o lars.
T h e p a tie n t re tu r n e d in a w e e k to h a v e th e s u r g ic a l d r e s s in g re m o v e d a n d to r e c e iv e o ra l p h y s io th e r a p y in s tr u c tio n . E v e ry t h r e e m o n t h s th e r e a f t e r t h e p a t ie n t r e tu rn e d fo r ré é v a lu a tio n . A t th e fir s t th re e m o n th e v a lu a tio n a p p o in tm e n t (F ig 5), d e f in it e im p ro v e m e n t w as s e e n in r e s p o n s e to th e ra p y . T h e p e r io d o n ta l s u lc a l d e p th h a d d e c r e a s e d to 4 m m ; th e lin g u a l fu r c a tio n s c o u ld n o t b e p ro b e d , an d th e ra d io g ra p h s h o w e d a p p a r e n t r e o r g a n iz a tio n o f th e o s se o u s t is s u e o n th e m e s ia l a s p e c t o f th e fo u r m a n d ib u la r fir s t m o la rs. A t s ix m o n th s , u n m is ta k a b le e v id e n c e o f o s s e o u s r e g e n e ra tio n a n d fo r m a tio n o f a n e w la m in a d u ra w a s s e e n o n th e m a n d ib u la r firs t m o la rs a n d m a x illa r y in c is o r s (F ig 6 -8 ). P e r io d ic e v a lu a tio n fo r th r e e y e a rs h a s v e rifie d th e s ta b ility o f th is p a t ie n t’s d e n ti F ig 3 ■ P re tre a tm e n t ra d io g ra p h o f m a x illa ry
tio n to s u r g e r y a n d p o s to p e r a tiv e tr e a t m en t.
in c is o r a re a w ith d iffu se re s o rp tio n o f cre s ta l bone.
Discussion The techniques used in this case were not unusual. The initial preparatory
F ig 5 ■ T h ree -m o n th p o sto p e ra tiv e ra d io g ra p h o f m a n d ib u la r rig h t first m o la r w ith a p p a re n t o s seo u s re o rg a n iz a tio n in p ro ce ss.
F ig 4 ■ R a d io g ra p h o f m a n d ib u la r in c is o r a re a sh o w in g ex ten siv e a lv e o la r b o n e d estru ctio n .
796 ■ JADA, Vol. 101, November 1980
procedures we used are accepted app r o a c h e s to a m a n a g e m e n t o f periodontitis, and the surgical proce dure is a basic technique for the treat ment of periodontal disease. The re sponse to treatment, however, was un expected and encouraging. This case gave us a chance to study th e sy m p to m s o f an ex a m p le of periodontosis and to evaluate through postoperative followup the response to conventional periodontal therapy. Th e postop erativ e rad iog rap h ic changes in osseous appearance and clinical improvement suggest that, in this case, the progression of the bone loss has at least been arrested. The prognosis for the involved first molars and incisors remains questionable; the unpredictable nature of the disease could result in resumption of bone loss. However, the case does show that periodontosis may respond to therapy, and, therefore, conventional forms of
CLIN IC A L
REPO RTS
Fig 6 ■ Three-year post operative radiograph of mandibular right first molar with partial elimi nation of osseous defect visible and reformation of crestal lamina dura (ar row).
Fig 8 ■ Three-year postoperative radiograph of maxillary anterior area with suggestion of in creased osseous density between maxillary cen tral and lateral incisors.
'3 k
Fig 7 ■ Three-year post operative radiograph of maxillary left first molar shows increased crestal radiopacity (arrow).
1 . G o t t l i e b , B . D ie d i f f u s e a t r o p h i e d e s alv eo la r-k n o ch e n s. Z Sto m a to l 2 1 :1 9 5 , 1 9 2 3 . 2. B a e r, P .N ., and B e n ja m in , S .D . P erio d o n ta l d isease in ch ild re n and a d o lesce n ts. P h ila d e l p h ia, J. B. L ip p in c o tt Co., 1 9 7 4 , pp 1 3 9 -1 6 9 . 3. K irk h am , D .B. P e rio d o n to sis— g en era l d is c u ss io n and report o f fa m ilia l ca ses. J W ise D ent A sso c 5 3 (8 ):3 4 7 -3 4 9 , 1 9 7 7 . 4 . B e n ja m in , S.D ., and B a er, P.N . F a m ilia l p a t tern s o f ad v an ced a lv eo la r b o n e lo ss an d a d o le s c e n c e (p eriod on to sis). J P erio d o n to l 5 :8 2 , 1 9 6 7 . 5 . V o g e l, R .I ., a n d D e a s y , M .J. J u v e n i l e p e rio d o n titis (p erio d o n to sis); cu rre n t co n cep ts. JAD A 9 7 (5 ):8 4 3 -8 4 6 , 1 9 7 8 . 6 . N ew m an, M .A ., and o th ers. S tu d ies o f th e
periodontal treatment should be con sidered in this unusual disease.
Summary
lam in a dura was seen on the ra diographs. This example showed that an instance of periodontosis may re spond to this type of therapy.
m ic r o b io lo g y o f p e rio d o n to s is . ) P e rio d o n to l 4 7 :3 7 3 -3 7 9 , 1 9 7 6 . 7. B aer, P .N ., and G am ble, J.W . A u tog en eou s d en tal tran sp lan ts as a m etho d o f treatin g th e os seo u s d efects in p erio d o n to sis. O ral S u rg 2 2 :4 0 5 , 1966. 8 . G o ld ste in , M .C ., and F ritz , M .E . T rea tm en t o f p erio d o n to sis by co m b in ed o rth o d o n tic and
This case report describes the treat ment of a patient with periodontosis. Surgical treatment was used on all first molar and m axillary incisor areas. Mucoperiosteal flaps were made, and, at six months, evidence of osseous re g en eratio n and form ation of new
Drs. H oge and K irkham are a ssista n t c lin ic a l p ro fe s s o rs , d e p a rtm e n t o f p e rio d o n tic s , M ar q u ette D en tal S c h o o l, M ilw a u k ee, and are in the p riv ate p ra ctice o f p e rio d o n tics. A d dress requests fo r rep rin ts to Dr. H oge, 6 9 4 4 N Port W ash ing to n
p e rio d o n ta l a p p ro a ch : rep o rt o f a ca se . JA D A 9 3 (5 ):9 8 5 -9 9 0 , 1 9 7 6 . 9 . D em arco, T .J., an d S o le tta , L.J. T h e u se o f au to gen eo u s h ip m arrow in th e trea tm en t o f ju v e n ile p e rio d o n titis. J P erio d o n to l 4 1 :6 8 3 ,1 9 7 0 .
Rd, M ilw au k ee, 5 3 2 1 7 .
Hoge-Kirkham : PERIODONTOSIS ■ 797