An 85-year-old Taiwanese male with a history of hypertension was admitted to the emergency department of our hospital, reporting unexplained weight loss and frequent urination persisting for several days. His nonfasting blood glucose level was 777 mg/dL. He had been taking amlodipine and enalapril maleate for 14.5 years to control his hypertension. During his hospitalization, he was diagnosed with type 2 DM and referred to our dental department for severe GE and spontaneous bleeding. The dentist made a diagnosis of DIGE and recommended that alternative treatments be administered to control the patient's hypertension. A physician specialized in metabolic medicine replaced amlodipine and enalapril maleate with valsartan + hydrochlorothiazide (Co-Diovan®, Novartis, London, United Kingdom) for hypertension and prescribed metformin to control the patient's DM. The patient was discharged 12 days later. After 7 months of discharge, the aforementioned physician switched the patient's hypertension regimen again to benazepril + amlodipine (Amtrel®, TTY Biopharm, Taipei, Taiwan). According to his latest blood test results, his HbA1c was as normal as 6.3%.\nThe patient visited our outpatient dental clinic because of severe swollen and erythematous gum, which had been deteriorating over the previous 3 months. Oral examination revealed that his oral hygiene was poor. Severe GE was noted throughout all quadrants []. His gingival overgrowth index (as established by Seymour et al.)[] was 90%. All teeth had a probing depth of ≥7 mm at the deepest site. According to the patient's self-observation, teeth #13–23 and #43–44 had significant PTM [Figures and ]. The radiographs revealed generalized severe bone loss, particularly in teeth #16 and #26 []. The patient gave oral consent for treatment.\nAfter the necessary periodontal parameters were collected, the patient was diagnosed as having DIGE and generalized Stage IV Grade C periodontitis on the basis of the new classification system for periodontal and peri-implant diseases developed in 2017.[] Full-mouth scaling and root planing were accomplished within 1 week, divided into four appointments. Adjunctive antibiotics (amoxicillin 250 mg q8 h + metronidazole 250 mg q8 h) were prescribed for 8 days. Oral hygiene instructions were provided continuously. The patient's oral hygiene exhibited gradual improvements during the periodontal treatment period. We suggested extraction for teeth #16 and #26, but the patient chose to postpone the procedure. The extraction of the residual root of tooth #18 and the restoration of tooth #46 caries were performed during the root planing appointments.\nAll the periodontal parameters were re-evaluated 5 weeks after scaling and root planing was completed. The patient's oral hygiene exhibited considerable improvement: gingival swelling, enlargement, and bleeding considerably subsided [Figures and ] and gingival overgrowth index decreased to 22%. Moreover, compared with , illustrates a considerable reduction in the degree of PTM. Probing depths also demonstrated generalized reduction. The patient and his family refused additional surgical or prosthetic treatment. We reinforced the oral hygiene instructions and arranged for maintenance every 3 months. Teeth #16 and #26 were extracted 3 months later because of recurrent abscesses.\nOne year after initial periodontal treatment, 94.7% of detection sites displayed a probing depths of ≤3 mm. The patient's GE and PTM exhibited a near-complete resolution [Figures and ]. His gingival overgrowth index was 4%. Radiography revealed reduction in the furcation defects in teeth #46 and #47 []. The patient is currently in periodontal supportive treatment every 3 months, and no further complications have been reported.
A 50-year-old male patient visited our department on July 14, 2009 with the chief complaint of anterior teeth sloping down and open. As mentioned above, clinical and radiographic examinations were performed ( and , ). He was diagnosed with chronic periodontitis localized in the maxillary anterior teeth area and pathologic tooth migration. The treatment plan was periodontal therapy to eliminate causes, tooth movement of 11, and prosthodontic treatment.\nand show clinical photographs of the front side and the occlusal plane after periodontal treatment. As mentioned above, teeth were fixed at the location to where the teeth would shift with wax on the cast after space analysis ( and ), and the clear aligner was fabricated ().\nand show clinical photographs of the front side and the occlusal plane after 3 weeks. After space analysis, the teeth were fixed at the location where the teeth will be shifted to with wax again and the clear aligner was fabricated ( and ).\nand show photographs of the front side and occlusal plane after 6 weeks. Since the patient was satisfied with the results, use of a retention appliance was planned instead of prosthodontic treatment. After taking radiographs (), the retention appliance was applied ().\nAs a result, the probing pocket depth (PPD) and gingival recession (GR) decreased about 1 mm, and clinical attachment level (CAL) decreased about 2 mm when compared to the first visit. Also, mobility decreased slightly ().\nIn the radiographs, vertical and horizontal dimensions were measured (). Radiographically, the size of the infrabony defects decreased 0.8 mm vertically and 0.4 mm horizontally. However, actual bone filling in the lesions could not be determined based on the radiographic view alone.