We report a case involving a 12-year follow-up after treatment for chronic periodontitis with furcation involvement. A 54-year-old woman presented with the chief complaint of hypersensitivity. Clinical examination at the first visit revealed 15% of sites with a probing depth ≥4 mm and 35% of sites with bleeding on probing. Initial periodontal therapy was implemented based on a clinical diagnosis of severe chronic periodontitis. Surgical periodontal therapy was subsequently performed at selected sites. For #44, regenerative periodontal therapy using enamel matrix derivative (Emdogain(®)) was selected. For #16, which exhibited a 2- to 3-wall vertical bony defect and class III (mesio-distal) furcation involvement, bone graft was scheduled. Other sites with residual periodontal pockets were treated by open flap debridement. For #37, with a gutter-shaped root, odontoplasty was performed. After reevaluation, the patient was placed on supportive periodontal therapy (SPT). During 12 years of SPT, the periodontal condition remained uneventful in most of the teeth. However, bone resorption was observed in the distal aspect of #37, making the prognosis poor. This indicates the need to continuously monitor risk factors, including inflammation and traumatic occlusion, during SPT. Although some problems still remain, severe periodontitis with furcation involvement was successfully maintained longitudinally with an adequate level of patient compliance and careful SPT.
Background: Antimicrobial proteins are abundant in saliva. The purpose of this study was to determine and compare the amounts of two types of antibacterial protein, cystatin and lysozyme, in saliva between healthy persons and subjects with periodontitis. Methods: Forty subjects with periodontitis visiting Tokyo Dental College Chiba Hospital, Chiba, Japan, and 27 healthy persons were evaluated. Whole saliva was collected by requiring all subjects to expectorate into a sterile tube. Salivary levels of cystatin SA, cystatin C, and lysozyme were determined by enzyme‐linked immunosorbent assay or immunoblot assay. Results: Cystatin SA levels in saliva from the periodontally diseased group showed a mean value of 0.063 ± 0.026 mg/ml, statistically lower than that in the healthy group ( P <0.05). The average cystatin C level in the periodontally diseased group was 2.27 ± 1.20 ng/ml, markedly lower than that in the healthy group (3.79 ± 1.28 ng/ml; P <0.05). Average lysozyme levels in the periodontitis and healthy groups were 16.75 ± 15.31 μg/ml and 30.03 ± 15.03 μg/ml, respectively. The lysozyme level in the periodontitis group was significantly lower than in the healthy group ( P <0.05). Conclusion: Specific monoclonal antibodies are useful for the detection of family 2 cystatins in saliva samples, and the amount of antibacterial protein in saliva offers a potential indicator of the risk for periodontitis.
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