DISKUSI REKAM MEDIS KASUS

DEPARTEMEN PERIODONSIA

Instruktur : drg. Malianawati F, Sp. Perio

Syifayudha Nuari 190160100111089

Tanggal Diskusi : 3 Januari 2023

PROGRAM STUDI PROFESI DOKTER

GIGI FAKULTAS KEDOKTERAN GIGI
UNIVERSITAS BRAWIJAYA
MALANG
2023
 REKAM MEDIS KASUS PERIODONSIA

Nama Pasien : Tn. X

Nomor RM :-

Nama Instruktur : drg. Malianawati F,

Sp.Perio Nama Mahasiswa : Syifayudha Nuari
NIM 190160100111089
Tanggal :03 Januari 2023

DATA PASIEN
Nama : Tn.X
Jenis Kelamin : Laki-laki
Tanggal Lahir : (28 tahun)

Suku :-

Status Perkawinan :-

Agama :-
Alamat :-
No. Hp
Pendidikan Terakhir : -

Pekerjaan :-
RIWAYAT MEDIS
Konsul dari : Rujukan Dokter Umum
Keluhan Utama : Terdapat nanah pada gigi atas belakang kanan dan gigi bawah
belakang kiri
Anamnesa : Pasien laki-laki datang dengan keluhan terdapat nanah pada gigi atas
belakang kanan dan kiri belakang bawah. Pasien mengaku tidak memiliki
kebiasaan merokok. Pasien juga sedang tidak mengkonsumsi obat rutin.
Pasien ingin dilakukan perawatan.
Penyakit Sistemik :-
Kebiasaan Buruk : TAK
Riwayat Alergi : TAK

Riwayat Perawatan Gigi : -

STATUS PRAESENS
Keadaan Umum : Baik

Ekstra Oral : TAK

Intra Oral : Terdapat abses pada gigi 16 dan 36
Oral Hygiene :-
Keterangan Radiografi

 Terdapat penurunan tulang secara vertikal  2mm pada bagian mesial gigi 22 sampai mesial gigi 25 dan
kehilangan lamina dura
 Terdapat penurunan tulang secara vertikal  2mm pada bagian mesial gigi 47 sampai mesial gigi 46

 Terdapat penurunan tulang secara vertikal  2mm pada bagian distal gigi 42 sampai mesial gigi 44
 Diagnosis Primer : Periodontitis Agresif Generalisata
Diagnosis Sekunder :-
Etiologi : Bakteri plak
Faktor Predisposisi : Malposisi Gigi
Faktor risiko :-
Prognosis : Good (pasien kooperatif dan tidak ada faktor
sistemik, tulang penyangga yang tersisa masih
memadai)

Rencana Perawatan :
Emergency Phase

 DHE KIE
Non Surgical Phase (I)
 SRP RA dan RB

 Pemeriksaan OHIS
 Pemeriksaan kedalaman poket
Reevaluation
 Pemeriksaan inflamasi gingiva

 Pemeriksaan OHIS
 Pemeriksaan kedalaman poket
Maintenance Phase (IV)  Pemeriksaan inflamasi gingiva

Surgical Phase(II) Restorative Phase (III)

- Pro Orthodonsia Piranti
Cekat Rahang atas dan
Bawah
FOTO INTRAORAL PASIEN

SEBELUM SESUDAH
 REKAM MEDIS KASUS PERIODONSIA

Nama Pasien : Tn. Y

Nomor RM :-

Nama Instruktur : drg. Malianawati F,

Sp.Perio Nama Mahasiswa : Syifayudha Nuari
NIM 190160100111089
Tanggal :03 Januari 2023

DATA PASIEN
Nama : Tn.Y
Jenis Kelamin : Laki-laki
Tanggal Lahir : (12 tahun)

Suku :-

Status Perkawinan :-

Agama :-
Alamat :-
No. Hp
Pendidikan Terakhir : -

Pekerjaan :-
RIWAYAT MEDIS
Konsul dari : Rujukan Dokter Umum
Keluhan Utama : Gusi bengkak pada gigi depan
Anamnesa : Pasien laki-laki datang dengan keluhan terdapat gusi bengkak pada gigi
atas depan. Pasien dalam keadaan sehat. Pasien juga sedang tidak
mengkonsumsi obat rutin. Pasien ingin dilakukan perawatan.
Penyakit Sistemik :-
Kebiasaan Buruk : TAK
Riwayat Alergi : TAK

Riwayat Perawatan Gigi : -

STATUS PRAESENS
Keadaan Umum : Baik

Ekstra Oral : TAK

Intra Oral : TAK

Oral Hygiene :-
Keterangan Radiografi

 Terdapat penurunan tulang secara vertikal  2mm pada bagian mesial gigi 12 sampai mesial gigi 21
dan kehilangan lamina dura

 Terdapat gambaran radiolusen pada servikal gigi 32

 Terdapat edentulous ridge dari mesial 17 sampai distal 15

 Terdapat edentulous ridge pada distal gigi 25 sampai mesial gigi 27

 Terdapat edentulous ridge pada mesial gigi 37 sampai distal gigi 35

 Terdapat gambaran radiopak pada oklusal gigi 46

 Diagnosis Primer : Periodontitis Agresif Generalisata
Diagnosis Sekunder : Gingivitis associated with dental plaque only gigi 11 dan 21
Etiologi : Bakteri plak
Faktor Predisposisi : Malposisi Gigi
Faktor risiko :-
Prognosis : Good (pasien kooperatif, usia pasien masih muda dan
tidak ada faktor sistemik, tulang penyangga yang
tersisa masih memadai)

Rencana Perawatan :
Emergency Phase

 DHE KIE
Non Surgical Phase (I)
 SRP RA dan RB

 Pemeriksaan OHIS
 Pemeriksaan kedalaman poket
Reevaluation
 Pemeriksaan inflamasi gingiva

 Pemeriksaan OHIS
 Pemeriksaan kedalaman poket
Maintenance Phase (IV)  Pemeriksaan inflamasi gingiva

Surgical Phase(II) Restorative Phase (III)

- - Pro orthodonsia
- Pro Konservasi
tumpat komposit kelas
3
FOTO INTRAORAL PASIEN

SEBELUM SESUDAH
Case Report
J Periodontal Implant Sci 2010;40:249-253 • doi: 10.5051/jpis.2010.40.5.249 JPIS Journal of Periodontal
& Implant Science

Clinical case report on treatment of generalized

aggressive periodontitis
Mi-Hwa Jung, Jin-Woo Park, Jo-Young Suh, Jae-Mok Lee*
Department of Periodontology, Kyungpook National University School of Dentistry, Daegu, Korea

Purpose: The purpose of this study was to evaluate the improvement of periodontal health of generalized aggressive peri-
odontitis (GAgP) diagnosed patients treated with non-surgical periodontal therapy accompanying systemic antibiotics
admin- istration.
Methods: Two patients with GAgP were chosen for this study. Clinical indices were taken and a radiographic examination
was performed at the baseline of the study and they were treated by periodontal therapy accompanying systemic
antibiotics ad- ministration. Post-surgical visits were scheduled at regular intervals to check clinical and radiographic
changes.
Results: Through non-surgical periodontal therapy accompanying systemic antibiotics administration, GAgP patients showed
decreased probing pocket depth, sulcus bleeding index, and increased attachment level and clinical index when comparing
the initial and six month follow up data. In the six month follow-up radiographic examination after non-surgical
periodontal therapy, resolution of the bony defect was observed.
Conclusions: Non-surgical therapy combined with systemic antibiotics administration in GAgP patients is suggested to be
an effective approach to enhance the periodontal health.

Keywords: Aggregatibacter actinomycetemcomitans, Periodontitis.

INTRODUCTION cally administered antibiotics were added. It has been

Generalized aggressive periodontitis (GAgP) is characterized
as “generalized interproximal attachment loss affecting at
least three permanent teeth other than the first molars
and incisors” [1,2].
GAgP affects a minority of patients, but it is highly
signifi- cant because it is characterized by severe
destruction of the supporting apparatus of teeth in a
relatively young subjects. Because of its less common
occurrence, few studies have evaluated different
treatment protocols for this condition. Among those, one
study [3] recently applied the principles of full-mouth non-
surgical periodontal treatment and found further
improvement in clinical parameters when systemi-
shown that successful treatment of GAgP is dependent on
the reduc- tion of specific pathogenic bacteria.
For example, the adjunctive use of metronidazole plus
amox- icillin may control Aggregatibacter
actionomycetemcomitans and Porphyromonas gingivalis
more efficiently than single an- tibiotic regimens or
mechanical therapy alone [4].
Its etiology is highly correlated to the presence of Aggregat-
ibacter actionmycetencomitans [5-7] and host response defects
[8-10] and is possibly related to a genetic inheritance [11-18].
There is no widely accepted treatment protocol for
GAgP [19]. Treatment alternatives include scaling and root
planing (SRP) alone or in conjunction with systemic
antibiotics [20-22] as well as surgical [23] and interdisciplinary
approaches [24,25],

Received: Jun. 14, 2010; Accepted: Aug. 22, 2010

*Correspondence: Jae-Mok Lee
Department of Periodontology, Kyungpook National University School of Dentistry, 188-1 Samduk-dong 2-ga, Jung-gu, Daegu 700-412,
Korea E-mail: leejm@knu.ac.kr, Tel: +82-53-600-7511, Fax: +82-53-427-3263

Copyright © 2010 Korean Academy of Periodontology Non-Commercial License nc/3.0/).

(http://creativecommons.org/licenses/by-
This is an Open Access article distributed under the terms of the Creative Commons Attribution
www.jpis.org pISSN 2093-2278
eISSN 2093-2286
250

JPIS
Antibiotics-supplemented non-surgical therapy is effective for GAgP Journal of Periodontal
& Implant Science

with adequate outcomes. However, there are only a few re-

ports [19,23,26] of long-term follow-up for these different
treatments.
Successful treatment of GAgP is considered to be
depen- dent on early diagnosis, directing therapy towards
elimina- tion or suppression of the infecting
microorganism and pro- viding an environment conductive
to long-term maintenance. The purpose of this study was to
evaluate the improvement of periodontal health of GAgP
diagnosed patients treated with non-surgical periodontal
therapy accompanying sys-
temic antibiotics administration.
CASE DESCRIPTION
Case 1
A 28-year-old male patient was referred by a general practi-
tioner to the Institute for Periodontology and School of
Den- tistry, Kyungpook National University, for treatment of
GAgP (Fig. 1). The initial examination revealed deep probing
pocket
depth (PD) with sulcus bleeding index (SBI). Suppuration
was registered at the maxillary right first molar and the
mandibu- lar left first molar. Gingival inflammation was
observed. The patient was in good general health, had
never smoked, and did not take any medications. Familial
aggregation of GAgP was denied. PD, tooth mobility (Mob),
SBI, and the presence of suppuration were recorded (Fig.
2). A full mouth series of periapical radiographs was
obtained (Fig. 3). Deep infrabony defects were evidence of
progressing periodontal destruc- tion. After full-mouth
scaling, the patient received quadrant root planing four
times at 1-weekly intervals over four con- secutive
sessions. Starting with SRP, systemic antibiotics
(amoxicillin/clavulanate 375 mg and metronidazole 250 mg,
both three times a day for 7 days) were prescribed. The pa-
tient was advised to abstain from mechanical oral hygiene
in the treated areas for the first 3 postoperative weeks and
to rinse with a 0.2% chlorhexidine solution twice daily.
Routine supportive periodontal therapy was performed every
3 months. Whole-mouth clinical measurements were
recorded with a

Figure 1. Initial clinical photographs of case 1 patient.

Figure 4. Clinical photographs of case 1 patient after 1 year therapy.
Additional orthodontic appliance was attached for malocclusion.

PD tical bone defects.

SBI

Mob

PD

SBI

Mob

Figure 2. Baseline periodontal scores of case 1 patient. PD:

probing pocket depth, SBI: sulcus bleeding index, Mob: tooth
mobility.

Figure 3. Initial radiographs of case 1 patient. Note the discrete ver-

 P

Mob

Mob

Figure 5. Periodontal scores of case 1 patient after 1 year

therapy. PD: probing pocket depth, SBI: sulcus bleeding index,
Mob: tooth mobility.

Figure 6. Radiographs of case 1 patient after 1 year therapy.

Note that marked fill of the bony defects and sharp contours of
the gained hard tissues.
JPIS
Journal of Periodontal
& Implant Science Mi-Hwa Jung et al. 251

manual periodontal probe at 6 month after the initiation

of therapy. Measurements demonstrated distinct clinical
DISCUSSION
im- provements. PD of the affected sites had decreased to a
Several antibiotic regimens have been investigated as
maxi- mum of 4 mm. Suppuration had been eliminated,
ad- juncts to the mechanical therapy for GAgP. The
and full- mouth SBI was as low as 10%. A negligible
combination of SRP with systemic administration of
increase in reces- sion was observed. Radiographs obtained 1
amoxicillin/clavula- nate/metronidazole suppressed
year after therapy showed fill of the bony defects and
Aggregatibacter actinomy- cetemcomitans and other tested
sharp contours of the gained hard tissues (Figs. 4-6).
pathogens to below detect- able levels. The concomitant
effect on clinical parameters em- phasizes the excellent
Case 2
efficacy of amoxicillin/clavulanate/met- ronidazole against
A 12-year-old male patient was referred by a general
periodontal infections in terms of micro- biologic and clinical
practi- tioner to the Institute for Periodontology and School
outcomes reported previously [20-22, 27].
of Den- tistry, Kyungpook National University, for treatment
Because persistently high bacterial counts and the pres-
of GAgP (Fig. 7). The initial examination revealed deep PD
ence of periodontal pathogens at surgery adversely
with SBI. Gingival swelling was observed, especially in
affect clinical attachment level gains [28], meticulous initial
both anterior areas. The patient was in good general
therapy and good oral hygiene are considered to be
health and did not take any medications. Familial
prerequisites for successful periodontal surgery [29].
aggregation of GAgP was de- nied. PD, Mob, SBI and the
presence of suppuration were re- corded (Fig. 8). A
panoramic radiograph was obtained (Fig. 9). Deep infrabony
defects were evidence of progressing peri- odontal
destruction. After full-mouth scaling, the patient re- ceived
quadrant root planing four times at 1-weekly intervals over
four consecutive sessions. Starting with SRP, systemic
antibiotics (amoxicillin/clavulanate 375 mg and metronidazole
250 mg, both three times a day for 7 days) were prescribed. At
supportive periodontal care six month after initial therapy,
measurements demonstrated distinct clinical improvements.
PD of the affected sites had decreased to a maximum of 7
Figure 9. RInitial radiographs of case 2 pateint. Note the discrete
mm. Full mouth SBI was as low as 5% (Figs. 10 and 11).
vertical bone defects and missing teeth.

Figure 7. Initial clinical photographs of case 2 patient. Figure 10. Clinical photographs of case 2 patient after 1 year thera-
py. There are no clinical signs of gingival inflammation.

PD
PD
SBI
SBI
Mob
Mob

Mob
Mob
SBI
SBI
PD
PD

Figure 8. Baseline periodontal scores of case 2 patient. PD:

Figure 11. Periodontal scores of case 2 patient after 1 year
probing pocket depth, SBI: sulcus bleeding index, Mob: tooth
therapy. PD: probing pocket depth, SBI: sulcus bleeding index,
mobility.
Mob: tooth mobility.
252

JPIS
Antibiotics-supplemented non-surgical therapy is effective for GAgP Journal of Periodontal
& Implant Science

In case 1, postoperative healing was excellent, facilitated by 3. Guerrero A, Griffiths GS, Nibali L, Suvan J, Moles DR, Lau-
the systemic administration of antibiotics, which has
been reported previously. Six month after therapy, distinct
clinical improvements were indicated. PD reduction
ranged from 3 to 7 mm. Suppuration had been eliminated,
and no gingival inflammation signs were observed. The
periapical radio- graphs obtained 1 year after therapy
showed fill of the bony defects and stability of the
treatment outcome,. Although all sites demonstrated
comparable clinical improvements, vary- ing degrees of
radiographic defect fill were observed (Figs. 4-6).
In case 2, substantial and stable clinical periodontal
status were shown after conventional periodontal therapy
and ad- junctive administration of antibiotics. Six month
after initial therapy, measurements indicated distinct
clinical improve- ments with redection of PD and no
suppuration. And full mouth SBI was decreased.
A high “repair potential” of previously untreated young
GAgP patients is empirically assumed and has been a
regular subject of discussion. However, the noticeably
higher age, which was 28 years, of the patient presented
here might limit the clinical application of these findings.
Furthermore, after repeated attempts at periodontal
therapy with concomitant “mechanical damage” to the
root surfaces and subsequent bacterial recolonization
and disease progression, the indi- vidual healing potential
after the initial therapy alone could not be certain for the
present patient. To improve the unclear prognosis, the
depicted course of treatment included regen- erative
periodontal surgery, performed shortly after SRP and
adjunctive antibiotics therapy.
The combination of initial therapy with adjunctive
amoxi- cillin/clavulanate/metronidazole followed by non-
surgical periodontal therapy provided a good clinical,
radiographic, and esthetic result in the present patients
with severe and progressing GAgP. Beyond the limits of
these case reports, the significance of regenerative therapy
in the evidence-based treatment of GAgP remains to be
evaluated.

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article

was reported.

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