Periodontitis is a highly prevalent and complex disease, initiated by a dysbiotic biofilm but progressed largely by an exaggerated under-regulated host immune-inflammatory response. Its primary features include the loss of periodontal tissue support of the tooth, manifested through clinical attachment loss and radiographically assessed alveolar bone loss, presence of periodontal pocketing and gingival bleeding. Periodontitis could increase the systemic inflammation in patients with CVD due to bacteremias with periodontal origin. A male patient, 47, was presented to the University San Sebastian at Concepción, Chile, School of Dental Clinic on June 01, 2016 for oral and periodontal examination. The patient's medical history included dyslipidemia (DLP), coronary heart disease (CHD), acute coronary syndrome (ACS), angina and history of myocardial revascularization surgery in 2013. Full-mouth probing depths showed overall pockets up to 8 mm. Loss of attachment levels were in the range of 8 mm. The periodontal examination described the gingival margins as erythematous and edematous, with multiple periodontal abscesses, increased tooth mobility and furcation involvement. Radiographic evaluation showed severe alveolar bone loss. The diagnosis was generalized as severe chronic periodontitis. The nonsurgical periodontal treatment included scaling and root planning (SRP), local treatment with chlorhexidine and systemic treatment with amoxicillin and metronidazole. The treatment was successful with significant improvement of periodontal parameters. However, during 2017, it was not possible to continue the treatment due to worsening of the cardiovascular condition, in this case a new acute coronary syndrome (ACS) that was treated with angioplasty placing two medicated stent. Another acute episode of the coronary disease happened the same year and was treated with another angioplasty with balloon catheter. Drugs in use were: clopidogrel-75 mg day, carvedilol-3.125 mg bid, atorvastatin-80 mg at night, aspirine-100 mg day and enalapril-10 mg bid. Even with local and systemic drug treatment, aimed at prevention of systemic bacteremia due to the invasive periodontal procedures, the patient underwent a ACS, suggesting a possible antecedent infection link to a vascular plaque, leading to subsequent plaque destabilization, rupture and ACS. Despite the systemic condition, a maintenance non-invasive management of periodontitis was possible, avoiding its progression.
Areej Ayed Derham has completed her BDS from King Abdulaziz University, Faculty of Dentistry. She is a seasoned dentist with experience in all phases of four-handed dentistry. Successfully challenged the global board of human development and became a dimplomate in both Applied Psychology and Sign Language. Member of International Association of Dental Research, Behavioral, Epidemiologic and Health Services, and Arab Society for Disability and Oral Health. Recently joined the Global Oral Health Inequalities Research Network. She has several ISI publications and presented them in well-organized conferences. Currently she is working on several papers and contributing too many others.
Aim: This article aims to present an advanced therapeutic approach based entirely on adhesive dentistry. Background: The restoration of endodontically-treated teeth (ETT) has been widely and controversially discussed in the dental literature, most of which recommends cuspal coverage of ETT to protect against potential tooth fracture. The main goal of conservative dentistry in managing ETT is to achieve minimally invasive preparation with maximal cuspal coverage. The “endocrown” follows this rationale. In addition, proximal caries with deep cervical margins are particularly complex to manage clinically. Moreover, there are various clinical approaches to such challenges, such as placing a base of composite resin to coronally displace proximal margins underneath indirect bonded restorations as known as deep margin elevation (DME) or coronal margin relocation. Case Description: This study is a clinical case report of an endocrown restoration performed on ETT with extensive coronal destruction. In combination with the clinical procedure presented here, some of the ETT with deep cervical margins were managed by applying direct composite resin restoration using the DME technique. Conclusion & Clinical Significance: The ideal treatment of ETT has been controversially discussed in the literature. Based on current evidence, endocrowns can be considered as a reliable treatment option for moderately mutilated ETT. The achieved adhesive monoblock system reduces the need for macro-retentive geometry and provides an efficient outcome and better esthetics. Furthermore, the DME technique represents another useful treatment approach for patients with financial restrictions and those with higher risk of negative outcomes involving more invasive surgical procedures. Thus, it could be used in clinical situations with deep subgingival cervical margin where isolation with a rubber dam remains possible.