Minimally Invasive Non-surgical Periodontal Therapy and Photoactivated Disinfection for the Treatment of Furcation Involvement

Periodontitis is a biofilm-induced chronic inflammatory disease that, if left untreated, can result in alveolar bone and tooth loss. Intrabony defects and furcation involvement (FI) are particularly difficult to manage, as they often persist after step 1 and step 2 periodontal therapy. In this case, we report a relatively novel therapeutic approach to managing deep furcation involvement in the first mandibular right molar (#46). The concerned area of furcation involvement presented a localized periodontitis with a Silness-Loe plaque index of 3, positive bleeding on probing, gingival recession of 2 mm, periodontal pocket depth (PPD) of 7 mm, and clinical attachment loss (CAL) of 9 mm. Moreover, the preoperative periapical X-ray showed a clear radiolucency between the roots of #46, indicating alveolar bone loss in the concerned area. The treatment consisted of step 1 and step 2 periodontal therapy according to the recommendations of the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP). One week later, minimally invasive non-surgical periodontal treatment (MINST) and photoactivated disinfection (PAD) protocol were performed on the concerned FI. MINST was achieved with ultrasonic instrumentation using the TK2-1L and TK2-1R (Perio Maintenance, ultrasonic tips, Newtron, P5 XS Acteon, France). PAD was performed using tolonium chloride (TC) as a photosensitizer and a 635 nm semiconductor diode laser (Smart M laser, Lasotronix, Warsaw, Poland) as a light source. The irradiation parameters were set at 200 milliWatts (mW), applied for 30 seconds with an energy density of 4774.65 J/cm², using a 400-µm fiber diameter. Both contact and continuous modes were employed, with the protocol repeated three times during the same session. After six months of follow-up, a significant reduction of PPD and CAL was observed with values of 3 mm and 5 mm, respectively. Evidence of healed bone between the roots was noted on the peri-apical X-ray. The treatment, which consisted of MINST and PAD, was considered successful due to the significant improvement in the clinical periodontal parameters, the evidence of bone reparation, and patient satisfaction. This case report highlights the importance of minimally invasive non-surgical approaches and photoactivated disinfection in the management of periodontitis.