Treatment of Stage III Grade C Periodontitis With Smoking Cessation Care and Periodontal Surgery Including Regenerative Therapy: A Case Report With a Two-Year Follow-Up

We report a case of generalized chronic periodontitis requiring periodontal treatment, including smoking cessation care and surgical procedures. With a chief complaint of swelling and pain in the gingiva around #47, a 41-year-old man visited the Tokyo Dental College Suidobashi Hospital. The patient had been smoking cigarettes for 31 years. The initial periodontal examination identified a probing depth (PD) of ≥4 mm in 72.6% of sites and bleeding on probing (BOP) in 45.2% of sites. Radiographic examination demonstrated bone resorption extending to the root apex in #37 and 47, angular bone resorption in #17 and 24, furcation radiolucency in #17, 27, 37, and 47, and horizontal resorption in other areas. Following the clinical diagnosis of stage III grade C periodontitis, non-surgical therapy consisting of smoking cessation care, plaque control, scaling and root planing (SRP), and placement of occlusal splint was performed. Teeth #37 and 47 were extracted due to bone resorption extending to the root apex. The patient had achieved smoking cessation by the end of the non-surgical therapy. Subsequently, surgical periodontal treatment was performed at the selected site. Periodontal regenerative therapy using recombinant human fibroblast growth factor (rhFGF)-2 was carried out for #14 and 24. Guided tissue regeneration (GTR) was implemented for #17. Open flap debridement was performed in #16, 23, 25, 26, and 27 to facilitate the reduction of periodontal pockets. Following periodontal re-evaluation, supportive periodontal therapy (SPT) was initiated. The patient maintained smoking cessation after the non-surgical therapy, and periodontal stability was observed over a two-year period. Periodontal therapy contributed to a marked improvement in the patient's oral health-related quality of life.