Perioscopy-Assisted Sequential Therapy For Advanced Periodontitis: A Case Report

Stage IV grade C periodontitis, characterized by rapid progression and severe tissue destruction, challenges conventional debridement methods. This report presents a 19-year-old male diagnosed under the 2018 classification with PD 5–9 mm, CAL≥5 mm, and vertical bone loss. A sequential protocol was implemented: (1) Initial therapy (2024.7-2024.8): Perioscopy (Gloriscope®)-guided subgingival debridement combined with Er:YAG laser (Fotona®) disinfection and localized minocycline gel (Periocline®); (2) Surgical phase (2024.10): Minimally invasive flap surgery with Bio-Oss® bone grafting for vertical bone loss; (3) Maintenance (2024.10-now): quarterly follow-ups with tailored oral hygiene regimens. At 3 months, PD decreased from 5–9 mm to 3.2 mm, CAL improved by 2.8 mm and radiographs revealed enhanced bone density with resolved inflammation. The endoscopic system enabled precise calculus removal in deep pockets and furcation areas, surpassing traditional blind instrumentation. Er:YAG laser adjuncts reduced microbial colonization, while minimally invasive surgery promoted tissue regeneration with reduced trauma. This case highlights the efficacy of integrating endoscopic visualization, laser disinfection, and regenerative techniques. The protocol achieved significant PD reduction, CAL gain, and radiographic bone improvement, demonstrating its potential for managing high-risk Stage Ⅳ Grade C cases. Perioscopy-assisted therapy offers a reproducible, minimally invasive alternative to conventional approaches, emphasizing precision debridement. Further follow-up results are warranted to validate long-term outcomes.