Case 2: Interpreting risk after periodontal treatment A 14-year-old patient presented with swollen gums. She had been receiving regular dental care, including prophylaxis every six months, since age 5, but had recently developed severe gingival infl ammation and had undergone scaling/root planing at her general dentist's office. She was systemically healthy, but as an adoptee had no known family medical history. Her periodontal and radiographic measurements were as follows: Radiographic parameters Grading assessment * * Periodontal parameters * * * * * * * BoP: 50% of sites. PD range: 2-3mm generally; 4 -7mm at teeth #7-10. CAL range: 0-2mm. Furcation involvement: none. Mobility: none. Altered passive eruption in maxilla (Fig. 4). * Generally intact bone support (Figs. 5a-5f). Bone loss within coronal third (#7 and #10). Staging assessment * Severity: CAL range of 0-2mm suggests Stage I; bone loss within coronal third (#7 and #10) suggests Stage I; lack of tooth loss suggested Stage I or II. Complexity: PD range of 4-7mm at teeth #7-10 suggests Stage III. Primary criteria: High percentage of bone loss for age suggests Grade C. The fact that destruction exceeded expectation based upon the patient's history and clinical appearance also suggests Grade C. Taking into consideration the patient's clinical and radiograph appearance as well as her history of regular dental care, she was diagnosed with Stage I, Grade C periodontitis. With incipient disease in a very young person, the driving force is the grade. Considering the patient's high-grade periodontitis and recent history of nonsurgical periodontal therapy, surgical periodontal treatment was recommended (Fig. 6). Surgery involved root surface debridement as well as gingival and osseous recontouring. The patient healed well and without complication after surgery (Fig. 7). After active treatment, Fig. 4: Initial clinical appearance demonstrates gingival edema and erythema around maxillary anterior teeth. 66 JANUARY 2020 // dentaltown.comhttp://www.dentaltown.com