Introduction: Currently, Periodontitis is characterized by defining the stage and grade of the disease. Stage IV periodontitis has unique features that require treatment of a higher level of complexity. In this communication the sequence of periodontal treatment of a stage IV, generalized, grade C periodontitis is presented.
Clinical case description: A 30-year-old female patient attended at Periodontology Postgraduate Clinic in the Faculty of Dental Medicine, Lisbon, with complaints of tooth mobility and gingival bleeding. Smoker (≥ 1o cigarettes/day) without any other systemic diseases (ASA II). After the clinical and radiographic evaluation was diagnosed with a Stage IV, generalized, grade C Periodontitis. Following the interventions in Step 1 which included smoking cessation, explanation of the disease, professional oral hygiene instructions, patient started step 2 interventions – subgingival instrumentation (2 appointment of scaling and root planning). At periodontal re-evaluation, presented a plaque index of 15% and the presence of residual periodontal pockets. Step 3 included subgengival repeated instrumentation (2nd sextant), Resective/access periodontal surgery (3rd , 4th , 5th e 6th sextant) and Regenerative periodontal surgery (tooth 14 and 15).
Conclusion: The treatment has been successful in achieving a stable and healthy periodontium. Patient was placed in a supportive periodontal care programme (follow-up 8 months), with regular visits (3 in 3 months)
Keywords: Periodontitis, stage, grade, non-surgical treatment, surgical treatment