Rt. quadrants 1st visit July, 1977	X-rays at initial visit July, 1977.

Presenting findings:

A thirty-four year old healthy male presented with multiple purulent abscesses. A native of Saudi Arabia, he had recurrent infections for the seven years he had gone to school and worked in the United States. With 10 weeks left before leaving America for good, he sought relief for his dental problems.

The patient was examined in July 1977, and found to be in good health. The gingival tissues were swollen, edematous, and bled easily on probing. Many areas were suppurative and pus could be elicited by pushing on the labial tissues with finger pressure. There was an abscess on the palate between teeth #s 2 and 3, and the patient complained about a bad odor and a general discomfort throughout his mouth. Inspection revealed that all posterior teeth were severely mobile, while the anterior teeth were firm. Severe bone loss was noted about most teeth, approaching the apices in some instances.

The diagnosis was severe periodontitis. A treatment plan was suggested including removing many teeth, fabricating provisional restorations, root amputations, bone grafts, etc. It is important to note that in 1977, standard periodontal care did not include implants and guided tissue regeneration.

Though the patient was interested in a definitive approach to treating his problem, time did not permit its execution. Accordingly, the following treatment plan was instituted:

1. Tetracycline therapy - 1 gram/day for ten days, then one 250mg. capsule each evening.
2. A-splint the posterior teeth. Amalgam and wire was used, instead of acrylic, because the patient stated he could not return in the near future.
3. Retain all teeth during this early phase, and remove hopeless teeth during surgery.
4. Periodontal surgery in all four quadrants

Treatment:

After completing the A-splints, the patient returned for oral hygiene instruction and some gross debridement. Though the suppuration had stopped because of the tetracycline therapy, the tissues were still engorged and red. There was not enough time to perform four quadrants of scaling and root-planing, so surgery was performed right away.

Surgery:

All four surgeries were similar. They were performed half-mouth at a time, separated by three weeks. Each surgery was performed with Lidocaine with 1/100,000 epinephrine, and proceeded uneventfully. In some areas, there was so much granulation tissue that visibility during most of the procedure was hampered by poor homostasis.

Flaps reflected, max right.	Flaps reflected, max right.

The goal of the surgery was to gain access to debride the roots and to remove the granulomatous tissues in the periodontal defects. Furcations had little bone and, oftentimes, the curettes passed closed to the root apices. All teeth were retained. After thorough root scalings, freeze-dried demineralized bone grafts were placed in most defects. The bone chips were large by todays standards. No blood or autogenous bone was mixed with the graft material. No attempt was made to cover the bone grafts with the flaps. Periodontal dressing was placed over each area and the tetracycline regimen was increased back to one gram/day for seven days. After one week of healing, the patient resumed nightly doses of one 250 mg. capsule of tetracycline.

Each surgical area healed uneventfully. The patient did not experience undo discomfort nor episodes of bleeding. Pain was minimal. The patient left the country ten days after the second half-mouth surgery was performed. He did not know when he could return again.

No contact was made with the patient for five years, when he returned from Saudi Arabia to be examined.

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