Case Study: Management of Dental Implants with Suboptimal Angulation

Case Study: Management of Dental Implants with Suboptimal Angulation

Referral case: Perio Abscess and Class 4 Periodontal Disease

by Dr Bruno Delaunay

Case Study: Non-Surgical Management of Periodontal Abscess and Stage 4 Periodontitis


This case study outlines the successful non-surgical management of a periodontal abscess in a patient with advanced periodontitis, conducted by Dr. Bruno Delaunay at the Perio and Implants Dental Referral Centre in Richmond. The case presents a significant insight into the potential of non-surgical techniques in controlling severe periodontal conditions, even in the absence of adjunctive pharmacological interventions.

Patient Presentation

A 48-year-old male patient presented with pain and localised swelling around the upper left third molar (UL3). The patient was medically fit, with no known allergies, medical conditions, or ongoing treatments. He was a non-smoker with fair oral hygiene and was not a regular dental attender.

Clinical Findings

A comprehensive periodontal examination revealed generalised periodontitis classified as stage 4, grade C, indicating severe periodontal disease with a high risk of further progression. Additionally, a periodontal abscess was identified on UL3, accompanied by an 11mm periodontal pocket, indicative of significant periodontal breakdown.

Treatment Approach

Given the severity of the condition and the challenges posed by the COVID-19 pandemic, a non-surgical treatment plan was devised, focusing on meticulous debridement and patient education on oral hygiene.


The treatment steps included:

Oral Hygiene Instruction (OHI): The patient received detailed instructions on effective tooth brushing using an electric toothbrush (ETB) and the use of interdental brushes (tepes) to improve oral hygiene practices.

Non-Surgical Therapy: Due to restrictions related to the COVID-19 pandemic, the treatment was limited to non-surgical debridement using hand scalers only. This approach focussed purely on the removal of plaque and calculus to control infection without the use of mouthwashes, drugs, or other treatments.

Re-evaluation: The patient was scheduled for a follow-up at 2 weeks to assess the integration of the tepe brush around UL3, and at 8 weeks for a final six-point pocket chart (6 PPC) to evaluate the outcome of the non-surgical therapy.



At the re evaluation, a remarkable improvement was observed. The periodontal pocket depth around UL3 had reduced from 11mm to 3mm, with a 1mm gingival recession. Importantly, the patient reported no more pain or discomfort, and there were no signs of sensitivity.


This case highlights the efficacy of non-surgical periodontal therapy, even in severe cases of periodontitis, when expertly applied. The combination of precise mechanical debridement and rigorous patient education on oral hygiene can lead to significant clinical improvements.

  • Notably, this case was managed without the adjunct use of antimicrobial agents, showcasing that mechanical control of plaque and calculus remains the cornerstone of periodontal therapy.
  • The reduction in pocket depth and resolution of symptoms underscore the efficacy of non-surgical methods to stabilise periodontal health, particularly when surgical intervention is not feasible or preferred.
  • This case serves as an important reminder of the power of fundamental periodontal therapy techniques and the critical role of patient compliance in achieving successful outcomes.


Dr. Delaunay’s management of a complex case of periodontal abscess in the context of advanced periodontitis demonstrates the effectiveness of non-surgical periodontal therapy. It reinforces the importance of skilful mechanical debridement and patient education in controlling periodontal diseases and highlights the potential to achieve significant clinical improvements without surgical intervention.

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