Effective Management of Non-Surgical Periodontal Treatment in a Patient with Severe Gingival Enlargement and Periodontal Bone Loss: A Case Report

Zana S. Dalipi, Fatmir Dragidella, Donika K. Dragidella

International Journal of Biomedicine. 2022;12(2):311-315.
DOI: 10.21103/Article12(2)_CR
Originally published June 5, 2022


The immune-inflammatory response of periodontal tissue can be influenced by various systemic variables such as hormone disorders, hematologic diseases, nutrition, and medications. Inflammatory cytokines released by infected periodontal tissue are implicated in suppressing erythrocyte growth, differentiation, and erythropoiesis inhibition.
We present a case of non-surgical periodontal treatment in a 31-year-old female patient with severe gingival enlargement associated with aggressive bone destruction combined with iron deficiency anemia (IDA). The periodontal treatment plan was achieved in collaboration with the hematologist, starting with oral hygiene instruction, scaling and root planning (SRP) by sextants with systemic antibiotic therapy combined with a chemical agent and low-level-laser-therapy (LLLT), and extraction of hopeless teeth.
Effective non-surgical periodontal treatment with SRP and LLLT reduces inflammation and gingival enlargements and controls the recolonization of subgingival sites by periodontal pathogens as a crucial factor to proceed with periodontal surgery. Function, aesthetics, and the patient’s social communication are all improved.

scaling and root planning • periodontal pockets • gingival enlargment • low level laser therapy
  1. Hajishengallis G, Korostoff JM. Revisiting the Page & Schroeder model: the good, the bad and the unknowns in the periodontal host response 40 years later. Periodontol 2000. 2017 Oct;75(1):116-151. doi: 10.1111/prd.12181.
  2. Pan W, Wang Q, Chen Q. The cytokine network involved in the host immune response to periodontitis. Int J Oral Sci. 2019 Nov 5;11(3):30. doi: 10.1038/s41368-019-0064-z. 
  3. Jain P, Hassan N, Khatoon K, Mirza MA, Naseef PP, Kuruniyan MS, Iqbal Z. Periodontitis and Systemic Disorder-An Overview of Relation and Novel Treatment Modalities. Pharmaceutics. 2021 Jul 30;13(8):1175. doi: 10.3390/pharmaceutics13081175. 
  4. Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015 Jan;15(1):30-44. doi: 10.1038/nri3785. 
  5. Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014 Feb;19(2):164-74. 
  6. Chakraborty S, Tewari S, Sharma RK, Narula SC, Ghalaut PS, Ghalaut V. Impact of iron deficiency anemia on chronic periodontitis and superoxide dismutase activity: a cross-sectional study. J Periodontal Implant Sci. 2014 Apr;44(2):57-64. doi: 10.5051/jpis.2014.44.2.57. 
  7. Lainson PA, Brady PP, Fraleigh CM. Anemia, a systemic cause of periodontal disease? J Periodontol. 1968 Jan;39(1):35-8. doi: 10.1902/jop.1968.39.1.35. 
  8. Graziani F, Karapetsa D, Alonso B, Herrera D. Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontol 2000. 2017 Oct;75(1):152-188. doi: 10.1111/prd.12201. 
  9. Sobouti F, Khatami M, Heydari M, Barati M. The role of low-level laser in periodontal surgeries. J Lasers Med Sci. 2015 Spring;6(2):45-50. 
  10. Isola G, Polizzi A, Santonocito S, Dalessandri D, Migliorati M, Indelicato F. New Frontiers on Adjuvants Drug Strategies and Treatments in Periodontitis. Scientia Pharmaceutica. 2021;89(4):46. doi: 10.3390/scipharm89040046
  11. Tonetti MS, Lang NP, Cortellini P, Suvan JE, Eickholz P, Fourmousis I, Topoll H, Vangsted T, Wallkamm B. Effects of a single topical doxycycline administration adjunctive to mechanical debridement in patients with persistent/recurrent periodontitis but acceptable oral hygiene during supportive periodontal therapy. J Clin Periodontol. 2012 May;39(5):475-82. doi: 10.1111/j.1600-051X.2012.01864.x. 
  12. Cobb CM, Sottosanti JS. A re-evaluation of scaling and root planing. J Periodontol. 2021 Oct;92(10):1370-1378. doi: 10.1002/JPER.20-0839. 
  13. Pradeep AR, Anuj S. Anemia of chronic disease and chronic periodontitis: does periodontal therapy have an effect on anemic status? J Periodontol. 2011 Mar;82(3):388-94. doi: 10.1902/jop.2010.100336. 
  14. Nibali L, Darbar U, Rakmanee T, Donos N. Anemia of inflammation associated with periodontitis: Analysis of two clinical studies. J Periodontol. 2019 Nov;90(11):1252-1259. doi: 10.1002/JPER.19-0124.
  15. Wu D, Lin Z, Zhang S, Cao F, Liang D, Zhou X. Decreased Hemoglobin Concentration and Iron Metabolism Disorder in Periodontitis: Systematic Review and Meta-Analysis. Front Physiol. 2020 Jan 31;10:1620. doi: 10.3389/fphys.2019.01620. 
  16. Sobouti F, Khatami M, Heydari M, Barati M. The role of low-level laser in periodontal surgeries. J Lasers Med Sci. 2015 Spring;6(2):45-50. 
  17. Woodruff LD, Bounkeo JM, Brannon WM, Dawes KS, Barham CD, Waddell DL, Enwemeka CS. The efficacy of laser therapy in wound repair: a meta-analysis of the literature. Photomed Laser Surg. 2004 Jun;22(3):241-7. doi: 10.1089/1549541041438623.
  18. Conlan MJ, Rapley JW, Cobb CM. Biostimulation of wound healing by low-energy laser irradiation. A review. J Clin Periodontol. 1996 May;23(5):492-6. doi: 10.1111/j.1600-051x.1996.tb00580.x.
  19. Hämmerle CH, Joss A, Lang NP. Short-term effects of initial periodontal therapy (hygienic phase). J Clin Periodontol. 1991 Apr;18(4):233-9. doi: 10.1111/j.1600-051x.1991.tb00420.x. 
  20. Hou GL, Tsai CC. Clinical observations of the effects of nonsurgical periodontal therapy on human periodontal disease. II. Ultrasonic scaling and root planing for 6 months. Gaoxiong Yi Xue Ke Xue Za Zhi. 1989 Feb;5(2):72-86. 
  21. Haffajee AD, Cugini MA, Dibart S, Smith C, Kent RL Jr, Socransky SS. The effect of SRP on the clinical and microbiological parameters of periodontal diseases. J Clin Periodontol. 1997 May;24(5):324-34. doi: 10.1111/j.1600-051x.1997.tb00765.x. 
  22. Ximénez-Fyvie LA, Haffajee AD, Som S, Thompson M, Torresyap G, Socransky SS. The effect of repeated professional supragingival plaque removal on the composition of the supra- and subgingival microbiota. J Clin Periodontol. 2000 Sep;27(9):637-47. doi: 10.1034/j.1600-051x.2000.027009637.x.
  23. Crispino A, Figliuzzi MM, Iovane C, Del Giudice T, Lomanno S, Pacifico D, Fortunato L, Del Giudice R. Effectiveness of a diode laser in addition to non-surgical periodontal therapy: study of intervention. Ann Stomatol (Roma). 2015 May 18;6(1):15-20. 

Download Article
Received March 24, 2022.
Accepted April 18, 2022.
©2022 International Medical Research and Development Corporation.