Systemic Teriparatide Administration Promotes Osseous Regeneration of an Intrabony Defect: A Case Report

Abstract

Introduction: Teriparatide comprises the first 34 amino acids of parathyroid hormone and is a systemic anabolic agent that is Food and Drug Administration approved for the treatment of osteoporosis but not for periodontitis. To our knowledge, this is the first clinical case report to document the treatment of a patient with severe periodontitis using an open-flap debridement procedure in conjunction with teriparatide.

Case presentation: A 45-year-old female patient was diagnosed with severe chronic periodontitis, including the presence of an intrabony defect on tooth #6. She received open-flap debridement surgery in conjunction with daily systemic administration of 20 μg teriparatide, oral vitamin D, and calcium supplements for 6 weeks. Radiographic, clinical, gingival crevicular fluid (pyridinoline cross-linked carboxy-terminal propeptide of type I procollagen, procollagen type 1 N-propeptide, and osteocalcin), and serum parameters (parathyroid hormone, bone alkaline phosphatase, calcium, and 25-hydroxyvitamin D) were assessed. Treatment outcomes were evaluated over 4 years, with successful radiographic and clinical results throughout the follow-up period.

Conclusion: Teriparatide administration in conjunction with traditional open-flap debridement surgery offers potential for the treatment of severe intrabony defects resulting from chronic periodontitis.

Keywords: Bone regeneration; guided tissue regeneration; parathyroid hormone; periodontal attachment loss; periodontal bone loss; teriparatide.

FIGURE 1

1a Preoperative image of tooth #6. 1b Open-flap debridement with an intrabony defect noted on tooth #6M. 1c Sutured flap using simple, interrupted sutures. 1d One week postoperative healing is within normal limits. 1e After 12 months of healing, PDs were reduced to 3 mm. 1f Four years after surgery, PDs on tooth #6M remain stable with no BOP.

FIGURE 2

Imaging of the defect presented in Figure 1. 2a Initial radiograph illustrating an intrabony defect on tooth #6M. 2b Radiograph at 9 months demonstrating significant defect fill. 2c Four years after surgery, significant bone fill remains. 2d Digital subtraction radiography shows the area and degree of bone fill on tooth #6M from baseline to 9 months. 2e Reconstructed CBCT image of the maxillary right quadrant before surgery. 2f Reconstructed CBCT image of the maxillary right quadrant 1 year postoperatively. In all panels, white arrows represent the baseline bone level as well as the current bone level. Black arrows illustrate the reference point from which measurements were obtained.