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Case Reports
. 2025 May 23;104(21):e42037.
doi: 10.1097/MD.0000000000042037.

Multidisciplinary treatment combined with a modified apically positioned flap technique for generalized stage III grade C periodontitis: A five-year follow-up case report

Shun Mao  1   2 , Hui Xie  1   2 , Fei Ma  1   2 , Chang Zeng  1   2 , Jian Liu  1   2 , Jincai Guo  1   2 , Yan Xie  1   2
Affiliations
Case Reports

Multidisciplinary treatment combined with a modified apically positioned flap technique for generalized stage III grade C periodontitis: A five-year follow-up case report

Shun Mao et al. Medicine (Baltimore). .

Abstract

Rationale: The management of patients with generalized stage III grade C periodontitis involves complex considerations, particularly in cases of inadequate peri-implant keratinized mucosa. We present a case study highlighting the multidisciplinary management of periodontitis and the feasibility of a modified apically positioned flap procedure to increase the width of the keratinized mucosa at the implant site during the second stage of implant surgery.

Patient concerns: A 45-year-old woman presented to our hospital with a 4-year history of tooth mobility that caused difficulty chewing and bleeding gums when brushing.

Diagnoses: The patient was diagnosed with generalized stage III grade C periodontitis.

Interventions: The patient underwent a initial periodontal therapy, periodontal surgery, endodontic treatment, implant treatment, prosthodontic treatment, soft tissue augmentation procedures during the second stage of implant surgery, and supportive periodontal therapy.

Outcomes: The patient showed a healthy periodontal status and stable occlusal function after 5 years of follow-up.

Lessons: Multidisciplinary management of generalized stage III grade C periodontitis requires full consideration of systematic periodontal therapy, personalized treatment planning, and patient compliance; in particular, a modified apically positioned flap procedure may serve as an option for soft tissue augmentation at the dental implant site.

Keywords: a modified apically positioned flap; peri-implant keratinized mucosa; periodontal surgery; periodontitis; soft tissue augmentation surgery.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Pretreatment intraoral photographs. (A) Right side view. (B) Front view. (C) Left side view. (D) Upper occlusal view. (E) Lower occlusal view.
Figure 2.
Figure 2.
Panoramic radiograph. (A) Pretreatment. (B) Six months after periodontal surgery. (C) One year after periodontal surgery. (D) Three year after periodontal surgery. (E) Five year after periodontal surgery.
Figure 3.
Figure 3.
Dental radiograph of the left upper molar during root canal treatment and implant surgery. (A) Pretreatment. (B) Posttreatment of root canal treatment. (C) Five years after root canal treatment and implant surgery.
Figure 4.
Figure 4.
Intraoral photograph of the restoration loading and soft tissue augmentation procedure in the left upper molar position. (A) Suture removal 2 weeks after implant surgery. (B and C) Suture removal 2 weeks after restorative loading and a modified root-directional flap procedure (buccal and palatal). (D) Three years after final restoration. (E and F) Five years after final restoration (buccal and palatal).
Figure 5.
Figure 5.
Intraoral photographs after 5 years of periodontal surgery. (A) Right side view. (B) Front view. (C) Left side view. (D) Upper occlusal view. (E) Lower occlusal view.
See this image and copyright information in PMC

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