The authors declare that they have no competing interests.
The case report was presented as a poster abstract at the Europerio 2012.
SN and SA carried out the treatment of the patient and drafted the manuscript. TB helped to draft the manuscript. AK, SR, TB and TF revised critically the manuscript for important intellectual content. All authors read and approved the final manuscript.
Plasminogen deficiency is a rare autosomal recessive disease, which is associated with aggressive periodontitis and gingival enlargement. Previously described treatments of plasminogen deficiency associated periodontitis have shown limited success. This is the first case report indicating a successful therapy approach consisting of a non-surgical supra- and subgingival debridement in combination with an adjunctive systemic antibiotic therapy and a strict supportive periodontal regimen over an observation period of 4 years.
The intraoral examination of a 17-year-old Turkish female with severe plasminogen deficiency revealed generalized increased pocket probing depths ranging from 6 to 9 mm, bleeding on probing over 30%, generalized tooth mobility, and gingival hyperplasia. Alveolar bone loss ranged from 30% to 50%. Clinical attachment loss corresponded to pocket probing depths. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Prevotella nigrescens and Eikenella corrodens have been detected by realtime polymerase chain reaction. Periodontal treatment consisted of full mouth disinfection and adjunctive systemic administration of amoxicillin (500 mg tid) and metronidazole (400 mg tid). A strict supportive periodontal therapy regimen every three month in terms of supra- and subgingival debridement was rendered. The reported therapy has significantly improved periodontal health and arrested disease progression. Intraoral examination at the end of the observation period 3.5 years after non-surgical periodontal therapy showed generalized decreased pocket probing depths ranging from 1 to 6 mm, bleeding on probing lower 30%, and tooth mobility class I and II. Furthermore, microbiological analysis shows the absence of Porphyromonas gingivalis, Prevotella intermedia and Treponema denticola after therapy.
Adjunctive antibiotic treatment may alter the oral microbiome and thus, the inflammatory response of periodontal disease associated to plasminogen deficiency and diminishes the risk of pseudomembrane formation and progressive attachment loss.
This case report indicates that patients with plasminogen deficiency may benefit from non-surgical periodontal treatment in combination with an adjunctive antibiotic therapy and a strict supportive periodontal therapy regimen.
Schuster V, Seidenspinner S, Zeitler P, Escher C, Pleyer U, Bernauer W, et al. Compound-heterozygous mutations in the plasminogen gene predispose to the development of ligneous conjunctivitis. Blood. 1999;93(10):3457–66. PubMed
Lindhe J, Nyman S. The role of occlusion in periodontal disease and the biological rationale for splinting in treatment of periodontitis. Oral Sci Rev. 1977;10:11–43. PubMed
Beikler T, Karch H, Flemmig TF. Adjuvante Antibiotika in der Parodontitistherapie. Wissenschaftliche Stellungnahme DGZMK und DGP. 2003.
Chi AC, Prichard E, Richardson MS, Rasenberger KP, Weathers DR, Neville BW. Pseudomembranous disease (ligneous inflammation) of the female genital tract, peritoneum, gingiva, and paranasal sinuses associated with plasminogen deficiency. Ann Diagn Pathol. 2009;13(2):132–9. doi:10.1016/j.anndiagpath.2008.02.005. CrossRefPubMed
Silva GB, Bariani C, Mendonca EF, Batista AC. Clinical manifestations due to severe plasminogen deficiency: a case report. J Dent Child. 2006;73(3):179–82.
- Periodontitis associated with plasminogen deficiency: a case report
Sarah H Neering
Thomas F Flemmig
- BioMed Central
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