Periodontics · patient case question
Which adjunct is most appropriate alongside scaling and root planing in a patient with very deep pockets confined to molars and incisors?
Patient case: Patient with a mucopolysaccharidosis requiring periodontal treatment
Patient: Adult with a diagnosed mucopolysaccharidosis
Chief complaint: Referred for scaling and root planing of the lower anterior teeth.
Background: Mucopolysaccharidosis (a lysosomal storage disorder). Otherwise cooperative.
Current findings: Periodontal status is otherwise normal. Treatment required is limited to scaling and root planing of the lower anterior segment.
Show answer and explanation
Correct answer: C. Locally delivered minocycline microspheres
- A. Chlorhexidine rinse does not reach the base of a deep pocket — it penetrates only 1–2 mm subgingivally.
- B. Adjuncts are genuinely indicated in selected sites that fail to respond to mechanical therapy alone.
- C. Best answer for LOCALISED deep pockets. Site-specific local delivery (minocycline microspheres, doxycycline gel, chlorhexidine chips) places a high antimicrobial concentration exactly where it is needed, without systemic exposure. A molar-and-incisor distribution is the classic localised pattern.
- D. Prolonged systemic tetracycline carries resistance, gastrointestinal and photosensitivity burdens, and is reserved for generalised aggressive disease.
Note: The molar–incisor pattern should prompt you to consider what used to be called localised aggressive periodontitis, associated with Aggregatibacter actinomycetemcomitans.