Background: Plasminogen deficiency is a rare autosomal recessive disease, which is associated with aggressive\nperiodontitis and gingival enlargement. Previously described treatments of plasminogen deficiency associated\nperiodontitis have shown limited success. This is the first case report indicating a successful therapy approach\nconsisting of a non-surgical supra- and subgingival debridement in combination with an adjunctive systemic\nantibiotic therapy and a strict supportive periodontal regimen over an observation period of 4 years.\nCase presentation: The intraoral examination of a 17-year-old Turkish female with severe plasminogen\ndeficiency revealed generalized increased pocket probing depths ranging from 6 to 9 mm, bleeding on\nprobing over 30%, generalized tooth mobility, and gingival hyperplasia. Alveolar bone loss ranged from 30% to\n50%. Clinical attachment loss corresponded to pocket probing depths. Aggregatibacter actinomycetemcomitans,\nPorphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Prevotella nigrescens and Eikenella corrodens\nhave been detected by realtime polymerase chain reaction. Periodontal treatment consisted of full mouth\ndisinfection and adjunctive systemic administration of amoxicillin (500 mg tid) and metronidazole (400 mg tid).\nA strict supportive periodontal therapy regimen every three month in terms of supra- and subgingival debridement\nwas rendered. The reported therapy has significantly improved periodontal health and arrested disease progression.\nIntraoral examination at the end of the observation period 3.5 years after non-surgical periodontal therapy showed\ngeneralized decreased pocket probing depths ranging from 1 to 6 mm, bleeding on probing lower 30%, and tooth\nmobility class I and II.\nFurthermore, microbiological analysis shows the absence of Porphyromonas gingivalis, Prevotella intermedia and\nTreponema denticola after therapy.\nConclusion: Adjunctive antibiotic treatment may alter the oral microbiome and thus, the inflammatory response of\nperiodontal disease associated to plasminogen deficiency and diminishes the risk of pseudomembrane formation and\nprogressive attachment loss.\nThis case report indicates that patients with plasminogen deficiency may benefit from non-surgical periodontal\ntreatment in combination with an adjunctive antibiotic therapy and a strict supportive periodontal therapy regimen.
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