An Eagle’s View in Case Analysis Unveils Diagnostic Dilemmas: A Case Report

Special Article - Gingivitis

J Dent & Oral Disord. 2016; 2(6): 1029.

An Eagle’s View in Case Analysis Unveils Diagnostic Dilemmas: A Case Report

Satyanarayana KV1*, Anuradha BR1, Priyanka M1 and Praveena CH2

1Department. of Periodontics, MNR Dental College and Hospital, India

2Department of Prosthodontics, Sibar Institute of Dental Sciences, India

*Corresponding author: Satyanarayana KV, Department. of Periodontics, MNR Dental College and Hospital, Sangareddy, Hyderabad, India

Received: June 28, 2016; Accepted: July 29, 2016; Published: August 01, 2016


Chronic and aggressive periodontitis are differentiated mainly by progression of the disease; local factors, age of onset and neither of the diseases are having pathognomonic features to diagnose specifically. Sometimes overlapping features like patterns of bone loss, pathological migration, pocket formation leads to diagnostic dilemma. This ambiguity can be overcome by thorough clinical examination and case analysis. Here, one such case is reported with spacing between teeth, radio graphically bilateral mirror images and pathological migration mimicking features of aggressive periodontitis which later on cast analysis revealed other clinical features like traumatic occlusion with reversal of occlusal phenomenon, plunger cusps causing pocket formation, related to site specificity of chronic periodontitis and finally alignment of teeth which decide plane of interdental septum and giving mirror images radio graphically in this case. Hence a thorough clinical history and careful analysis of the patient is mandatory prior to proper diagnosis and treatment planning.

Keywords: Periodontitis; Chronic; Aggressive; Occlusion


Chronic and aggressive periodontitis can be differentiated in few cases and in some other cases overlapped features makes diagnosis difficult but not impossible. Bilateral mirror images of alveolar bone loss around first molars tend to conclude aggressive periodontitis but angulated plane of interdental septum is determined by alignment of teeth and cementoenamel junction of approximating teeth. Many such cases are improperly diagnosed which finally results in erroneous prognosis and treatment plan. Here a unique case is reported which exemplifies the ambiguous nature of periodontitis in diagnosing it precisely.

Case Presentation

Case report

A twenty two years old healthy female patient reported to the Department of Periodontics, MNR Dental College and Hospital, Sangareddy, with the chief complaint of spacing between upper front teeth region since 3 months, and space was gradually progressing. No relevant systemic and family history noticed.

Intra oral examination revealed pale pink color of the gingiva with discrete melanin pigmentation and erythematous marginal gingiva in relation to upper left central incisor. The consistency was soft and edematous with loss of scalloping in relation to upper and lower anterior region. Generalized bleeding on probing was observed. Oral hygiene status was fair with gingival and plaque index with a score of one. Periodontal examination revealed probing depth of five to seven millimeters in relation to first molars and right and left central incisors. Grade II mobility in relation to upper central incisors and grade I in relation to lower central incisors was observed. Tongue thrusting habit with open contacts was noticed anteriorly between 11&21; 11&12; 21&22; 31&32; 41&42 and posteriorly between 16&17; 26&27. Plunger cusps were seen in relation to 37 and 47, causing food impaction interdentally. Pathological migration was seen in relation to upper central incisors. The extruded right and left central incisors resulted in uneven gingival margins [1] (Figure 1).