A case Report
Mark J. Manhart DDS, 1998
This is a six-year case report of long-range calcium therapy to the periodontal tissues. When this case presented itself, the condition was considered hopelessly refractory. Upon treatment the periodontal disease was resolved rapidly without anesthesia, without surgical intervention, and without untoward reactions. The periodontal tissues continue to exhibit significant improvement.
Calcium materials have been employed for dental tissue treatment for over a century. Hermann  introduced chemically pure calcium hydroxide as a pulp capping material seventy years ago. Orban  reasoned in 1981 that since the pulp tissues and blood cells are virtually the same as in other connective tissues of other body organs, the pulp could heal itself provided overwhelming adverse conditions are controlled, or “environmentalized” for a long period of time.
A year later routine use of calcium materials on endodontic tissues was reported . Subsequent clinical experience led this author to conclude that another step could be taken in the utilization of calcium materials. If the connective tissues of pulp and endodontic tissues are similar to those of the periodontium, and provided that overwhelming adverse conditions of the periodontium are controlled with the proper non-invasive calcium material, periodontal disease could also be induced to heal and controlled over long periods of therapy.
It is for this reason that slow-release calcium materials have been regularly applied to stimulate healing and to control the environment of the periodontal tissues. Standley  has recently added to the understanding of such an approach to periodontal therapy with four criteria in pulp capping which may be applied to the following report.
This is a report of a periodontal case that was treated over an extended period of time with calcium materials. The object of this study of a refractory periodontal case is simply to present the data of the case that would indicate a single reality, namely, that the calcium material was administered regularly for six years with no untoward effect on the patient. The report also shows that the condition of advanced periodontal disease was not only resolved in a short time without surgical intervention, but controlled indefinitely.
In 1983 a Caucasian female teacher of 45 years presented herself in relatively good health with nearly perfect occlusion of her teeth except for the absence of three third molars. However, she exhibited severe periodontal infection throughout her mouth and generalized alveolar bone loss and tooth mobility. At the first appointment her entire oral cavity, “The gums and roof of my mouth,” were “burning and extremely sensitive.” Her teeth were mobile to the point of, “feeling spongy when I chew anything.” The situation had been described by her regular dentist as “Hopeless” and I don’t know what can be done to save your teeth.” Consequently, the patient was very apprehensive about further dental work being started. The most severe sensitivity was apparent on the Left side of the maxillary and mandibular posterior dentition and gingivae. A fistula was draining through the labial plate and mucosa at the apical region of the upper Left central. Many of her other teeth had faulty restorations or were decayed.
Periodontal disease was explained to the patient as the result of one or more factors at work causing her condition, that is, inadequate cleaning of the teeth and mouth, the occlusion of the teeth, missing critical teeth, and/or stress on the entire body systems. With her consent treatment was then initiated.
Without anesthesia a timed-release calcium paste was applied to the periodontal structures which hardened rapidly and remained for several days or as long as a week at a time. The following is a record of the appointments and the calcium therapy provided for the patient. There is no attempt to detail the Operative procedures or the patient’s impressions of her recovery from periodontal disease. At that point she insisted on calcium treatments monthly because, “It feels so good.”
TIME FRAME APPOINTMENT PROCEDURES
- September, 1983 1 Consultation, oral exam
- October 2 Root canal therapy (RCT) #9, open, file, med.
- Calcium treatment (CT) into fistula #9,
- CT upper & lower molars Left
- 3 RCT & temp. seal #9, CT smaller fistula
- CT upper & lower, adjust old restorations Left posterior
- November 4 Operative (Oper)
- December 5 Oper , adjust old restorations posterior
- 6 Oper , CT #8 fistula
- 7 Oper
- 8 Recal,l exam, bitewings
- 9 Oper
- 10 Oper, CT #9 fistula
- January, 1984 11 Equilibrate old restorations
- June 12 Recall, exam, bitewings
- July 13 Oper #7
- October 14 RCT #7
- 15 Oper, RCT seal #7
- January 1985 16 Recall, exam
- April 17 Crowns #7, 8, 9, 10
- 18 Crowns #5, 6, 11, 12
- June 19 Recall, exam, bitewings
- July 20 Oper
- November 21 CT #30, 31
- December 22 Recall, exam,
- January, 1986 23 Crown #19
- 24 Oper. CT four post. quadrants
- February 25 CT
- CONTINUED with 36 more appointments with CT, eight Recalls, some Oper,
a RCT #20, Crowns on #29 & #2, EXTRATION of #15, and EXCELLENT periodontal
- June, 1989 62 CT
- July 63 Recall, exam, bitewings
- August 64 Oper
- September 65 CT
- November 66 CT
- December, 1989 67 CT
The patient was treated over a period of six years and three months, or 39 months, with 67 timed-release treatments of calcium material applied into the periodontium. The average therapy was 1.74 treatments per month. The patient’s periodontium responded rapidly and repeatedly, “In a few minutes and I could feel it last for hours every time.” The response was markedly evident in tissues of the upper and lower Left periodontal regions, and “over the whole mouth.” The burning sensation abated “almost right away after the first treatment and has never returned.” Within a few treatments she reported that the “sponginess is gone and my teeth have tightened in place,” as was obvious upon examination.
To this day the patient’s teeth remain sensitive to cold, “as if normal.” She now expects to keep her teeth for the rest of her life. The patient changed none of her eating, drinking or smoking habits since long before the calcium therapy began. She continues to use her same dentifrice. At no time in these six years of treatment has there any untoward effects, nor abnormal systemic or oral manifestations. The patient’s periodontal disease healed within a few days of her initial treatment and her periodontium has recovered.
After a year of normal maintenance (January, 1984), extensive crown restoration was undertaken. A year later (January, 1985) the patient asked to be placed on a regimen of treatments because the doses of calcium, “felt good,” and the benefits to her periodontium were significant. Therefore, the treatments were continued and soon her interest was drawn to long-range systemic benefits that might serve as an alternative to traditional daily oral calcium supplementations. Her therapy continues.
Over the past 25 years these calcium compounds hae been found to reduce inflammation and induce healing of endodontic and periodontal tissues. Recently, Stewart and Watson  reported that these materials exhibit the least inflammatory reaction on oral tissues of all the materials in their study of oral foreign body reactions. Furthermore, the anthropologic-epidemiologic findings of Clarke and Hirsch  would seem to support such conservative, nonsurgical therapies as slow-release calcium materials for controlling periodontal pathology.
This report details a case of periodontal disease that was treated with slow-release calcium materials for six years, the four years with regular doses resembling therapy for long-range calcium deficiencies. Additional studies of these relationships would be of unique value, especially in the care of aging women.
- Hermann B.W., Calciumhydroxd als mittel sum behandel und fullen von wurzelkanlen (Dissertation). Wursgurg 1920.
- Orban B., Contribution to the history of dental pulp and periodontal membrane with specific reference to the cells of “defense” of these tissues. J. Am. Dent. Assoc. 1929 16:965-81
- Manhart M. J., The calcium hydroxide method of endodontic sealing. Oral Surg. Oral Med. Oral Path. 1982 54:219-14.
- Sandley H. R. Pulp capping: Conserving the dental pulp ‐ Can it be done?
- Stweart M. C., Watson R. E., Experimental oral foreign body reactions. Oral Surg. Oral Med. Oral Path., 1990 69:713-19
- Clarke N. G., Hirsch R. S., Periodontitis and angular alveolar lesions: a critical distinction. 1990 69:564-71