Radiographic Bone Fill in Molar Furcations Following Nonsurgical Treatment of Stage III, Grade C Periodontitis: A Four-Year Follow-Up Case Report

Stage III, grade C periodontitis is characterized by severe periodontal tissue destruction and a high risk of disease progression.Although nonsurgical periodontal therapy is effective in controlling periodontal inflammation, radiographic bone fill in advanced periodontal defects, particularly in molar furcation regions, represents a clinically relevant outcome.This case report describes the clinical and radiographic outcomes of nonsurgical periodontal treatment performed exclusively with piezoelectric ultrasonic instrumentation in a 28-year-old female patient diagnosed with stage III, grade C periodontitis.Treatment consisted of full-mouth ultrasonic subgingival instrumentation combined with adjunctive systemic amoxicillin and metronidazole, followed by regular supportive periodontal therapy (SPT).At baseline, the mean probing pocket depth (PPD) was 4.8 mm, with a plaque score of 86% and bleeding on probing (BOP) of 82%.At the two-year reevaluation, the mean PPD decreased to 2.0 mm, while the plaque and BOP scores declined to 14% and 19%, respectively.At the three-year reevaluation, these improvements were largely maintained, with a mean PPD of 2.1 mm, a plaque score of 6%, and BOP of 7%.Comparative intraoral radiographs obtained at baseline and approximately 31 months after the initial presentation suggested bone fill in selected posterior periodontal defects, including regions adjacent to molar furcations, without surgical intervention.These findings suggest that exclusively ultrasonic subgingival instrumentation, as part of a comprehensive nonsurgical treatment approach incorporating adjunctive systemic antibiotics and sustained supportive periodontal care, may be associated with substantial clinical improvement and favorable radiographic bone changes in advanced periodontitis.However, radiographic bone fill does not establish true periodontal regeneration, and the contribution of individual treatment components cannot be determined from a single case.