Conservative Management of Deep Residual Periodontal Pockets Using Adjunctive Mucoadhesive Polymeric Hydrogel: A Case...

Deep residual periodontal pockets after nonsurgical periodontal therapy represent a clinical challenge, particularly in molar sites with furcation involvement. This case report describes the short-term outcome of a combined conservative retreatment protocol including repeated subgingival instrumentation, erythritol-based air polishing, and adjunctive application of a mucoadhesive polymeric hydrogel.

A 57-year-old systemically healthy, nonsmoking female with periodontitis, Stage III Grade B, presented with a persistent 9 mm residual pocket and Grade II buccal furcation involvement at Tooth 26 (maxillary left first molar) after initial nonsurgical periodontal therapy. The patient showed good plaque control and preferred to avoid surgical treatment. The site was retreated with mechanical debridement, subgingival erythritol air polishing, and adjunctive hydrogel application. A second hydrogel application was performed after 37 days because bleeding on probing persisted despite partial pocket reduction.

At 4 months after the first hydrogel application, probing depth at the treated site decreased from 9 to 3 mm, bleeding on probing was absent, and furcation involvement was clinically reduced from Grade II to Grade I. No adverse events were reported.

In this single highly compliant patient, a combined conservative retreatment protocol was associated with short-term clinical improvement of a deep residual periodontal pocket with furcation involvement. Because multiple interventions were performed and concurrent clear-aligner therapy was present, the specific contribution of the hydrogel cannot be isolated. Longer follow-up and controlled studies are needed before any inference regarding efficacy or equivalence to surgical therapy can be made.