Saving a Canine Tooth in a Cat with Periodontitis: GTR and PRF

Reason for the visit

The owner presented with her 5-year-old cat due to gum inflammation and an unpleasant mouth odor.

The initial request was professional dental scaling.

However, bad breath and visible tartar alone cannot reveal the condition of the tissues beneath the gumline. This requires evaluating each tooth, performing periodontal probing, and taking dental radiographs.

What the initial examination found

The examination revealed:

• Gingivitis
• Dental calculus
• Signs of periodontitis at several teeth
• Mobility of individual teeth
• The need for a full dental diagnostic workup

At this stage it was not yet possible to determine the full extent of bone support loss or evaluate the tooth roots.

Therefore, treatment was not planned as a routine scaling.

Why professional cleaning alone was not enough

Professional cleaning helps remove supragingival and subgingival plaque and calculus.

But on its own it cannot:

• Restore alveolar bone that has already been lost
• Restore support to a tooth with severe periodontitis
• Resolve a resorptive lesion of a tooth
• Stabilize a tooth with marked pathological mobility
• Determine a tooth's prognosis without dental radiography

This is why the final treatment plan could only be formed after a complete oral evaluation.

Preliminary treatment plan

The owner wanted to preserve the cat's canine teeth as much as possible.

Before the procedure, it was discussed that:

• Teeth with an unfavorable prognosis would have to be extracted
• The possibility of saving each canine tooth would be determined separately
• The condition of the roots and bone support needed to be assessed on dental radiographs
• A decision on regenerative treatment of the upper canine tooth could only be made after assessing the shape and location of the periodontal defect

Whether the upper canine tooth could be saved, and whether regenerative periodontal treatment could be performed, was to be determined after periodontal probing and evaluation of the dental radiographs.

The goal of treatment was not to save every tooth at any cost, but to assess the prognosis of each tooth individually and apply a tooth-sparing approach only where it was clinically justified.

Diagnostics under the COHAT protocol

Under controlled general anesthesia, a dental procedure was performed under the COHAT protocol.

It included:

• A complete oral examination
• Assessment of each tooth
• Periodontal probing
• Assessment of tooth mobility
• Professional supragingival and subgingival cleaning
• Full-mouth dental radiography
• Development of an individual treatment plan
• Performance of the agreed-upon procedures

COHAT is not just professional cleaning. It is a complete protocol for diagnosing and treating the oral cavity under anesthesia.

What the dental radiographs showed

Full-mouth dental radiography revealed:

• Loss of alveolar bone support at teeth affected by periodontitis
• Resorption of individual teeth
• Differing prognosis for the two canine teeth
• A localized one-sided defect in alveolar bone support at the upper canine tooth, which made it possible to consider tooth-sparing periodontal treatment

The dental radiographs were important not only for detecting pathology, but also for deciding between extraction and an attempt to save a specific tooth.

Periodontitis and resorption are different conditions

This patient had both periodontitis and tooth resorption at the same time.

Periodontitis involves destruction of the tissues that support the tooth:

• Periodontal attachment
• The periodontal ligament
• Alveolar bone

Tooth resorption is a pathological loss of the tooth's own hard tissues.

Treatment strategy depends on the specific tooth, the type of pathology, and the radiographic findings.

Not every affected tooth can or should be saved.

Why one canine tooth had to be extracted

One of the canine teeth already had pronounced mobility.

Mobility of a permanent tooth indicates loss of its support, but the prognosis depends on the degree of mobility, the nature of the bone defect, the condition of the periodontal attachment, and the radiographic changes.

The prognosis depends not only on the fact of mobility itself, but also on:

• Its degree
• The extent of bone support loss
• The nature of the bone defect
• The condition of the periodontal attachment
• The radiographic changes
• The ability to achieve stable cleaning and further monitoring

For this canine tooth, the mobility and loss of supporting tissues were so significant that a predictable long-term outcome for the tooth was not achievable.

Therefore, extraction was chosen.

Why the other canine tooth's prognosis was different

The other upper canine tooth also had periodontal changes.

However, the loss of bone support was localized mainly to one side of the tooth, while part of its support remained intact.

The shape and location of the defect made it possible to consider regenerative periodontal treatment.

This did not guarantee that the tooth would be saved.

The decision was based on the fact that this specific localized, one-sided defect in alveolar bone support potentially offered better conditions for a tooth-sparing approach than generalized or circumferential support loss.

What guided tissue regeneration is

Guided tissue regeneration — GTR — is a periodontal surgical technique in which, after cleaning a localized defect, conditions are created for periodontal tissue healing while limiting rapid epithelial ingrowth into the defect area.

After cleaning the root surface and the bone defect area, conditions are created that:

• Limit rapid epithelial ingrowth into the defect area
• Maintain space for healing
• Support more organized regeneration of periodontal tissues

GTR is not a universal treatment for every case of periodontitis.

The outcome depends on the shape and depth of the defect, the number of remaining bony walls, tooth mobility, control of bacterial plaque, stability of the surgical site, home care, and individual healing.

What PRF is

Platelet-rich fibrin — PRF — is an autologous product derived from the patient's own blood, used as a supportive biological fibrin matrix at the surgical site.

In this case, PRF was used as an adjunct component of comprehensive regenerative periodontal therapy.

PRF does not replace:

• Cleaning of the root surface
• Removal of pathological tissue
• Proper shaping and stabilization of the surgical site
• Guided tissue regeneration
• Plaque control
• Ongoing follow-up

Its use was part of a comprehensive treatment plan, not a standalone procedure.

Regenerative treatment of the upper canine tooth

After cleaning the periodontal defect and preparing the site, guided tissue regeneration with PRF was performed.

The goal of the treatment was to:

• Reduce the depth of the pathological defect
• Create more favorable conditions for periodontal tissue healing
• Support the preserved structures around the root
• Attempt to save a functional upper canine tooth

At the time of surgery it was not possible to guarantee complete restoration of the lost bone or periodontal attachment.

The outcome had to be assessed over time.

Treatment of the other teeth

Teeth with an unfavorable prognosis due to significant periodontitis, pathological mobility, or clinically significant resorption were extracted in accordance with clinical and radiographic findings.

Postoperative care

After the procedure, the cat was prescribed:

• An individualized pain-management protocol
• Local care of the oral cavity and surgical site
• Antibacterial therapy as clinically indicated for this case
• An appropriate postoperative feeding regimen
• A follow-up examination on day 10

Follow-up examination on day 10

A clinical follow-up examination was performed on day 10.

The surgical site was healing well.

Mild gingival inflammation remained in the treated area around the canine tooth, which was assessed as part of the early postoperative period.

The cat was active and had a good appetite.

This examination allowed assessment of early soft-tissue healing but could not confirm:

• Restoration of alveolar bone
• Formation of new periodontal attachment
• The long-term stability of the canine tooth
• The final outcome of GTR

Update from the owners a month later

About a month later, the owners sent a video of the cat.

According to their observations:

• The cat was active
• Played readily
• Ate with a good appetite
• Was eating dry food again
• They did not notice obvious discomfort

This was a positive remote update on overall well-being.

However, a video from the owners does not replace:

Why a remote update does not replace a follow-up visit

A home video does not replace:

• A dental examination
• Periodontal probing
• Assessment of tooth mobility
• Dental radiographs
• Long-term monitoring of the periodontal defect

Why further monitoring is needed

Regenerative periodontal treatment is not assessed by the appearance of the gums alone.

During further follow-up visits, it is important to evaluate:

• Gum condition
• Plaque accumulation
• Periodontal pocket depth
• Canine tooth mobility
• Stability of periodontal attachment
• The state of alveolar bone support on dental radiographs

The timing of clinical and radiographic follow-up is determined individually.

Home care

After the initial postoperative period was over, the owners were given individualized recommendations for at-home oral hygiene.

Plaque control is especially important for a tooth after periodontal regenerative treatment.

Home care may include only the methods and starting timelines agreed upon with the veterinarian, based on how the surgical site is healing.

Home hygiene helps control plaque but does not replace professional follow-up examinations.