case_images: PMC8548172_01
case_images: Appearances of the palm at (a) first visit and (b) 1 year after periodontal treatment. (a) Scaly erythemas with tiny pustules were scattered on the palm. (b) Marked improvement was observed after periodontal treatment.
case_images: CRIDM2021-5548760.001.jpg
case_images: PMC8548172_01_CRIDM2021-5548760.001.jpg
case_images: fig1
case_images: A 56-year-old woman with PPP was referred to a dentist with suspected intraoral disease deteriorating factors (Figure 1(a)). In addition, although more than 2 years had passed after complete remission, no recurrence was observed (Figure 1(b)).
case_images: Appearance of the patient's periodontal tissues at the first visit (a) and radiograph of the periodontium (b). Note the severe alveolar bone resorption and so-called "floating teeth" due to severe periodontitis (b) and moderate gingival inflammation (a). "Floating teeth" were indicated by arrows. In addition, many metal restorations are observed.
case_images: CRIDM2021-5548760.002.jpg
case_images: PMC8548172_01_CRIDM2021-5548760.002.jpg
case_images: fig2
case_images: It was severe (stage IV and grade C) (Figures 2(a) and 2(b)).
case_images: The course of dental treatment and the changes in hs-CRP levels, WBC, PISA value, and the ratio of PPD >4 mm. As periodontal treatment advanced, the value of inflammatory markers showed a decreased tendency.
case_images: CRIDM2021-5548760.003.jpg
case_images: PMC8548172_01_CRIDM2021-5548760.003.jpg
case_images: fig3
case_images: Upon her visit at our centre, we performed a regular examination and measured hs-CRP, white blood cell (WBC) count, and calculated PISA.  Figure 3 shows the results of the initial dental examination and the changes in each parameter according to the treatment. Periodontitis showed further improvement 3 months after periodontal surgery (Figure 3). The symptoms of PPP gradually improved, and complete remission was observed in the supportive periodontal therapy (SPT) phase.  Figure 3 shows the changes in laboratory and clinical examination data.