Omega-3 with guided biofilm therapy in periodontitis: Case report
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Abstract
Stage IV periodontitis requires sustained biofilm and inflammatory control. Evidence for omega-3 adjuncts is heterogeneous, and their use within a structured Guided Biofilm Therapy (GBT) pathway for Stage IV disease has not been evaluated. This case report describes a 54-year-old man recorded as having generalised Stage IV, Grade C periodontitis who received GBT, site-specific ultrasonic and hand instrumentation, and adjunctive omega-3 supplementation. NOW Ultra Omega-3 was prescribed as one 1,000-mg softgel once daily before breakfast for 90 days; each softgel provided 500 mg eicosapentaenoic acid and 250 mg docosahexaenoic acid. From baseline to 6 months, full-mouth plaque and bleeding-on-probing scores decreased from 100% to 28%, mean probing depth from 4.8 to 3.2 mm, and mean clinical attachment level from 5.6 to 4.7 mm. Total leukocytes decreased from 8.87 to 6.70 × 10³/μL and C-reactive protein from 4.5 to 3.9 mg/L. The periodontal changes are compatible with a favourable short-term response to comprehensive non-surgical care, whereas the laboratory shifts remain descriptive. Because behaviour change, air polishing, instrumentation, supportive care, and omega-3 were delivered concurrently in one patient, neither component-specific efficacy nor causality can be inferred. A placebo-controlled randomised trial using identical periodontal care in both arms is required to isolate omega-3 effects; a factorial design would additionally test the GBT pathway. This case therefore provides a detailed hypothesis-generating observation rather than evidence of efficacy.
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How to Cite
Tanumiharja, L. J. S., Keziana, J. A., Natanael, D. G., Meriana, T., & Satyoprawiro, A. (2026). Omega-3 with guided biofilm therapy in periodontitis: Case report. International Journal on Health and Medical Sciences, 4(3), 190–196. https://doi.org/10.35335/healmed.v4i3.753
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Savran, L., & Sağlam, M. (2024). Clinical effects of omega-3 fatty acids supplementation in the periodontal treatment of smokers and non-smokers with periodontitis: a retrospective study. Clinical Oral Investigations, 28(8). https://doi.org/10.1007/s00784-024-05835-8
Serhan, C. N. (2017). Treating inflammation and infection in the 21st century: New hints from decoding resolution mediators and mechanisms. In FASEB Journal (Vol. 31, Number 4). https://doi.org/10.1096/fj.201601222R
Stańdo, M., Piatek, P., Namiecinska, M., Lewkowicz, P., & Lewkowicz, N. (2020). Omega-3 polyunsaturated fatty acids epa and dha as an adjunct to non-surgical treatment of periodontitis: A randomized clinical trial. Nutrients, 12(9). https://doi.org/10.3390/nu12092614
Stein, J. M., Yekta-Michael, S. S., Schittenhelm, F., Reichert, S., Kupietz, D., Dommisch, H., Kasaj, A., Wied, S., Vela, O. C., & Stratul, S. I. (2021). Comparison of three full-mouth concepts for the non-surgical treatment of stage III and IV periodontitis: A randomized controlled trial. Journal of Clinical Periodontology, 48(12). https://doi.org/10.1111/jcpe.13548
Suvan, J., Leira, Y., Moreno Sancho, F. M., Graziani, F., Derks, J., & Tomasi, C. (2020). Subgingival instrumentation for treatment of periodontitis. A systematic review. In Journal of Clinical Periodontology (Vol. 47, Number S22). https://doi.org/10.1111/jcpe.13245
Tomasi, C., Abrahamsson, K. H., & Apatzidou, D. (2023). Subgingival instrumentation. In Periodontology 2000. https://doi.org/10.1111/prd.12485
Tonetti, M. S., Greenwell, H., & Kornman, K. S. (2018). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Periodontology, 89. https://doi.org/10.1002/JPER.18-0006
Van Ravensteijn, M. M., Timmerman, M. F., Brouwer, E. A. G., & Slot, D. E. (2022). The effect of omega-3 fatty acids on active periodontal therapy: A systematic review and meta-analysis. In Journal of Clinical Periodontology (Vol. 49, Number 10). https://doi.org/10.1111/jcpe.13680
Braun, A., Jepsen, S., & Krause, F. (2007). Subjective intensity of pain during ultrasonic supragingival calculus removal. Journal of Clinical Periodontology, 34(8). https://doi.org/10.1111/j.1600-051X.2007.01100.x
Deore, G. D., Gurav, A. N., Patil, R., Shete, A. R., NaikTari, R. S., & Inamdar, S. P. (2014). Omega 3 fatty acids as a host modulator in chronic periodontitis patients: A randomised, double-blind, palcebo-controlled, clinical trial. Journal of Periodontal and Implant Science, 44(1). https://doi.org/10.5051/jpis.2014.44.1.25
Donos, N., Calciolari, E., Brusselaers, N., Goldoni, M., Bostanci, N., & Belibasakis, G. N. (2020). The adjunctive use of host modulators in non-surgical periodontal therapy. A systematic review of randomized, placebo-controlled clinical studies. In Journal of Clinical Periodontology (Vol. 47, Number S22). https://doi.org/10.1111/jcpe.13232
El‐Sharkawy, H., Aboelsaad, N., Eliwa, M., Darweesh, M., Alshahat, M., Kantarci, A., Hasturk, H., & Van Dyke, T. E. (2010). Adjunctive Treatment of Chronic Periodontitis With Daily Dietary Supplementation With Omega‐3 Fatty Acids and Low‐Dose Aspirin. Journal of Periodontology, 81(11). https://doi.org/10.1902/jop.2010.090628
Gheorghe, D. N., Bennardo, F., Silaghi, M., Popescu, D. M., Maftei, G. A., Bătăiosu, M., & Surlin, P. (2023). Subgingival Use of Air-Polishing Powders: Status of Knowledge: A Systematic Review. In Journal of Clinical Medicine (Vol. 12, Number 21). https://doi.org/10.3390/jcm12216936
Gheorghiu, A., Franzen, R., Arweiler, N. B., Ciurescu, C. E., Gutknecht, N., Ciurescu, V. A., Sculean, A., & Cosgarea, R. (2021). Two-year outcomes following the adjunctive use of InGaAsP and Er,Cr:YSGG lasers in nonsurgical periodontal therapy in patients with stages III and IV periodontitis. Quintessence International, 52(10), 848–861. https://doi.org/10.3290/j.qi.b1702285
Herrera, D., Sanz, M., Kebschull, M., Jepsen, S., Sculean, A., Berglundh, T., Papapanou, P. N., Chapple, I., & Tonetti, M. S. (2022). Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. In Journal of Clinical Periodontology (Vol. 49, Number S24). https://doi.org/10.1111/jcpe.13639
Jentsch, H. F. R., Flechsig, C., Kette, B., & Eick, S. (2020). Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy: a randomized clinical trial. BMC Oral Health, 20(1). https://doi.org/10.1186/s12903-020-01363-5
Kruse, A. B., Kowalski, C. D., Leuthold, S., Vach, K., Ratka-Krüger, P., & Woelber, J. P. (2020). What is the impact of the adjunctive use of omega-3 fatty acids in the treatment of periodontitis? A systematic review and meta-analysis. In Lipids in Health and Disease (Vol. 19, Number 1). https://doi.org/10.1186/s12944-020-01267-x
Mainas, G., Ide, M., Rizzo, M., Magan-Fernandez, A., Mesa, F., & Nibali, L. (2022). Managing the Systemic Impact of Periodontitis. In Medicina (Lithuania) (Vol. 58, Number 5). https://doi.org/10.3390/medicina58050621
Oliveira, L. M., Sari, D., Schöffer, C., Santi, S. S., Antoniazzi, R. P., & Zanatta, F. B. (2020). Periodontitis is associated with oral health-related quality of life in individuals with end-stage renal disease. Journal of Clinical Periodontology, 47(3). https://doi.org/10.1111/jcpe.13233
Papapanou, P. N., Sanz, M., Buduneli, N., Dietrich, T., Feres, M., Fine, D. H., Flemmig, T. F., Garcia, R., Giannobile, W. V., Graziani, F., Greenwell, H., Herrera, D., Kao, R. T., Kebschull, M., Kinane, D. F., Kirkwood, K. L., Kocher, T., Kornman, K. S., Kumar, P. S., … Tonetti, M. S. (2018). Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Periodontology, 89(March), S173–S182. https://doi.org/10.1002/JPER.17-0721
Sanz, M., Herrera, D., Kebschull, M., Chapple, I., Jepsen, S., Beglundh, T., Sculean, A., Tonetti, M. S., Merete Aass, A., Aimetti, M., Kuru, B. E., Belibasakis, G., Blanco, J., Bol-van den Hil, E., Bostanci, N., Bozic, D., Bouchard, P., Buduneli, N., Cairo, F., … Wennström, J. (2020). Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 47(S22). https://doi.org/10.1111/jcpe.13290
Savran, L., & Sağlam, M. (2024). Clinical effects of omega-3 fatty acids supplementation in the periodontal treatment of smokers and non-smokers with periodontitis: a retrospective study. Clinical Oral Investigations, 28(8). https://doi.org/10.1007/s00784-024-05835-8
Serhan, C. N. (2017). Treating inflammation and infection in the 21st century: New hints from decoding resolution mediators and mechanisms. In FASEB Journal (Vol. 31, Number 4). https://doi.org/10.1096/fj.201601222R
Stańdo, M., Piatek, P., Namiecinska, M., Lewkowicz, P., & Lewkowicz, N. (2020). Omega-3 polyunsaturated fatty acids epa and dha as an adjunct to non-surgical treatment of periodontitis: A randomized clinical trial. Nutrients, 12(9). https://doi.org/10.3390/nu12092614
Stein, J. M., Yekta-Michael, S. S., Schittenhelm, F., Reichert, S., Kupietz, D., Dommisch, H., Kasaj, A., Wied, S., Vela, O. C., & Stratul, S. I. (2021). Comparison of three full-mouth concepts for the non-surgical treatment of stage III and IV periodontitis: A randomized controlled trial. Journal of Clinical Periodontology, 48(12). https://doi.org/10.1111/jcpe.13548
Suvan, J., Leira, Y., Moreno Sancho, F. M., Graziani, F., Derks, J., & Tomasi, C. (2020). Subgingival instrumentation for treatment of periodontitis. A systematic review. In Journal of Clinical Periodontology (Vol. 47, Number S22). https://doi.org/10.1111/jcpe.13245
Tomasi, C., Abrahamsson, K. H., & Apatzidou, D. (2023). Subgingival instrumentation. In Periodontology 2000. https://doi.org/10.1111/prd.12485
Tonetti, M. S., Greenwell, H., & Kornman, K. S. (2018). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Periodontology, 89. https://doi.org/10.1002/JPER.18-0006
Van Ravensteijn, M. M., Timmerman, M. F., Brouwer, E. A. G., & Slot, D. E. (2022). The effect of omega-3 fatty acids on active periodontal therapy: A systematic review and meta-analysis. In Journal of Clinical Periodontology (Vol. 49, Number 10). https://doi.org/10.1111/jcpe.13680
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