Sir, an 81-year-old male patient presented to an undergraduate restorative clinic in 2019 for a new patient assessment, following a near 20-year absence from dental treatment.

He first presented to Liverpool Dental Hospital back in 1986, having just been provided an upper complete denture and complaining that 'his teeth felt unclean'. His notes from 1986 recorded a diagnosis of 'Chronic Periodontal Disease', which translates into the new 2017 periodontal classification as, 'Generalised Periodontitis, Stage IV, Grade C, Currently unstable with no risk factors'.1 His clinical notes from 1986 included the OPG seen in Figure 1.

Fig. 1
figure 1

Full OPG from 1986 showing severe bone loss in posterior sextants

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The last standing molars (47/38) were extracted immediately, and after some oral hygiene instruction and trials of at-home irrigation of deep pockets with chlorhexidine, he was considered an appropriate candidate for periodontal surgery. Between June and July of 1987, this patient underwent periodontal surgery involving apically repositioned flaps from the canine to the last standing molar bilaterally, without regenerative techniques or grafting.

Despite a 20-year absence of professional periodontal treatment and self-reported 'poor cleaning at home', this patient presented in 2021 having maintained the 45 to the 37 for over 35 years! The most recent periapical radiographs even show a significant improvement in bone level and the patient has been re-enrolled in supportive periodontal therapy (Fig. 2).

Fig. 2
figure 2

Periapical radiographs from 2019 showing LR and LL posterior teeth

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The patient consented both verbally and in written format.

We hope this serves as a reminder to us all to not give up hope on periodontally involved teeth in the long term, and to empower patients to maintain these teeth we label as having a 'poor prognosis'.