Focused Clinical Question In patients presenting with generalized moderate to severe chronic periodontitis and continuing to smoke, does host modulation improve the maintenance of alveolar bone support and clinical attachment level? Clinical Scenario A 45-year-old woman with a 25-pack-year history of smoking presents for comprehensive periodontal therapy including four quadrants of regenerative surgery and is now receiving supportive care at 3-month intervals. Clinical examination reveals excellent oral hygiene, and the patient resists a referral for smoking cessation. The patient is anxious about the potential for tooth loss. See Figures 1 to 3 for clinical presentation.
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