I am fortunate to have had several patients these last two years who were treated with periodontal therapy, were released to maintenance, and were in need of my reevaluation. Below, I have one such patient who had received nonsurgical scaling and root planing therapy approximately 15 months prior to seeing me. He had his evaluation of initial therapy (EIT) shortly after treatment, and had been seen for two periodontal maintenance appointments in the intervening months. I performed a comparison of my periodontal assessments and biofilm accumulation with those noted at the time of his last recorded assessments. My faculty and I were in agreement about his worsening periodontal condition. Importantly, the patient had a highly complicated medical history, which included diabetes mellitus type II, hypertension, a history of stent placement and bypass grafts, usage of nitroglycerin for stable angina and a history of two separate prosthetic joint replacements. In conjunction with worsening oral hygiene status, I, along with my faculty, deemed repeat nonsurgical therapy and targeted education the best course of action for the patient. As part of my capstone project, I documented the patient's treatment case from our initial encounter through his release back to a periodontal maintenance recall. Through the course of my clinical education, I learned how capricious periodontal healing can be after therapy. This experience reinforced the scientific evidence which recommends providers address the multifactorial salutogenic and pathogenic aspects of disease to increase the likelihood of positive outcomes.