This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. All teeth were present except for 46, 26, and 41. Some experts believe that aggressive periodontitis is caused by the bacterium Aggregatibacter actinomycetemcomitans. It is one of the most evaluated drug combinations in GAgP, and there is ample evidence now to show that Amoxycillin-Metronidazole combination as an adjunctive treatment in GAgP at initial therapy significantly improves the results and hence should be preferred over other antibiotic regimens as the first-line treatment (Table 1) [50–55].The usefulness of microbial testing may be limited because of the variability of test reports between different labs and the mixed flora, and hence an empiric use of antibiotics like the above-mentioned combination may be more clinically sound and cost-effective than bacterial identification and antibiotic-sensitivity testing in the treatment of aggressive periodontitis .Single-agent therapy with Doxycycline [53, 55], azithromycin , metronidazole [53, 57], and clindamycin  is effective when used adjunctively to nonsurgical procedure of SRP in AgP patients. A subgingival scaling was performed after which the patient was advised to continue the chlorhexidine mouthwashes. Diode laser treatment has shown a superior clinical and microbiological effect when used along with SRP, compared to SRP alone or laser therapy alone in aggressive periodontitis patients . It aims at attending the psychologic effect and potential mental depression following tooth loss due to rapid periodontal destruction which provides the patient with relatively less time to cope with the situation. A 32-year-old female patient presented with the complaint of a recently noticed spacing between the upper front teeth. Orthodontic treatment can be commenced once attachment gain and bone stability is achieved after periodontal therapy but is generally advised to postpone till 3 months to 1 year after active periodontal therapy. Topical application of antimicrobial agents and local drug delivery is also a treatment option especially if there are localized areas of exudation and deep pockets not responding adequately to mechanical and systemic antibiotic therapy. This underlies the therapeutic effect of smoking cessation and cessation of other forms of tobacco, and patients should be advised of the benefits of smoking cessation and the potential risks of smoking in worsening their periodontal condition, and if needed expert counseling for cessation of the habit should be sought [32–36]. However, with the exponential rate of developments in periodontal research, regenerative therapy, tissue engineering, and genetic technologies, the future seems promising in regard to options at managing the disease. All together there were minimal signs of inflammation other than bleeding on probing. Sign up here as a reviewer to help fast-track new submissions. During this period, there will be active bone destruction and attachment loss. Van Eldere, and D. Van Steenberghe, “One stage full-versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. B. Novaes, and M. Taba Jr., “Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: a preliminary randomized controlled clinical study,”, J. J. Kamma, V. G. S. Vasdekis, and G. E. Romanos, “The effect of diode laser (980 nm) treatment on aggressive periodontitis: evaluation of microbial and clinical parameters,”, A. D. Haffajee, S. S. Socransky, and J. C. Gunsolley, “Systemic anti-infective periodontal therapy. Supragingival scaling was performed, and the patient was educated in oral hygiene maintenance. In the periods of quiescence, patients are free of symptoms and the gingiva appears pink and healthy even though probing reveals deep periodontal pockets. Probing should be done with calibrated periodontal probes at six sites around each tooth. Human histologic studies have shown that a combination of Bio-Oss with either purified porcine collagen (Bio-Oss Collagen)  or a synthetic cell-binding polypeptide (Pepgen P-15)  has the capacity of inducing regeneration of the periodontal attachment apparatus when placed in intrabony defects. An evaluation of the response to nonsurgical treatment is done 2-3 weeks after treatment during which the gingival and periodontal status of the patient will be reevaluated and compared with the pretreatment values to assess the response to therapy and to assess the areas which need surgical therapy. Case reports,”, I. G. Needleman, H. V. Worthington, E. Giedrys-Leeper, and R. J. Tucker, “Guided tissue regeneration for periodontal infra-bony defects,”, A. Sculean, D. Nikolidakis, and F. Schwarz, “Regeneration of periodontal tissues: combinations of barrier membranes and grafting materials—biological foundation and preclinical evidence: a systematic review,”, M. Kiernicka, B. Owczarek, E. Gałkowska, and J. Wysokińska-Miszczuk, “Use of Emdogain enamel matrix proteins in the surgical treatment of aggressive periodontitis,”, A. Miliauskaite, D. Selimovic, and M. Hannig, “Successful management of aggressive periodontitis by regenerative therapy: a 3-year follow-up case report,”, A. S. Plachokova, D. Nikolidakis, J. Mulder, J. Aggressive periodontitis: ... Necrotizing periodontal disease: Death of periodontal tissue caused by a lack of blood supply can pave the way for a severe infection, and this usually affects people with a suppressed immune system. Though it can be found in less than two percent of the general population, it's often found in younger patients, even children, and the disease usually affects the first molars more than other teeth. A reevaluation 2 weeks after subgingival scaling showed a reduction in probing depths and absence of bleeding on probing. Aggressive periodontitis is considered to progress far more quickly than chronic periodontitis, and can cause bone and tooth loss. With further understanding of the genetic risk factors, a futuristic application of genetic screening tests will be in identifying the susceptible individuals and instituting the preventive measures to keep the gene expression and thus the disease under control [105, 106]. Various modalities are being employed for periodontal regeneration which includes use of bone replacement grafts, barrier membranes or guided tissue regeneration (GTR), biologic modifiers like growth and differentiation factors (GDF), and extracellular matrix proteins like enamel matrix proteins (EMD) or use of a combination of the above techniques and materials which has been extensively reviewed elsewhere . Aggressive periodontitis can be differentiated from chronic periodontitis by the age of onset, rapid rate of disease progression, the nature and composition of the associated subgingival microflora, alterations in host immune response, and a familial aggregation of the diseased individuals . Objectives . Family history may reveal a history of early tooth loss in the parents or immediate blood relatives of the patient . Our current understanding of this disease is that speciﬁc bacteria invade the oral cavity and the host reacts with an inﬂammatory response leading to … A regular recall visit preferably at one-week intervals should be performed especially at the initial stages of the treatment to monitor the efficiency of the patient’s plaque control measures and to assess the response of the patient towards nonsurgical therapy. When the patient presents in this stage, the gingiva will show all signs of mild to severe inflammation. SRP reduced the total sub gingival bacterial counts and some gram-negative bacteria but no periodontal pocket became free of A.a Earlier tetracyclines were used extensively for this purpose since systemic tetracycline was found to be a useful adjunct to mechanical periodontal therapy in patients with aggressive periodontitis [46–48], but the concern for tetracycline resistance has shifted the focus to the use of other antibiotics both as combination therapy or serial antibiotic therapy .The preferred combination antibiotic therapy at present for treatment of GAgP is 250 mg of amoxicillin thrice daily along with metronidazole 250 mg twice daily for 8 days [24, 49]. The gingiva was firm and resilient except in the region on 22 where it was soft in consistency. One theory is that herpesviruses cooperate with specific bacteria in the etiopathogenesis of the disease. The amount of microbial deposits will be inconsistent with the amount of destruction when compared to chronic periodontitis and plaque will be minimal. Aggressive periodontitis usually causes damage to the teeth and jaw three or four times faster than does chronic periodontitis. The etiology of periodontitis is very complex including the dental biofilm, which triggers the immuno-inflammatory response in a susceptible host. (Figures 5(a)–5(d)). are of promising results. The American Academy of periodontology revised the classification of periodontal diseases in 1999. Periodontal disease is usually a chronic disease taking many months to develop. Symptoms can vary widely, however, from one person to the next. GAgP patients who smoke and/or maintain a poor oral hygiene demonstrate more severe destruction of periodontium compared to those who do not smoke or maintain a satisfactory oral hygiene (Figures 2(a)–2(e)). Bleeding on probing or even spontaneous bleeding and purulent exudation may be evident. Herpesvirus‐bacteria synergistic interactions, are likely to comprise an important pathogenic determinant of aggressive periodontitis. Keywords: aggressive, bacteria, dysbiosis, genetic, pathogenesis, periodontitis A paradigm shift several decades ago elucidated that aggressive periodontitis (AgP) was not a degenerative disorder but a rapid progressive form of plaque-induced inﬂammatory periodontal disease. Several local anti-infective agents combined with SRP appear to provide additional benefits in PD reduction and CAL gain compared to SRP alone. A quadrant-wise full-mouth flap surgery was performed including bone grafting in relation to the molar regions where predominantly vertical or intrabony defects were detected. Family history of similar complaints or early tooth loss could not be elicited. Distinguishing diagnostic factors: Both involve irreversible loss of attachment and bone. Depending on the time of diagnosis and the intensity of the disease, the treatment will vary accordingly. What are the Different Gum Disease Natural Treatments. With the current treatment modalities, successful long-term maintenance of the dentition in a healthy and functional state can be achieved. The decision to use local anti-infective adjunctive therapy remains a matter of individual clinical judgment, the phase of treatment, and the patient’s status and preferences. Localized aggressive periodontitis can, later on, develop into a generalized one, so assessment, diagnosis, and treatment should be prompt and consistent as well. Aggressive periodontitis: It is a severe condition that represented the high proportion of younger cohort patients, the progression of disease is rapid, and the degree of destruction of the tissue (connective tissue) is high. Grade II furcation involvement was present with molars and maxillary first premolars. A fluoride-containing mouthwash was prescribed postsurgically to the patient. Tooth 26 was grossly decayed with just root stump present. 19. Some of the complications that may arise from the condition include tooth loss, heart disease, stroke, and worsening of diabetes and respiratory conditions. A systematic review,”, F. F. Duarte, R. F. Lotufo, and C. M. Pannuti, “Local delivery of chlorhexidine gluconate in patients with aggressive periodontitis,”, D. Kaner, J. P. Bernimoulin, W. Hopfenmüller, B. M. Kleber, and A. Friedmann, “Controlled-delivery chlorhexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial,”, D. Sakellari, I. Vouros, and A. Konstantinidis, “The use of tetracycline fibres in the treatment of generalised aggressive periodontitis: clinical and microbiological findings,”, P. Purucker, H. Mertes, J. M. Goodson, and J. P. Bernimoulin, “Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis,”, A. Saito, Y. Hosaka, T. Nakagawa, K. Seida, S. Yamada, and K. Okuda, “Locally delivered minocycline and guided tissue regeneration to treat post-juvenile periodontitis. Various commercially available regenerative materials including bone replacement grafts, GTR membranes, enamel matrix derivatives, are in the market for use in periodontal therapy with varying results, and the choice of the material depends on the dentist’s preference and experience with the products helping in clinical judgment of the therapeutic results of individual products and procedures and their cost-benefit ratio. The type of bone graft which gives the maximum benefit with minimum tissue reaction is autograft , but there are limitations of obtaining it in large quantities as is needed in most cases of generalized aggressive periodontitis. Any site which shows signs of recurrence of the disease like bleeding on probing which is considered as the first clinical sign of inflammation should be treated vigorously and monitored for resolution of the signs. Conceivably, herpesviruses rely on co-infection with to produce periodontitis and, conversely bacteria may develop on viruses for the initiation and progression of some types of periodontal diseases. 1–6, 1999. Interleukin-2 -330 and 166 gene polymorphisms in relation to aggressive or chronic periodontitis and the presence of periodontopathic bacteria. Aggressive periodontitis (AgP) is a form of periodontitis characterized by rapid and severe periodontal destruction in otherwise young healthy individuals. Aggressive periodontitis refers to periodontal disease of an aggressive and rapid nature that usually occurs in patients younger than 30 years. Finally an attempt to summarize the available protocol for a comprehensive management of GAgP is done which can serve as a guideline till more definite clear-cut guidelines are established for the disease in the future. Sites with persisting pockets >5 mm depth, vertical bone defects which need regenerative therapy, difficult to instrument areas like furcation involvement, and areas which need recontouring or resective osteoplasty are indications for surgery. Unlike chronic periodontitis, aggressive periodontitis has been associated with the specific bacteria, namely Aggregatibacter actinomycetemcomitans and Porphymonas gingivalis. In Morocco, Aggregatibacter actinomycetemcomitanshas been strongly associated with AgP, however limited knowledge is available about the implication of other periodontal pathogens in this entity. Depression, anxiety and social withdrawal are seen in patients with tooth loss, and resulting compromised esthetics can be helped with therapy, relaxation techniques, and, in some cases, antidepressants. A recent study reported that psychotherapy offered at 3 levels (individual, group, and conjoint family psychotherapy) to GAgP patients gave positive psychologic effects that restored their ability to socialize in their environment contributing to their positive experience in life . Aa is considered a vary common oral bacteria, as it's found in the mouths of up to 20 percent of the population. Three-walled or intrabony defect is the ideal defect for bone grafts and has a better success rate compared to a two-walled and one-walled defect. Background:Actinobacillus actinomycetemcomitans is considered a major etiologic agent of aggressive periodontitis. Mechanical plaque control can be successfully achieved by educating and motivating the patient if needed with the aid of disclosing solutions regarding the need for optimal plaque control, demonstration of brushing techniques (modified Bass technique for patients without gingival recession and modified Stillman technique in patients with hypersensitivity and generalized recession), and use of interdental cleansing aids like dental floss and interdental brushes where indicated. The patient was systemically healthy with no relevant medical history. Aggressive periodontitis refers to multifactorial, severe, & rapidly progressive form of periodontitis, which primarily but not exclusively … Gingivitis is a non-destructive disease that causes inflammation of the gums. Slots, “Practical antimicrobial periodontal therapy,”, S. P. Ramfjord and R. R. Nissle, “The modified widman flap,”, F. M. De Carvalho, E. M. B. Tinoco, M. Govil, M. L. Marazita, and A. R. Vieira, “Aggressive periodontitis is likely influenced by a few small effect genes,”, J. Waerhaug, “Plaque control in the treatment of juvenile periodontitis,”, J. M. Moran, “Chemical plaque control—prevention for the masses,”, M. E. Guarnelli, F. Zangari, R. Manfrini, C. Scapoli, and L. Trombelli, “Evaluation of additional amine fluoride/stannous fluoride-containing mouthrinse during supportive therapy in patients with generalized aggressive periodontitis: a randomized, crossover, double-blind, controlled trial,”, J. Nemes, J. Bánóczy, M. Wierzbicka, and M. Rost, “The effect of mouthwashes containing amino-fluoride and stannous fluoride on plaque formation and gingivitis in adults,”, J. Haber, J. Wattles, M. Crowley, R. Mandell, K. Joshipura, and R. L. Kent, “Evidence for cigarette smoking as a major risk factor for periodontitis,”, American Academy of Periodontology, “Position paper: tobacco use and the periodontal patient,”, P. Obeid and P. Bercy, “Effects of smoking on periodontal health: a review,”, B. H. Mullally, B. Breen, and G. J. Linden, “Smoking and patterns of bone loss in early-onset periodontitis,”, S. E. Borbour, K. Nakashima, J. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms (also called plaque) that is attached to tooth surfaces, termed plaque-induced gingivitis.Most forms of gingivitis are plaque-induced. The majority of the patients refer to dental consultation at this stage of the disease (Figures 3(a)–3(c)). The maintenance therapy starts soon after the phase I therapy or nonsurgical therapy and should be continued throughout the lifetime of the patient. Long-term clinical observations,”, M. Quirynen, C. Mongardini, M. Pauwels, C. M. L. Bollen, J. The disease which includes both localized and generalized forms was previously known as “early onset periodontitis” which included the three categories of periodontitis—prepubertal, juvenile, and rapidly progressing periodontitis [8, 9]. Application of enamel matrix proteins alone  or in combination with bone grafts including bioactive glass has shown to result in the successful treatment of intrabony defects in aggressive periodontitis . DFDBA, because of its osteoinductive property, has shown to have better results than the alloplastic materials which are osteoconductive . The key to successful treatment is early diagnosis. Biomodification of the root surface (Root conditioning) with citric acid, tetracycline, or fibronectin is preferable when performing bone grafting or GTR for better clinical results . I. Early diagnosis helps in prevention of progression of the disease thus avoiding the possibility of advanced tissue destruction and alveolar bone loss. A periodontal pack was placed, and antibiotics and analgesics were prescribed for the patient for 5 days. This condition used to be called juvenile periodontitis. Alphonse Gargiulo, DDS, MS, Rachel Degen, RDH, and Mark Val, CDT, present a case report of a 20-year-old African American female who was diagnosed at puberty with localized aggressive periodontitis, which developed into a generalized form of the disease as the patient entered late adolescence. There was grade I mobility of 15 and 22 and grade II mobility of 11, 12, 21, 31, 32, 33 and 42. Severe periodontal destruction was evident with more than 10 mm of clinical attachment loss at multiple sites especially in the incisor and canine regions. Chemical plaque control agents like chlorhexidine 0.12% or 0.2% mouthwashes, and 1% povidone iodine can be advised for further plaque control as an adjunct to the patient’s mechanical plaque control measures . A combined periodontal and orthodontic treatment demands a detailed evaluation in both specialties, particularly when the periodontium is reduced. Management of GAgP patients essentially consists of a nonsurgical phase, surgical therapy an interdisciplinary therapy and a lifelong supportive periodontal therapy. There was no associated complaint other than a generalized mild hypersensitivity to cold and sweet food. New bone formation with autografts and allografts determined by strontium-85,”, M. R. Urist and B. S. Strates, “Bone formation in implants of partially and wholly demineralized bone matrix. Other alloplastic grafts which can be used are beta tricalcium phosphate and bioactive glass [80, 81]. Mobility of the affected teeth will be seen towards the later stages of the infection. Non-surgical therapy It’s effect on aggressive periodontitis is less clear. The main aim of a flap procedure is to get access and visibility to root and furcation areas so that a thorough instrumentation and debridement can be performed. Experts don't yet understand why, if Aa is so common, aggressive periodontitis is so rare. Regular recall appointments were given for maintenance therapy during which the treatment results were well maintained. Other periodontopathic bacteria such as Porphyromonas gingivalis are also suspected of participating in aggressive periodontitis, although the evidence is controversial. The bacteria responsible for periodontitis can enter your bloodstream through gum tissue, possibly affecting other parts of your body. Lack of visible signs of clinical inflammation despite the presence of deep periodontal pockets and severe attachment loss in an otherwise healthy young individual is the classic sign of aggressive periodontitis presenting at this stage (Figures 1(a)–1(c)). The study bacteria occurred in 78-83% (P. gingivalis, T. forsythia, C. rectus) and in 44% (P. intermedia, A. actinomycetemcomitans) of the periodontitis samples, and in 0-19% of the samples from healthy periodontal sites. A distinct clinical condition,”, A. Stabholz, W. A. Soskolne, and L. Shapira, “Genetic and environmental risk factors for chronic periodontitis and aggressive periodontitis,”, G. C. Armitage and M. P. Cullinan, “Comparison of the clinical features of chronic and aggressive periodontitis,”, L. Suresh, A. Aguirre, R. J. Buhite, and L. Radfar, “Intraosseous sarcoidosis of the jaws mimicking aggressive periodontitis: a case report and literature review,”, A. Zaghbani, S. Ben Youssef-Boudegga, O. Gharbi, S. Ayachi, and C. Baccouche, “Eosinophilic granuloma or aggressive periodontitis,”, S. S. Silvestros, A. However, Generalized Aggressive Periodontitis (GAP) manifests when one’s genetic make-up is in concurrence with certain environmental factors and the exposure to pathogenic bacteria causing GAP occurs. A diagnosis of generalized aggressive periodontitis was made according to the established criteria (American Academy of Periodontology, 1999). Localized happens when a child’s first molars and incisors are affected and become detached to the jaw bone prematurely. Localized aggressive periodontitis typically presents “arc-shaped” mirror image radiolucency in the first molars starting from the distal aspect of second premolars to the mesial aspect of the second molar. Aa in most peoples' mouths do the same thing that other types of bacteria typically do in the mouth, which is to form the filmy tooth coating known as plaque. 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