The diagnosis "Aggressive Periodontitis", defined by the International Workshop for Classification of Periodontal Diseases and Conditions in 1999, refers to the multifactorial, severe, and rapidly progressive form of Periodontitis, which primarily – but not exclusively – affects younger patients. Amoxicillin and metronidazole as an adjunctive treatment in generalized aggressive periodontitis at initial therapy or re‐treatment: a randomized controlled clinical trial. al . However, in general, the risk factors associated with periodontal disease may include: It is important to note that having a risk factor does not mean that one will get the condition. 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. Supragingival scaling was performed, and the patient was educated in oral hygiene maintenance. The diagnostic features of the disease are characteristic, but the clinical presentation and patterns of destructions may vary between patients. Periodontal evaluations are scheduled concomitantly with orthodontic appointments to monitor the periodontal stability as the tooth movement occurs. The defects may be a combination of vertical and horizontal defects (Figures 4(a) and 4(b)). The treatment plan may range from oral cleaning, removal of plaque, to medication administration for bacterial infection. Regular visits for dental health checkups and maintaining good oral hygiene, such as brushing and flossing after each meal, are generally recommended. Generalized aggressive periodontitis (GAgP) is characterized by “generalized interproximal attachment loss affecting at least 3 permanent teeth other than first molars and incisors” . Smoking has been well documented as a significant risk factor for aggressive periodontitis with GAgP patients who smoke having more affected teeth and more loss of clinical attachment than nonsmoking patients with GAgP . Adjunctive use of locally administered alendronate gel with SRP for host modulation has shown promising results in aggressive periodontitis . Journal of periodontology, 83(10), 1213-1225. With infection of the gums, the spongy bone decays and retreats. Surgery may be necessary for severe disease. Can you cure Periodontal Disease? (2010). Generalized Aggressive periodontitis: affects at least three permanent teeth other than the first molars or incisors. (2008). The disease has a strong genetic predisposition. A modified Widman flap surgery  in conjunction with bone replacement graft was performed in the molar regions (Figures 8(a)–8(e)) whereas a sulcular incision flap (Kirkland flap) was performed in the maxillary and mandibular anterior region to minimize the recession after healing for esthetic purposes. METHODS: Thirty-five patients treated for GAgP and 18 periodontally healthy patients orally rehabilitated with osseointegrated implants participated in the Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. 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)). Periodontitis is a gum disease that leads to loss of bone that normally supports the teeth. Nonsurgical therapy remains the first line of antimicrobial therapy in GAgP. The patient was put on maintenance therapy during which he continued with the topical antimicrobial agents and desensitizing agents and was evaluated for surgical therapy. Lonq-terrn impact on microbial load,”, A. Both PDT and SRP have been shown to have similar clinical results in the nonsurgical treatment of aggressive periodontitis [42, 43]. Generalized Aggressive Periodontitis - Clinical Features. Journal of clinical periodontology, 38(1), 43-49. Allogeneic freeze-dried bone (FDBA) mixed with tetracycline powder along with systemic tetracycline has demonstrated a better clinical outcome in treatment of juvenile periodontitis . Journal of clinical periodontology, 37(4), 313-323. The signs and symptoms associated with Generalized Aggressive Periodontitis (GAP) vary and may include: Additionally, the following may be noted: The diagnostic tests for Generalized Aggressive Periodontitis may involve the following: Many clinical conditions may have similar signs and symptoms. Even a minimal amount of plaque is enough to elicit untoward host response in those patients susceptible to the disease, and a reduced resistance to the invasion of subgingival plaque can be compensated for by a correspondingly strong emphasis on total plaque control . Efficacy of amoxicillin and metronidazole combination for the management of generalized aggressive periodontitis. The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. 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. Mestnik, M. J., Feres, M., Figueiredo, L. C., Duarte, P. M., Lira, E. A. G., & Faveri, M. (2010). A 32-year-old female patient presented with the complaint of a recently noticed spacing between the upper front teeth. Over the past 20 years, locally delivered, anti-infective pharmacological agents, most recently employing sustained-release vehicles, have been introduced to achieve this goal . Generalized aggressive periodontitis. Laser irradiation of subgingival sites to eradicate periodontopathic microorganisms is also being considered in the nonsurgical therapy of periodontitis patients. Pus discharge was associated with bad breath and usually subsided spontaneously after a few weeks. Generalized aggressive periodontitis may begin around puberty and involve the entire mouth. Poor serum antibody response to affecting agent. Some patients may show systemic manifestations such as weight loss, mental depression and general malaise . The emotional effects of tooth loss are devastating for some patients and have a dramatic impact on their life, and they take longer time to come to terms with the tooth loss . T. Roshna, K. Nandakumar, "Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature", Case Reports in Medicine, vol. Molecular Oral Microbiology, 23(2), 112-118. Journal of periodontology, 81(7), 964-974. Preparing the patients with advanced disease having multiple teeth with hopeless prognosis emotionally for extraction also has to be dealt with carefully by the dentist, if needed using multiple appointments, and the extent of the impact that bad news, such as having to lose teeth, has on an individual is most often dependent on the way in which the information is communicated . 5–10% of all cases are aggressive, rapidly-progressing forms (Ahrens & Bublitz 1987, Miller et al. The disease is generally found to have a racial and sex predilection, with blacks and male teenagers having higher risk for the disease compared to whites and females, although reports vary between different ethnic groups and populations, with some populations showing prevalence as high as 28.8% [4, 5]. Additionally use of fluoride mouthwashes is advised to help in remineralization of the exposed root surfaces, and for patients complaining of hypersensitivity, use of desensitizing toothpastes and mouthwashes is mandatory. 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. Further understanding of the etiology, risk factors, pathogenesis, and host immune response in aggressive periodontitis along with advances in regenerative concepts, tissue engineering, and gene therapy is needed for formulating better management protocols in the treatment of generalized aggressive periodontitis. Laser-assisted surgery (Nd: YAG laser) is suggested as a valid alternative to conventional scalpel surgical therapy, in individuals at increased surgical risk like in coagulation and platelet function disorders . The periods of inactivity may remain for weeks to months or even years and will be followed by periods of active disease. Early diagnosis helps in prevention of progression of the disease thus avoiding the possibility of advanced tissue destruction and alveolar bone loss. Copyright © 2012 T. Roshna and K. Nandakumar. Any of the above symptoms should be addressed with a qualified psychotherapist to improve the quality of life. Based on the history, examination findings, and the radiographic findings, a diagnosis of generalized aggressive periodontitis was made according to the criteria by AAP 1999 classification. BL: Serum IgG responses are similar in generalized aggressive periodontitis and localized aggressive periodontitis, but when compared to localized or generalized chronic periodontitis, serum IgG levels were significantly greater in GAgP. Regeneration of the periodontal supporting structures lost due to periodontal disease so that the form and function of the periodontium is reestablished has been an elusive or difficult-to-achieve goal for periodontal therapists. However, the condition is difficult to treat, The prognosis of Generalized Aggressive Periodontitis is usually difficult to predict. Full complement of teeth was present. Currently, the best approach to prevent the development of Generalized Aggressive Periodontitis is to maintain good oral hygiene. Gingivitis, … The flap was reflected following which sulcular incision and interdental incision were made to remove the wedge of tissue. Patients may complain of halitosis and pus discharge from gums. Clinical Criteria Assigned to Periodontal Case Types of Health, Gingivitis, Chronic Periodontitis and Aggressive Periodontitis. In generalized aggressive periodontitis, most permanent teeth are affected. Yek, E. C., Cintan, S., Topcuoglu, N., Kulekci, G., Issever, H., & Kantarci, A. Prevention and Treatment. Controversy exists as to whether the two are distinct entities, or if they are two forms of the same disease.10 Evidence supports the notion that in some cases localized disease progresses to a generalized form as a patie… Role of Systemic Antibiotic Therapy in GAgPSystemic antibiotics are indicated in aggressive periodontitis since the pathogenic bacteria like Aggregatibacter actinomycetem-comitans and Porphyromonas gingivalis have been found to be tissue invasive and mechanical therapy is insufficient to eliminate the bacteria from these sites [58, 59]. Regular recall appointments were given for maintenance therapy during which the treatment results were well maintained. These have been tried as adjuncts to mechanical therapy to inhibit the pathogenic bacteria in periodontal pockets [41–44]. Localized Aggressive Periodontitis (LAP) Generalized Aggressive Periodontitis (GAP) Localized Aggressive Periodontitis is an aggressive and rapidly-progressing condition that results in loss of tooth attachment and destruction of bone structure (alveolar bone) supporting teeth Extraoral examination revealed bilateral submandibular lymph node enlargement, which was firm, mobile, and nontender. Attachment loss, or loss of periodontal support to tooth, is marked in this category of people, Conditions causing hormonal imbalance in the body including puberty and menstruation, Certain diseases and disorders such as heart diseases and rheumatoid arthritis, Use of certain medications including those that are prescribed for heart and neurological conditions, Genetic susceptibility: Some individuals have a higher risk for gum disease due to their genetic make-up, HIV infection causing weak immune function makes one more at risk for gingivitis, Bruxism: A condition in which individuals tend to grind their teeth, When this plaque is left on the teeth for extended periods of time, it hardens, and bacteria in the mouth start to release toxins that damage the gums, Over time, as the plaque builds up, pockets form between the teeth and gums that lead to deeper infection of the gums, Eventually, this infection spreads to the ligaments and bone in the mouth causing degradation of these structures resulting in periodontitis, Aggregatibacter actinomycetemcomitans (seen specifically in GAP), Porphyromonas gingivalis (seen specifically in GAP), Absence of a contributory (underlying) systemic disease or condition to GAP, Destruction of periodontal structures is rapid (such as attachment loss and loss of bone), A positive family history or connection is identified - a higher genetic susceptibility is observed, Extensive gum and tissue destruction is disproportionate to the quantity of dental plaque present (implying lower amounts of bacteria can also cause severe damage), Presence of certain bacteria in higher levels, especially A. actinomycetemcomitans and P. gingivalis (in some cases), is noted, Cells that protect the body, called phagocytes, are impaired and show abnormal behavior, Abnormally functioning macrophages, which are a type of white blood cell. 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