AGGRESSIVE PERIODONTITIS

History
deep cementopathia parodontitis marginalis progressiva Periodontosis Juvenile periodontitis

Localised Aggressive Periodontitis

Age of onset: Puberty "localized first molar/incisor presentation with interproximal attachment loss on at least two permanent teeth, one of which is a first molar, and involving no more than two teeth other than first molars and incisors. lack of clinical inflammation despite the presence of deep periodontal pockets. Plaque is minimal, inconsistent with the amount of periodontal destruction present . forms a thin biofilm, rarely mineralizes

 elevated levels of Actinobacillus actinomycetemcomitans Causes for localized nature 1. Host immune response 2. Antagonistic bacteria 3. Loss of virulence 4. Cemental defects

C/F:
Rapid rate of periodontal destruction distolabial migration of the maxillary incisors increasing mobility of the first molars, Root sensitivity, deep, dull, radiating pain Periodontal abscesses Regional lymph node enlargement

R/F:
Vertical loss of alveolar bone around the first molars and incisors arc-shaped loss of alveolar bone

Generalized Aggressive Periodontitis

Age of onset: under 30 years "generalized interproximal attachment loss affecting at least three permanent teeth other than first molars and incisors Poor antibody response Amount of plaque inconsistent with extent of periodontal destruction Destruction appears to occur episodically P. gingivalis, A. actinomycetemcomitans, and Bacteriodes forsythus

C/F:
Period of Advanced Destruction Severe, acutely inflamed tissue, often proliferating, ulcerated, and fiery red Bleeding - spontaneously /with slight stimulation. Suppuration Attachment and bone are actively lost

Period of Quiescence pink, free of inflammation, stippling deep pockets bone level remains stationary

weight loss, mental depression, general malaise Systemic involvement.

R/F:
severe bone loss associated with the minimal number of teeth, advanced bone loss affecting the majority of teeth in the dentition

Risk Factors
Microbiologic A. actinomycetemcomitans primary pathogen Immunologic functional defects of polymorphonuclear leukocytes (PMNs), monocytes hyperresponsive monocytes

Genetic Autosomal dominant gene

TREATMENT OF AGGRESSIVE PERIODONTITIS

Localized Aggressive Periodontitis

1. Extraction uneventful healing ensues. 2. Standard periodontal therapy scaling and root planing, curettage, flap surgery with and without bone grafts, root amputations, hemisections, occlusal adjustment, strict plaque control, Frequent maintenance visits

3. Antibiotic therapy presence of A. actinomycetemcomitans in the tissues systemic tetracycline 250 mg, four times daily 1 week. Doxycycline 200 mg 1st day 100 mg, once daily 1 week Chlorhexidine rinses

Generalized Aggressive Periodontitis

Microbial Diagnostic and Susceptibility Tests i. culture analysis ii. microscopic assessment, iii. nucleic acid probe analysis, iv. Restriction endonuclease analysis, v. detection of bacterial antigens and enzymes vi. polymerase chain reaction.

Combination Therapy
metronidazole/amoxicillin (Augmentin) metronidazole/doxycycline metronidazole/ ciprofloxacin amoxicillin/doxycycline A. actinomycetemcomitansassociated periodontitis recurrent periodontitis microflora associated with enteric rods and pseudomonads A. actinomycetemcomitansand/or Porphyromonas gingivalis-associated periodontitis

Local Drug Delivery

a. b. c. d. Minocycline microspheres (Arrestin) Doxycycline gel (Atridox) Chlorhexidine chip (Periochip) Tetracycline Fibers (Actisite)

Host Modulation
a. Sub-antimicrobial dose drug E.g: Periostat (doxyxline hyclate, 20 mg) b. NSAIDs E.g: flurbiprofen, indomethacin, and naproxen

Restorative Treatment
Plan for future tooth loss. removable partial dentures

 monitor and observe the patient's overall physical status. Close collaboration between members of the treatment team, which includes i. the periodontist, ii. the general dentist, iii. the dental hygienist, and iv. the patient's physician frequent monitoring cycle