A actinomycetemcomitans secretes some factors such as endotoxin, collagenase and leukotoxin to facilitate the colonization of bacteria in the periodontal pocket and cause destruction of periodontal tissues. Available from: Localized aggressive periodontitis (LAgP), Generalized aggressive periodontitis (GAgP), Faculty of Dentistry, Department of Periodontology, Pamukkale University, Denizli, Turkey. The disease is most commonly seen in African-Caribbean (80%) and least Norwegian (0.2%) [20]. However, after 6 months despite frequent visits to the physician and strengthening oral hygiene, relapses and disease progression have been reported [88]. Elevated fibrinogen levels can activate the inflammatory cascades. IL1B + 3954 (+3953) C → T gene polymorphisms and carriage rate of the rare (R) allele in Caucasians found associated with AgP in a study [65]. This is suggested to be protective against wider spread periodontal breakdown. In some studies AgP was found to be more common in women than men with 3: 1 ratio [22, 23, 24, 25]. In general, the least amount of work on this issue and it is not long to observe the final results. Twenty-five periodontal lesions in seven patients with LAgP divided into three treatment groups: SRP; SRP plus soft tissue curettage; SRP plus modified Widman flap surgery. freeze-dried bone allograft), xenografts (bovine or corral derived) and alloplastic materials (e.g. specific periodontal microbial pathogens. In the form of LAgP there is little or no inflammation of the gums [5, 6]. Twenty randomly selected patients were given 500 mg metronidazole and 500 mg amoxicillin three times a day for 1 week in addition to mechanical treatment, and the remaining 21 patients were given placebo in addition to mechanical treatment. Aggressive periodontitis: A review Vaibhavi Joshipura 1, Umesh Yadalam 1, Bhavya Brahmavar 2 1 Department of Periodontics, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Cholanagar, Bangalore, India 2 Department of Periodontics, Mathikeri Sampige Ramaiah College of Dental Sciences and Hospital, Affiliated to Rajiv Gandhi Health University, Bengaluru, Karnataka, India [79] and Park et al. Aysan Lektemur Alpan (November 5th 2018). The combination of 250 mg of metronidazole and 375 mg of amoxicillin, three times a day for 7 days, as an adjunct to SRP, was found to be very effective in suppressing subgingival A. actinomycetemcomitans load [96]. These intra-oral appliances should also be well-designed and fitting. 0 explanations. The use of azithromycin in recent years has become an issue in AgP treatment. Aggressive periodontitis is a low-prevalence, multifactorial disease, of rapid progression and with no systemic compromise. As the overall treatment concepts and goals for AgP are not significantly different from that of chronic periodontitis, the different treatment phases (cause related therapy; re-examination for response to therapy; definitive therapy; and maintenance) are similar for both types of periodontitis. Environmental factors such as oral hygiene/bacterial plaque, smoking, stress and systemic factors may exacerbate the inflammation and play an important role in the periodontitis progression. In generalized aggressive periodontitis, radiographs may show generalized bone destruction ranging from mild crestal bone resorption to severe extensive alveolar bone destruction depending on the severity of the disease. Human leukocyte antigens (HLA) are antigens that regulate the immune response. Two and six months re-evaluations were made. [84] investigated metronidazole + amoxicillin, doxycycline, metronidazole efficacy in 43 GAgP patient clinically and microbiologically. Studies have shown that there is a positive correlation between AgP and stress [60]. Figure 23-1 Clinical features of generalized chronic periodontitis in a 49-year-old, medically healthy, male patient. [115] treated patients with GAgP with a total of 12 intrabony defects with the combination of platelet rich plasma +bovine derived xenograft combination. HLA class II antigens are capable bind peptides derived from bacterial antigens and present them to T cells while HLA class I antigens generally present peptides derived from viruses and self-antigens to cytotoxic T cells. Unfortunately, second surgery for removal or membrane exposure take place among its disadvantages. Smoking is a major risk factor for periodontal disease and it further adds to the susceptibility for severe aggressive disease. The severity of periodontal tissue destruction is out of proportion to amount of bacteria present . It can be localized or generalized. 1 and 2) and a generalized form (figs. Radiographs should be taken separately from each tooth or area affected by the disease once a year. Only registered users can add explanations . We are IntechOpen, the world's leading publisher of Open Access books. In a study performed in population of Chilean patients with GAgP and CP, P. gingivalis, P. micra and C. rectus isolated from subgingival plaque and found to be related to disease progression [36]. Some researchers suggested monthly checks during the first 6 months after the treatment finished. They suggest the PMNL is not hypofunctional or deficient, but it is hyperfunctional and excessed activity is responsible of the tissue damage. [102] concluded that additional applied local (tetracycline fibers) and systemic (500 mg amoxicillin/clavulanic acid) antibiotics showed equally benefits in terms of clinical parameters. Common features generally present are: Patients are healthy except for periodontitis compared local chlorhexidine chip and ministration and systemic amoxicillin plus metronidazole combination in addition to SRP on clinical parameters in GAgP patients. It is important to treat and obtain frequent controls of individuals with AgP. A. actinomycetemcomitans affects the host response in many ways after colonization in first molars and incisors: A actinomycetemcomitans secretes a factor that inhibits Polymorphonuclear leukocytes (PMNL) chemotaxis. Surgical and non-surgical techniques can be applied in the treatment of AgP. These features are common for both localized and generalized form of disease. Lindhe and Liljenberg [105] treated 16 patients with modified Widman flAgP surgery plus tetracycline (14 days). Publishing on IntechOpen allows authors to earn citations and find new collaborators, meaning more people see your work not only from your own field of study, but from other related fields too. With aggressive periodontitis, as compared with the more common variant chronic periodontitis, the loss of attachment progresses significantly faster. In addition to this mild appearance there may be deep pockets upon probing. The disease can progress so quickly that the aggressive nature, radiographs taken at different times, bone loss is easily recognizable [8]. HeadquartersIntechOpen Limited5 Princes Gate Court,London, SW7 2QJ,UNITED KINGDOM. Dark red and ulcerated areas are characterized by severe acute inflammatory disease table is detected during the active phase. Many studies have shown that genetic factors contribute to the pathogenesis of this disease. Rapid attachment loss and bone destruction. This group of diseases includes; neutropenia, hypophosphatasia, leukemias, Cheidak-Higashi syndrome, leukocyte adhesion deficiency, Papillon-Lefevre syndrome, trisomy 21, histiocytosis and agranulocytosis [1]. The defects may be a combination of vertical and horizontal defects (Figures 4(a) and 4(b)). Each graft material showed a decrease in defect and pocket depth although no significant differences between the different grafting materials were found in terms of hard-tissue or soft-tissue changes. Colonize the periodontal tissues and prevent the colonization of A. actinomycetemcomitans in other areas of the mouth. The tetracycline group is considered first in systemic treatment. The main purpose of the treatment is to create a clinical condition that can hold the largest number of teeth in the mouth. [50] LAgP has been associated with various abnormalities of host cell function such as; neutrophil abnormalities, reduced chemotaxis, increased superoxide production, reduced receptor expression, reduced phagocytosis and killing of A. Actinomycetemcomitans, impaired leukotriene B4 and signal transduction abnormalities. Aggressive periodontitis has all of the following features EXCEPT radiographic evidence of bone loss rapid attachment loss ulcerations of the gingiva suspected periodontal microbial pathogens. Some of the bacteria found in periodontal pockets related to gingivitis, while some are related to periodontitis. During the disease bone loss in the first molar region is symmetric [9]. Mechanical treatment involves removal of plaque and its products from dental surfaces (supra/subgingival), as well as dental and other plaque-retaining local agents by hand or ultrasonic instruments. [17] found a high prevalence of AgP as 7.6% in Moroccan children aged 14–19 years. This could involve an open flap debridement with or without regenerative procedures, with the aim of gaining access and visibility to root and furcation areas so that a thorough instrumentation and debridement can be carried out. Red complex bacteria named P. gingivalis, T. forsythia and Treponema denticola (T. denticola) were associated with periodontal tissue destruction [31]. Prior to starting periodontal treatment, any overhanging or poorly contoured restorations should be modified or replaced. In line with this concept, it has been shown from the initial research attempts on early-onset periodontitis forms that affected individuals, suffer from metabolic imbalance or hereditary host response defects. Root planning are also included. By Ana-Maria Seciu, Oana Craciunescu and Otilia Zarnescu. AgP is a disease that shows significant differences from other periodontal diseases in terms of severity of destruction, rate of progression, response to treatment, etiologic factors and genetic susceptibility criteria. IL-23 is a pro-inflammatory cytokine and found positively correlated with CP but existing studies how that there is no significant association of IL-23 polymorphisms with AgP [75]. It is highly effective on periodontopathogenic bacteria such as P. gingivalis and P. intermedia which in the “red complex” [95]. CONCLUSION Aggressive periodontitis is the multifactorial, severe, & rapidly progressive form of periodontitis, which primarily but not exclusively affects younger patients where the amount of destruction manifested is not commensurate with the amount of local irritants. The hypoplasia or aplastic cement formation was seen in the examinations performed on teeth withdrawn from patients with LAgP. To date our community has made over 100 million downloads. Brief introduction to this section that descibes Open Access especially from an IntechOpen perspective, Want to get in touch? No significant differences found in term of 40 bacteria species in Generalized CP and GAgP [40]. Histopathological features of chronic and aggressive periodontitis. Hyper-responsive macrophage phenotype including elevated prostaglandin E2 and interleukin-1β levels took place among the features of AgP in the 1999 Workshop [49]. A. actinomycetemcomitans, short (0.4–1 μm), facultative anaerobic, immobile, Gram(−) rod. LAgP starts at a much earlier age than CP, but it is not right to go to a certain age limit. Various studies have associated Aggregatibacter actinomycetemcomitans, formerly known as Actinobacillus actinomycetemcomitans, with aggressive periodontitis. Secondary features that are often, but not always, present include the following: The amounts of microbial deposits are inconsistent with the severity of periodontal tissue destruction. Aggressive periodontitis can be differentiated from chronic periodontitis based on the primary and second­ ary features as described above, including the criteria for the classification of localised and generalised disease (Albandar, 2014). [8], Capnocytophaga spp are implicated as prime periodontal pathogens, especially in localised aggressive periodontitis. Patients also had increased antibody response against A. Actinomycetemcomitans, Prevotella intermedia (P. intermedia) and Campylobacter rectus (C. rectus) [14]. By making research easy to access, and puts the academic needs of the researchers before the business interests of publishers. [7] Fives Taylor et al. After 12 weeks, either of these antimicrobial agents provide significant additional improvement of the clinical parameters [100]. After the treatment performed and provided the health of periodontal tissues, patient should be included in the maintenance program. The objective of treatment is to create a conducive clinical condition for retaining as many teeth, for as long as possible.[40]. It is known that A. actinomycetemcomitans has virulence factors that can play a role in the development of the disease such as leukotoxin. Facebook. AgP classified into two categories named localized and generalized aggressive periodontitis. First group was received SRP plus 500 mg metronidazole +500 mg amoxicillin three times a day for 1 week, second group was received 200 mg for the first day loading, 100 mg doxycycline for the following 14 days, third group was received 500 mg metronidazole three times a day for 1 week, and the fourth group was evaluated as the control group. The prognosis of teeth that affected AgP depends on many factors such as the amount of missing bone, the presence or absence of furcation region, the morphology of bone defects, the degree of mobility, crown/root ratio, occlusal contacts, oral hygiene and general health. IL-17 plays an important role in natural and acquired immune response; there is a study in mice demonstrating that IL-17 receptor trigger bone loss in infectious conditions [73]. Given the high susceptibility for disease progression of the individual with AgP, there is a higher risk of disease recurrence. In areas where periodontal tissue destruction occurs in aggressive periodontitis patients, 90% of A. actinomycetemcomitans are found. Genetic variations may affect the host response to the disease. In a similar study Purucker et al. In studies involving IL-4 which have anti-inflammatory properties, no association was found between AgP and genotype encoding this cytokine [69]. Since tooth loss is frequently seen in AgP patients, dental implant applications can be applied. Greater numbers of both Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were found in active, destructive periodontal lesions in comparison to non-active sites. Facebook. It is characterized by rapid bone loss in the first molar and incisors [7]. It is also important to perform microbial testing at every control session whenever possible. The amount of bacteria is often indicated by the level of dental plaque. The outcome of rapid and severe alveolar bone loss; gingival recession, pathological migration of teeth, mobility and eventual loss of teeth occur. Aggressive periodontitis The practitioner should be aware that a small proportion of adolescents may suffer from aggressive periodontitis. Most studies show comparable disease prevalence in both male and female patients. Complex pathogens are involved in the etiology of AgP. [12] Patients with localised aggressive periodontitis have large amount of Aggregatibacter actinomycetemcomitans specific IgG2. The treatment of these patients is quite challenging, due to the absence of a standard treatment protocol for this disease which its etiology is not fully understood, but also because of the rapid progression, severe periodontal tissue loss and recurrence of the disease. Demmer RT, Papapanou PN. Chandy et al. A. actinomycetemcomitans, P. gingivalis, and C. rectus were higher in GAgP than in healthy controls. As well as Aggregatibacter actinomycetemcomitans being associated with this, the synergism of the disease also accounts for both Capnocytophaga spp and Porphyromonas gingivalis.[5]. Thus, differences in neutrophil functions in AgP are thought to be a combination of genetic and acquired properties of person [51]. Frequent follow-ups should not be neglected in these patients. Gender factor and its role in development of AgP have not become clear. This severe destruction can affect only a few teeth as well as the majority of the teeth in the mouth. Aggressive periodontitis (AgP) is a disease characterized by rapid loss of periodontal tissues affecting systemically healthy individuals during adolescence and adulthood, and forms a group of periodontal diseases [1]. Studies have shown that the total supragingival and subgingival plaque mass is reduced by mechanical treatment. Twitter. High serum antibody levels against A. actinomycetemcomitans were observed in the majority of locally aggressive periodontitis patients. It usually affects young people, but it can appear at any age, although this is less frequent(3,4). Because of the clinical results, AgP patients suffer social problems due to esthetic, phonetic and nutritional problems and their quality of life diminishes. [15][16], Patients do not have any underlying systemic disease that would contribute to aggressive periodontitis. 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