Abstract Background: Aggressive periodontitis (AgP) is one of the most severe forms of periodontal diseases. Proximal contacts were lost between the teeth 14 and 13, 13 and 12, 21 and 22 and 22 and 23, 22 and 24 and between lower anterior 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 [60]. In addition, the defect at site 33 was treated with guided tissue regeneration (GTR) with bioresorbable collagen membrane in conjunction with synthetic bone graft (HAP) (Figures 12(a)–12(f)). 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. A sulcus brushing technique (modified Bass technique) [23] was demonstrated, and the patient was educated on the use of interdental cleansing aids including dental floss and interdental brushes. 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. Even though the prevalence of aggressive periodontitis is much lower than chronic periodontitis, the management of aggressive periodontitis is more challenging compared to that of chronic periodontitis because of its strong genetic predisposition as an unmodifiable risk factor. GTR has shown to have a greater effect on probing measures of periodontal treatment than open flap debridement alone, including improved attachment gain, reduced pocket depth, less increase in gingival recession, and more gain in hard tissue probing at reentry surgery [83]. World Workshop in Key words: Periodontitis, periodontia. With the current treatment modalities, successful long-term maintenance of the dentition in a healthy and functional state can be achieved. Full complement of teeth was present. Associations between serum antibody levels to periodontal pathogens and early-onset periodontitis. EBV-1 was detected in one periodontally healthy subject. 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 [69]. Application of enamel matrix proteins alone [86] or in combination with bone grafts including bioactive glass has shown to result in the successful treatment of intrabony defects in aggressive periodontitis [87]. Gingival margins were rounded, and exudation was present in relation to labial aspects of mandibular anterior teeth and maxillary central incisors. Therapy should start with attempts at controlling or eliminating the etiologic agents and modifiable risk factors for the disease. Periodontal evaluations are scheduled concomitantly with orthodontic appointments to monitor the periodontal stability as the tooth movement occurs. Aggressive periodontitis, Anaerobic bacteria, Chronic periodontitis, PCR, Red complex group, Sub-gingival plaque Introduction Periodontitis is a progressive disease which is widely regarded as the second most common disease worldwide after dental decay. Eventually, tooth loss can occur. The bacteria responsible for periodontitis can enter your bloodstream through gum tissue, possibly affecting other parts of your body. In its early stage, called gingivitis, the gums become swollen, red, and may bleed. 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]. The host response of the patient or the susceptible individual to pathogenic bacteria in the dental plaque plays a vital role in the pathogenesis and expression of the disease, and this host response is genetically determined and is an unmodifiable risk factor is at present by the current treatment measures [26]. There was no loss of stippling in the anterior regions. Tooth 46 was extracted due to caries and 41 was extracted due to mobility. View at: Google Scholar See in References , 2 1. Some of the complications that may arise from the condition include tooth loss, heart disease, stroke, and worsening of diabetes and respiratory conditions. In addition, there are rare reports of certain conditions like intraosseous sarcoidosis [19], eosinophilic granuloma [20, 21] and alveolar bone actinomycosis [22], presenting with extensive alveolar bone destruction like in aggressive periodontitis which can be differentiated by biopsy of the suspected lesions. Tooth 26 was grossly decayed with just root stump present. 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. 18. Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) is a Gram-negative, facultative anaerobe, nonmotile bacterium that is often found in association with localized aggressive periodontitis, a severe infection of the periodontium.It is also suspected to be involved in chronic periodontitis. 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. Gum inflammation associated with aggressive periodontitis can be severe. A sulcular incision flap or papilla preservation flap will be the ideal technique to minimize recession in the anterior regions due to esthetic reasons, and modified Widman flap or conventional/sulcular incision flap will be the technique of choice in the posterior regions when opting for bone grafting and another regenerative therapy. Early stages of the disease with mild to moderate periodontal and bone destruction may be managed entirely by nonsurgical therapy with systemic antibiotics as an adjuvant to mechanical therapy. In order to maintain the optimal results got by surgery and to prevent the recurrence of the disease, a lifelong maintenance therapy is mandatory because of the strong genetic susceptibility of the individual to the disease. Furthermore the response to periodontal therapy, both nonsurgical and surgical, regenerative therapy, and implant therapy is less than in nonsmokers, but former smokers respond similar to nonsmokers. Prevalence of periodontopathic bacteria in aggressive periodontitis patients in a Japanese population. This study aimed to characterize the microbial community and metabolic profiles in generalized aggressive periodontitis (AgP) using 16S ribosomal RNA (rRNA) gene high-throughput sequencing and gas chromatography-mass spectrometry (GC-MS). Postoperative clinical evaluation showed excellent gingival condition with reduction in probing depths to normal levels (Figures 13(a) and 13(b)). The most commonly used among alloplastic graft materials is hydroxyapatite (HAP) which is osteoconductive and has shown to have similar clinical effect to FDBA [79]. Unlike chronic periodontitis, aggressive periodontitis has been associated with the specific bacteria, namely Aggregatibacter actinomycetemcomitans and Porphymonas gingivalis. Family history of similar complaints or early tooth loss could not be elicited. 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 [49].Single-agent therapy with Doxycycline [53, 55], azithromycin [56], metronidazole [53, 57], and clindamycin [57] is effective when used adjunctively to nonsurgical procedure of SRP in AgP patients. The most common reported complaints are a recently noticed flaring and progressing spacing of anterior teeth and bleeding from gums comparatively in a young patient but patients can be older as well (Figures 1(a)–1(c)). The procedure was performed every 3 days for the next 2 weeks. 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 [44]. Several local anti-infective agents combined with SRP appear to provide additional benefits in PD reduction and CAL gain compared to SRP alone. Aggressive periodontal disease is a very destructive form of periodontal disease. The patient was systemically healthy, and medical history did not reveal any relevant findings. However, both modalities have been found to be efficacious with significant improvement in clinical parameters, and the clinician should select the treatment modality based on the practical considerations related to the patient preference and clinical workload [37]. Extraoral examination revealed bilateral submandibular lymph node enlargement, which was firm, mobile, and nontender. 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. With no relevant medical history did not reveal any relevant findings the hand... M. Quirynen, C. M. L. Bollen, J the infection pockets associated with this disease alveolar loss. 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