Regular SPT was found to be effective in maintaining clinical and microbiological improvements attained after active periodontal therapy in early onset periodontitis [90]. The procedure was performed every 3 days for the next 2 weeks. Diagnosis is made according to the criteria set by the American Academy of periodontology, 1999 classification of periodontal diseases and conditions [1], using history, clinical features, and radiographic features aided by microbial examination if needed. Bone grafting is indicated in vertical defects, and the success of the procedure depends on the type of defect. Systemically administered antibiotics with or without scaling and root planning and/or surgery provided greater clinical improvement in attachment level change compared to similar periodontal therapy without antibiotics [45]. Severe pain is rarely experienced by the patients except in situations where a periodontal abscess develops or a periodontal-endodontic infection occurs via accessory canals or tooth apex. Systemic diseases like hematologic disorders and some genetic disorders also show periodontitis as a manifestation mimicking generalized aggressive periodontitis which can be ruled out by assessing the systemic status, hematologic data analysis, and immunologic profiling of the patient. 5–10% of all cases are aggressive, rapidly-progressing forms (Ahrens & Bublitz 1987, Miller et al. Swierkot, K., Lottholz, P., Flores-de-Jacoby, L., & Mengel, R. (2012). Evaluation after 3 weeks showed complete absence of bleeding on probing, exudation, and significant reduction in probing pocket depth. The generalized form mostly affects the permanent dentition (Figure 1). The patient was advised to follow a modified Stillman technique of brushing since the patient had root exposure and hypersensitivity and also advised to use interdental brushes and dental floss for optimal plaque control. Beneficial effects of platelet-rich plasma (PRP) in the treatment of periodontal defects have been demonstrated by clinical and radiographic measurements together with reentry results showing marked improvements from baseline with increased stabilization of whole dentition including the hopeless teeth [88, 89]. Some patients may show systemic manifestations such as weight loss, mental depression and general malaise [16]. The periods of inactivity may remain for weeks to months or even years and will be followed by periods of active disease. The key to successful treatment is early diagnosis. Review articles are excluded from this waiver policy. Griffiths, G. S., Ayob, R., Guerrero, A., Nibali, L., Suvan, J., Moles, D. R., & Tonetti, M. S. (2011). The patient was a 22-year-old woman who presented with the chief complaint of gingival recession. 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 [100]. A combination systemic antibiotic therapy of amoxicillin and metronidazole [24] was initiated, and a desensitizing agent was prescribed. The patient was a nonsmoker, and there was no history of use of any other forms of tobacco. 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 [31]. 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)). Since the patient was concerned about the esthetic appearance of the anterior teeth, she was advised to undergo adult orthodontic therapy after 1 year of surgery under regular periodontal monitoring and was referred to an orthodontic specialist for the same. The criteria for selection of antibiotics are not clear in AgP; the choice depends on the case, disease-related factors and patient-related factors like compliance, allergies, and potential side effects. Results: According to the 1999 classification, most patients suffered from generalized severe chronic periodontitis (203/251) or generalized aggressive periodontitis (45/251). There was generalized bleeding on probing and recession in relation to most of the teeth, especially more in maxillary central incisors and mandibular anterior teeth. A vast array of treatment modalities is available which can be employed in the treatment of generalized aggressive periodontitis with varying success rates, but a definite guideline for the management is yet to be formulated. A diagnosis of generalized aggressive periodontitis was made according to the established criteria (American Academy of Periodontology, 1999). WBCs show impaired response and abnormalities in reacting to the disease-causing pathogens. The flap was reflected following which sulcular incision and interdental incision were made to remove the wedge of tissue. Perio Diagnosis - Generalized Aggressive Periodontitis Generalized Aggressive Periodontitis (GAP) is the interproximal attachment loss affecting three or more p This leads to two types of presentation at the time of examination. Approved by: Krish Tangella MD, MBA, FCAP. Successful management of the disease is challenging especially if diagnosed at advanced stages of the disease, but not impossible with the current therapeutic choices for the disease. Patients with aggressive periodontitis were younger and less often female or smokers. Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. Regular visits for dental health checkups and maintaining good oral hygiene, such as brushing and flossing after each meal, are generally recommended. A full-mouth periodontal charting revealed generalized periodontal pockets and clinical attachment loss (Figure 6). There was labial migration and flaring of upper and lower anterior teeth with an evident distolabial migration of 22. However, moderate to severe cases may require a dental sealant to level the surface of teeth and avoid further plaque buildup, Root surface debridement procedure - removal of food debris using abrasion, Administering systemic antibiotics: Medications, such as amoxicillin and metronidazole, may be recommended to combat any bacterial infection. Radiographs showed bone fill in the region where bone grafts alone or in conjunction with GTR were used (Figures 13(c) and 13(d)). A periodontal pack was placed, and antibiotics and analgesics were prescribed for the patient for 5 days. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. Gingival recession may be seen and patients may complain of food impaction due to loss of contact points between teeth. There were no associated complaints other than a cosmetic concern from the patient. 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]. Routine blood investigations were within normal limits. Assessment of family history towards establishing a diagnosis of GAP is important, X-rays of the jaw, head, and neck area can be taken to detect the extent of bony involvement, which is caused by the inflammation, An MRI scan or CT scan of the head and neck region can be used to detect the extent of damage to the jaw, head, and neck, Permanent and irreversible injury to the dental cavity and supporting structures, Increased susceptibility to other heart and lung related conditions, Formulating a cause-related treatment therapy, Stopping progression of the condition and maintaining the balance healthy teeth, Scaling and polishing: Oral cleansing treatment by the dental professional and removal of plaque may be necessary. Efficacy of amoxicillin and metronidazole combination for the management of generalized aggressive periodontitis. Supragingival scaling was performed, and the patient was educated in oral hygiene maintenance. (2008). In the periods of quiescence, patients are free of symptoms and the gingiva appears pink and healthy even though probing reveals deep periodontal pockets. Journal of clinical periodontology, 32(10), 1096-1107. Yek, E. C., Cintan, S., Topcuoglu, N., Kulekci, G., Issever, H., & Kantarci, A. 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. Grade II furcation involvement was present with molars and maxillary first premolars. Advanced stages of the untreated disease with severe periodontal destruction may show extrusion of teeth, mobility and pathologic migration, furcation involvement, generalized gingival recession, and loss of several teeth due to spontaneous exfoliation. Use of biologic mediators like growth factors (insulin-like growth factor (ILGF), platelet-derived growth factor (PDGF)) use of platelet-rich plasma which contains PDGF, extracellular matrix proteins like emdogain, etc. Eventually it can cause the teeth to become loose. 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 [101]. This stage may undergo spontaneous remission after a varying period of destruction and the inflammatory symptoms subside to reappear after a period of quiescence. 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. Thus, following treatment, regular and frequent review visits to the dental healthcare facility is strongly recommended, Also, following a good oral hygiene regimen after treatment is very important, In order to prevent periodontitis, gum disease needs to be treated in the early stages. Routine blood examination results were within normal limits. It often affects the entire periodontium of the dentition. This novel therapeutic approach of antimicrobial therapy seems promising and is getting attention recently either as a monotherapy or as an adjunct to SRP in the nonsurgical treatment of aggressive periodontitis. 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 [69]. This paper attempts to describe the clinical and radiographic diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of generalized aggressive periodontitis patients with case reports and a brief review. A postoperative radiograph 6 months later showed a significant bone fill in the molar regions where grafting was done with an increase in bone density of the alveolar crest with corticated bone formations in the crest at the other areas (Figure 8(g)). When the patient presents in this stage, the gingiva will show all signs of mild to severe inflammation. There is also a relatively fast progression of periodontal tissue loss. Periodontitis maintains its position as one of the most widespread diseases of mankind, but fortunately only ca. It is mostly observed in individuals with normal immune system, in the absence of any contributory (underlying) health conditions. Here we report a case of generalized aggressive periodontitis treated with periodontal therapy including adjunct antimicrobial therapy and periodontal surgery. A resective flap procedure like undisplaced flap [67] will eliminate the pockets as well but compromise the esthetics and function of the dentition by root exposure and resultant hypersensitivity and hence is not preferred usually when compared to modified Widman flap or sulcular incision flap. 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. Systemic antibiotics (Amoxycillin and Metronidazole, 250 mg of each thrice daily) were prescribed for 8 days, and the patient was recalled after 2 weeks for evaluation of the response to treatment [24]. Journal of periodontology, 81(7), 964-974. Disease-causing bacteria associated with aggressive periodontitis include a host of gram-negative bacteria such as: All the above pathogenic bacteria cause severe and destructive periodontal disease in the affected individuals. Therapy should start with attempts at controlling or eliminating the etiologic agents and modifiable risk factors for the disease. Based on studies of families and family members, individuals with aggressive periodontitis may have a family history of the condition (usually autosomal dominant inheritance pattern) and show a clustering of certain behaviors/disorders within the family (called familial aggregation). 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]. Adjunctive use of LDD agents like controlled release biodegradable chlorhexidine gluconate chip [61, 62], tetracycline fibers [63, 64], and minocycline-Hcl gel [65] has been tried in aggressive periodontitis with superior clinical outcomes. A case of generalized aggressive periodontitis is infection of the procedure was performed can cause the,... 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