026.aggressive periodontitis
13
Dr Jaffar Raza Syed Page 1 Aggressive Periodontitis “characterized by the rapid loss of attachment and bone loss occurring in an otherwise clinically healthy patient with the amount of microbial deposits inconsistent with disease severity and familial aggregation of diseased individuals formerly classified as early onset periodontitis” localized juvenile periodontitis (LJP) has been changed to localized aggressive periodontitis (LAP) generalized aggressive periodontitis was previously classified as generalized juvenile periodontitis (GJP) and rapidly progressive periodontitis (RPP).
-
Upload
jaffar-syed -
Category
Health & Medicine
-
view
86 -
download
3
Transcript of 026.aggressive periodontitis
Dr Jaffar Raza Syed Page 1
Aggressive Periodontitis “characterized by the rapid loss of attachment and bone loss occurring in an otherwise
clinically healthy patient with the amount of microbial deposits inconsistent with
disease severity and familial aggregation of diseased individuals formerly classified as
early onset periodontitis”
localized juvenile periodontitis (LJP) has been changed to localized aggressive
periodontitis (LAP)
generalized aggressive periodontitis was previously classified as generalized juvenile
periodontitis (GJP) and rapidly progressive periodontitis (RPP).
Dr Jaffar Raza Syed Page 2
Clinical Features of LAP: Age and Sex Distribution
between puberty and 20 years of age
both sexes but predilection to female patients. Distribution of Lesions Three areas of localization of bone loss have been described:
1. First molar and/or incisors.
2. First molar and/or incisors + additional teeth (not exceeding 14 teeth).
3. Generalized involvement
Dr Jaffar Raza Syed Page 3
Clinical Findings
most striking feature is lack of clinical inflammation despite the presence of deep periodontal pockets
mobility and migration of first molars and incisors
other symptoms like root surface sensitivity, deep dull radiating pain, periodontal abscess formation and regional lymph node enlargement may occur Radiographic Findings
Arc-shaped loss of alveolar bone extending from distal surface of 2nd premolar to mesial surface of 2nd molar.
Frequently, bilaterally symmetrical patterns of bone loss occurs, called as “mirror image pattern”
Dr Jaffar Raza Syed
Page 4
Dr Jaffar Raza Syed
Page 5
Dr Jaffar Raza Syed Page 6
Pathogenesis
Specific microbiology of subgingival plaque,
A. actinomycetemcomitans,
Capnocytophaga sputigena
others
defects in cementum,
hereditary factors,
impaired PMNs function
disorders of the immune system.
Dr Jaffar Raza Syed
Virulence factors associated with
associated with A. actinomycetemcomitans are
Page 7
Dr Jaffar Raza Syed Page 8
Treatment
Extraction of involved teeth
Transplantation of developing third molars into the sockets of previously extracted 1st molars
Standard periodontal therapy: Includes
scaling, root planing,
curettage,
flap surgery with/without bone grafts,
root amputation,
hemisection,
occlusal adjustment and strict plaque control has been tried
Dr Jaffar Raza Syed Page 9
Antibiotic therapy
scaling and root planing and tetracycline 250 mg qid for 14 days every 8 weeks.
excellent bone fill noted in cases of LAP treated with tetracycline, flap surgery and placement of grafts
Doxycycline 100 mg/day may also be used.
Chlorhexidine rinses should be prescribed.
In refractory cases,
tetracycline resistant Actinobacillus species have been suspected. In such cases, a combination of amoxicillin and metronidazole has
Been suggested
Dr Jaffar Raza Syed Page 10
GENERALIZED AGGRESSIVE PERIODONTITIS “characterized by generalized interproximal attachment loss affecting atleast three permanent teeth other than first molars and incisors” most pathogenic organisms may be associated, e.g.
Porphyromonas gingivalis,
A. actinomycetemcomitans,
Bacteroids forsythus
Dr Jaffar Raza Syed Page 11
Clinical Characteristics Age and sex distribution:
It affects persons between puberty and 35 years (but may be older).
No sex discrimination is seen. Distribution of lesion:
No specific pattern is observed,
all or most of the teeth are affected.
Some of the patients may have systemic manifestations such as
weight loss,
mental depression and
general malaise.
Dr Jaffar Raza Syed
Page 12
Dr Jaffar Raza Syed Page 13
Treatment of Aggressive Periodontitis
full mouth disinfection which has been proposed by Quirynen et al. Since it was observed that A. a has the ability to translocate from one person to another and from site to site, full mouth disinfection was implemented.
It includes the following steps:
Full mouth scaling and root planing (in 2 sessions within 24 hours).
Brushing the dorsum of the tongue with an antimicrobial agent (1% chlorhexidine gel) for one minute.
Mouthrinsing with antimicrobial agents.
Home irrigation systems. Other Treatment Options • Local drug delivery system. • Host modulation therapy
