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• • • • deep cementopathia parodontitis marginalis progressiva Periodontosis Juvenile periodontitis

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

Antagonistic bacteria 3.• elevated levels of Actinobacillus actinomycetemcomitans • Causes for localized nature 1. Host immune response 2. 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. deep. Root sensitivity. 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. A. gingivalis. actinomycetemcomitans. and Bacteriodes forsythus .

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

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

. general malaise Systemic involvement. mental depression.• • • • weight loss.

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

monocytes • hyperresponsive monocytes Genetic • Autosomal dominant gene .Risk Factors Microbiologic • A. actinomycetemcomitans – primary pathogen Immunologic • functional defects of polymorphonuclear leukocytes (PMNs).


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

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

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


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

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

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

• removable partial dentures .Restorative Treatment • Plan for future tooth loss.

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