Aggressive Periodontitis - A Comprehensive Treatment Approach

Case Report

Austin J Dent. 2017; 4(3): 1075.

Aggressive Periodontitis - A Comprehensive Treatment Approach

Bapure S¹*, Triveni MG², Mehta DS², Vinod V³ and Khyati C²

¹Department of Periodontology & Implantology, College of Dental Science, India

²Department of Periodontics, Bapuji Dental College & Hospital, India

³Department of Prosthodontics and Implantology, College of Dental Science, India

*Corresponding author: Sunil Bapure, Department of Periodontology & Implantology, College of Dental Science, Amargadh-364210, Gujarat State, India

Received: March 09, 2017; Accepted: April 19, 2017; Published: May 10, 2017


Destructive periodontal disease affecting the connective tissue attachment & alveolar bone supporting the teeth have long been considered the principal cause for tooth loss. Aggressive periodontitis is a multifactorial disease consisting of a heterogenous group of infectious disease characterized by the complex host microbial interaction in the periodontium. Genetic, immunologic and environmental/behavioral risk factors are also involved. Aggressive periodontitis (AgP), as the name implies, is a type of periodontitis, where there is rapid destruction of periodontal ligament and alveolar bone which occurs in otherwise systemically healthy individuals generally of a younger age group, but patients may be older. Pathogenic bacteria in the dental plaque, especially Aggregatibacter Actinomycetemcomitans (AA) and Porphyromonas Gingival is having an indispensable role in the etiopathogenetic of an aggravated host response. A long-term stability of periodontal health can be achieved following comprehensive non-surgical, surgical periodontal therapy and systemic antimicrobial therapy.

The present report describes a case of Aggressive periodontitis treated successfully through a comprehensive dental approach.

Keywords: Aggressive periodontitis; Aggregatibacter actinomycetemcomitans; Comprehensive; Multifactorial


AgP: Aggressive Periodontitis; GagP: Generalized Aggressive Periodontitis; AA: Aggregatibacter Actinomycetemcomitans


Aggressive Periodontitis (AgP) is usually presented in early phase of life implies that etiologic agents have been capable of causing clinically detectable levels of disease over a relatively short time. The existence of specific forms of AgP has also been recognized based on specific clinical and laboratory features. Generalized Aggressive Periodontitis (GAgP) being one among its form is characterized by “generalized interproximal attachment loss affecting at least three permanent teeth other than the first molars and incisors” rapid attachment loss, bone destruction and familial aggregation [1].

According to Lang, et al. 1999; Tonetti & Mombelli 1999; the distinguishing features of GAgP include predilection for people under 30 years of age, but patients may be older, generalized inter proximal attachment loss affecting at least 3 permanent teeth other than the first molars and incisors, attachment loss occurring in pronounced episodic periods of destruction. The disease is frequently associated with the presence of periodontal pathogens, neutrophil function abnormalities, genetic factors including a poor serum antibody response to infecting agents and environmental/behavioral risk factors [2,3].

According to Shah, 1993 GAgP has been frequently associated with the detection of Porphyromonas gingivalis, Bacteroides forsythus and Aggregatibacter Actinomycetemcomitans, contrast to Aggregatibacter Actinomycetemcomitans, which is facultatively anaerobic, P. gingivalis and B. forsythus are fastidious strict anaerobes. P. gingivalis is known to produce potent enzymes and a relationship between the clinical outcome of therapy and bacterial counts has also been documented for P. gingivalis with non-responding lesions often containing this organism in elevated proportions.

Case Presentation

A 27-year-old Caucasian female patient reported to the Department of Periodontology, Bapuji Dental College & Hospital, Davangere with the chief complaint of bleeding gums since four to five months. On eliciting the familial history, it was revealed that the patient’s elder sister had similar complaint and was treated for the same. On intra-oral examination, an edentulous upper anterior region revealed clinically missing teeth that included 14, 13, 12, 11, 21, 22, 23, 24 (Figure 1) which were extracted previously due to increased mobility as told by the patient and periodontal condition illustrating severe generalized horizontal bone loss as revealed in the previous OPG (Figure 2). The preliminary examination of dentulous sites revealed, generalized enlarged reddish pink gingiva with thickened and rolled margins. The consistency of the gingiva was firm and nodular. Generalized deep probing pocket depths (PD) of 5-6 mm in the maxillary and 8-9 m min the mandibular arches, with 60% sulcus bleeding index (SBI) was recorded. Suppuration was noted. The patient was systemically healthy and was not under any medications. The blood investigations were in the normal range and based on the clinical and laboratory findings ruling out Trauma from Occlusion, a provisional diagnosis of generalized aggressive periodontitis was made (Chart 1).