DD 41

TAK RANUCH
NGET RATTANA
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 Content
Introduction
Classification
Genetic
Diagnosis
Treatment
Reference
Introduction
Periodontitis is the inflammation of the
periodontium which comprise of tissues
supporting the teeth in the oral cavity.
Early onset periodontitis was the previous
classification of aggressive periodontitis.
Anatomy of the
Periodontium
Classification of Aggressive
Periodontitis
Localized aggressive periodontitis (LAP)
Generalized aggressive periodontitis (GAP)
 Changes in junctional epithelium

Proliferates along the root surface (finger – like

projections)

Coronal portion Apical portion of

detaches form the junctional
root epithelium migrates

Due to bacterial
Replaced by pocket
enzymes and
epithelium
physical forces
exerted by them
Localized Aggressive
Periodontitis
First molar and/ or incisors
Low clinical inflammation
Poor inflammatory response
Mobility and migration of first molar and
incisors most common on the maxillary
(Diastema).
Neutrophils

Chemotatic
Factor

Matrix-
MetaloProteina
Macrophage
se

-Lysosomal
enzymes
-
collagenase
- PE2
Localized Aggressive
Periodontitis
Symptom of LAP
Root surface sensitivity
Deep dull radiating pain
Periodontal abscess formation
Regional lymph node enlargement.
Patient serum is be found Ig G2.
The high risks of LAP is seen mostly between
puberty and 20 year of age. (Female)
Localized Aggressive
Periodontitis
Aetiology of LAP
Plaque (primary): A. actinomycetemcomitans
(Aggregatibacter BDJ), P. gingivalis, P.
intermidia.
Diabetes
Trauma occlusion
Ig G2 type which is specific to antigens of
A. actinomycetemcomitans.
Generalized Aggressive
Periodontitis
Previously classified as Generalized Juvenile
periodontitis and Rapid Progressive periodontitits.
Characterized by generalized interproximal
attachment loss affecting at least 3 permanent teeth.
Highly inflammatory response
Highly bone and attachment loss
Generalized Aggressive
Periodontitis
Aetiology of GAP
Plaque: A. actinomycetemcomitans, P.
gingivalis, Baceroids forsuthus.
Invading bacteria: Capnocytophaga sputigena,
Mycoplasama sub-species and Spirochetes.
Generalized Aggressive
Periodontitis
Symptom:
Acute inflammation tissues
Spontaneous bleeding
Deep pocket
GAP affects persons between puberty and 35
year old.
Genetic Factors
 Many researchers have suggested that, a major
gene play a role in Aggressive periodontal
disease, which is transmitted by the autosomal
dominant mode of inheritance.
 Approximately 75% of LAP has dyfunctional
neutrophils. (Chemotatic )
 Complement component C5a
 Leukotriene B4
 40% deficiency in glycoprotein (GP110) on
neutrophil surface.
Diagnosis
Clinical diagnosis
X – ray
Test of mobility
Serological test (A. actinomycetecomitans)
Treatment
Remove plaque and calculus
Extraction
Oral hygiene
Scaling (mild)
Root planning (moderate)
Surgery (severe)
Medication
Tetracycline hydrochloride 250mg qid at least
a week
Doxycyline
Chlorhexidine rinse should be prescribed
Such case: Amoxicillin + Metronidazole
Reference
www.Scribd.com
www.Pubmed.com
Essential Clinical Periondontology and
Periodontologic (Shantipriya Reddy
2006)
Periodontology 10th edition (2008)