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Aggressive Periodontitis

Aggressive Periodontitis. DR. MAZOOD AHAMAD. AAP WORLD WORKSHOP IN CLINICAL PERIODONTITIS 1989. In 1999 International Classification workshop recognized 3 types of periodontitis. Chronic periodntitis Aggressive priodontitis Necrotizing form of periodontitis. INTRODUCTION.

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Aggressive Periodontitis

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  1. Aggressive Periodontitis DR. MAZOOD AHAMAD

  2. AAP WORLD WORKSHOP IN CLINICAL PERIODONTITIS 1989

  3. In 1999 International Classification workshop recognized 3 types of periodontitis • Chronic periodntitis • Aggressive priodontitis • Necrotizing form of periodontitis

  4. INTRODUCTION • Aggressive Periodontitis generally affects Systemically healthy individuals less than 30yrs old, although Patients may be older.

  5. Aggressive Periodontitis may be universally distinguished from chronic Periodontitis by • The age of onset, • The rapid rate of disease progression, • The nature and composition of the associated subgingivalmicroflora, ( ActinobacillusActinomycetemcomitans) • Alterations in the host's immune response, and • A familial aggregation of diseased individuals.

  6. DEFINITION • In 1971, Baer' defined it as "a disease of the periodontium occurring in an otherwise healthy adolescent which is characterized by a rapid loss of alveolar bone about more than one tooth of the permanent dentition.

  7. CLASSIFICATION • LOCALIZED AGGRESSIVE PERIODONTITIS (LAP) (LOCALIZED JUVENILE PERIODONTITIS ) • GENERELISED AGGRESSIVE PERIODONTITIS (GAP) (GENERELIZED JUVENILE PERIODONTITIS)

  8. classification

  9. Aggressive periodontitis describes three of the diseases formerly classified as early onset periodontitis. • LOCALIZED AGGRESSIVE PERIODONTITIS was formerly classified as localized juvenile periodontitis (LJP). • GENERALIZED AGGRESSIVE PERIODONTITIS encompasses the diseases previously classified as generalized juvenile periodontitis (GJP) and rapidly progressive periodontitis (RPP)

  10. Aggressive periodontitis describes three of the diseases formerly classified under “early onset periodontitis” • LOCALIZIED LOCALIZIED JUVENILE AGGRESSIVE PERIODONTITIS PERIODONTITIS • GENERALIZIED JUVENILE GENERALIZED • RAPIDLY PROGRESSIVE AGGRESSIVE PERIODONTITIS PERIODONTITIS

  11. Localized Aggressive Periodontitis • Localized aggressive periodontitis usually has an age of onset at around puberty. • Clinically, it is characterized as having "localized first molar/incisor presentation with interproximal attachment loss on at least two permanent teeth, one of which is a first molar, and involving no more than two teeth other than first molars and incisors"

  12. CLINICAL FEATURE • A striking feature is the lack of clinical inflammation despite the presence of deep periodontal pockets. • Amount ofplaque on the affected teeth is minimal • Deep dull radiating pain during mastication , probably because of irritation of the supporting structures by mobile teeth and impacted food.

  13. Rate of bone loss is about three to four times faster than in chronic periodontitis. • Increased mobility of the maxillary and mandibular incisors and first molars . • Sensitivity of denuded root surfaces to thermal & tactile stimuli • Distolabial migration of the maxillary incisors with diastemaformation.

  14. Increased levels of Aaa and p. gingivalis • Periodontal abscesses may form at this stage, and • Regional lymph node enlargement may occur.

  15. RADIOGRAPHIC FINDINGS • Vertical loss of alveolar bone around first molars and incisors • Arc. Shaped loss of alveolar bone which extends from the distal surfaces of the 2nd premolar to the mesial surface of the 2nd molar

  16. Why the lesion are localized ? 1. Incisor and molars are the first teeth to erupt in the oral cavity thus A.A. colonizes them later host response limit their further colonization at different site. 2. Bacteria antagonistic to A. actinomycetemcomitansmay colonize the periodontal tissues and inhibit A. actinomycetemcomitansfrom further colonization of periodontal sites in the mouth.

  17. 3. A.actinomycetemcomitans may lose its leukotoxin producing ability for unknown reasons." If this happens,the progression of the disease may become arrested or retarded and colonization of new periodontal sites averted. • 4. Cemental defects present in root surface are responsible for localized destruction.

  18. GENERELIZED AGGRESSIVE PERIODONTITIS • Generalized aggressive periodontitis usually affects individuals under the age of 30, but older patients also may be affected. • Evidence suggests that individuals affected with generalized aggressive periodontitis produce a poor antibody response to the pathogens present.

  19. is characterized by "generalized interproximal attachment loss affecting at least three permanent teeth other than first molars and incisors". • Patients with generalized aggressive periodontitis often have small amounts of bacterial plaque associated with the affected teeth .

  20. P. gingivalis, A.actinomycetemcomitans,and Bacteriodes forsythus frequently are detected in the plaque that is present. • The destruction appears to occur episodically with periods of advanced destruction followed by stages of quiescence of variable length.

  21. Radiographic findings • Radiographic pictures ranges from severe bone loss associated with normal number of teeth , to advanced bone loss affecting the majority of teeth in the dentition

  22. RISK FACTORS FOR AGGRESSIVE PERIODONTITIS • 1) MICROBIOLOGIC FACTORS: A. ACTINOMYCETEMCOMITANS has been implicated as the primary pathogen associated with this disease. • (1) A. actinomycetemcomitans is found in high frequency (app. 90%) in lesions, • (2) sites with evidence of disease progression often show elevated levels of A. actinomycetemcomitans,

  23. (3) Elevated serum antibody titers to A. a in patient with LaP • (4) Strong correlation between reduction in the subgingival load of A. a during treatment and a successful clinical response • (5) A. actinomycetemcomitans produces a number of virulence factors that may contribute to the disease process .

  24. 2) IMMUNOLOGIC FACTORS : • Some immune defects have been implicated in the pathogenesis of aggressive periodontitis. • Patients with aggressive periodontitis display functional defects of polynorphonucler leukocyle , monocyte or both . • The human leukocyte antigens (HLA), which regulate immune responses have been evaluated as candidate markers for aggressive periodontitis . HLA-A9 and B15 antigens are consistently associated with aggressive periodontitis

  25. 3) GENETIC FACTORS • Results from several studies support the concept that all individuals are not equally susceptible to aggressive periodontitis. • Familial pattern of alveolar bone loss • Specific genes have not been identified that are responsible for these diseases

  26. 4)ENVIRONMENTAL FACTORS :- • Smoking is an important factor that influence the periodontal destruction. • Patients with generalized aggressive periodontitis who smoke have more affected teeth and more loss of clinical attachment than nonsmoking patients with generalized aggressive periodontitis.

  27. THANK YOU

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