28. 0000002103 00000 n Surgical and non-surgical techniques are applied in the treatment of AgP [84]. xref When using such systems, cost-benefit and efficiency should be considered well. Implantate bei Patienten mit aggressiver Parodontitis. After 12 weeks, either of these antimicrobial agents provide significant additional improvement of the clinical parameters [100]. Patients also had increased antibody response against A. Actinomycetemcomitans, Prevotella intermedia (P. intermedia) and Campylobacter rectus (C. rectus) [14]. 24. 104 0 obj <>stream Aggressive periodontitis, an uncommon and destructive periodontal disease, is characterized by followings: rapid attachment loss and bone destruction in otherwise clinically healthy patient, amount of microbial deposits inconsistent with disease severity, and familial aggregation of diseased individuals.1 It usually occurs in the early decades of age. Lesions are mostly associated with the biofilm layer. It’s based on principles of collaboration, unobstructed discovery, and, most importantly, scientific progression. Aggressive periodontitis can be localized or generalized. Aggressive Parodontitis 30 1.2.4. Several local antibiotic applications have been developed in addition to initial periodontal therapy. The aim of this study is to study whether generalized aggressive periodontitis (GAgP) has similar survival rates (SRs) and marginal bone loss (MBL) when compared with patients with chronic periodontitis (CP) and/or healthy patients (HPs). In terms of the prevalence of racial attachment, it was found that AgP was higher in black people (2.6%) than white people (0.17%) [21]. Severe attachment and bone loss occur during this period of the disease [10, 11]. Dark red and ulcerated areas are characterized by severe acute inflammatory disease table is detected during the active phase. The results of the studies investigating polymorphism on the gene that encoded IL-10 were not significant [71, 72]. In Europe it has relatively low prevalence been observed; 0.1% in Denmark, 0.1% in Finland, 0.5% in Italy, 0.1–0.3% in Netherlands, 0% in Norway, 0.11–0.13% in Switzerland, 0.02–0.8% in United Kingdom [19]. For unknown reasons, A. actinomycetemcomitans may lose its ability to produce leukotoxin. Also environmental and behavioral factors determine the final clinical outcome. Their effectiveness on periodontium were demonstrated in many studies with CP but studies with AgP, mostly exist as case reports [113, 114]. [12] reported that in patients with GAgP, the loss of alveolar bone in regions where periodontal destruction is more severe is increased from 25–60% over 9 weeks (Figure 2). AgP is a complex disease and has multifactorial etiology. AgP classified into two categories named localized and generalized aggressive periodontitis [2] and took place prepubertal, juvenile, rapidly progressive periodontitis in the group that was defined as early onset periodontitis in 1999 International Workshop for a Classification of Periodontal Disease and Conditions [1]. This severe destruction can affect only a few teeth as well as the majority of the teeth in the mouth. aggressiv parodontitis (3,6). Our readership spans scientists, professors, researchers, librarians, and students, as well as business professionals. Interleukin-1 (IL-1) is a potent pro-inflammatory mediator that is mainly released by monocytes, macrophages and dendritic cells and genetic polymorphisms of IL1 have been studied in association with AgP. 0000007600 00000 n Aggressive periodontitis: Types and symptoms. These controls should be lifelong, but there is no definitive protocol for frequency. doctor referral. This situation leads the localization of infection and tissue destruction. A Japanese study reported an association for a composite genotype of the Fc cRIIIa N allele and the Fc cRIIIb +141 R allele in AgP [77] in contrast in a stud performed with Caucasian population there is no association found in term of this gene [78]. It is highly effective on periodontopathogenic bacteria such as P. gingivalis and P. intermedia which in the “red complex” [95]. Care should be taken when considering dental implant in AgP patients. Die Prognose der Parodontitis ist abhängig von einer frühzeitigen ... Weichgewebe in Gegend der Implantate ist sehr dünn. In this phase, periodontal abscess and regional lymphadenopathy may occur [8]. Herein, we applied the Toronto Bridge to rehabilitate a patient with generalized aggressive periodontitis; this article suggests that an implant-supported Toronto Bridge can be a reliable and acceptable treatment modality for patients suffering from tooth loss and vertical bone loss as the result of generalized aggressive periodontal disease. A. actinomycetemcomitans is considered to be the most effective etiologic agent in AgP for about 30 years [28]. 1 viser en helstatus og kliniske fotos af en patient med lokaliseret aggressiv parodontitis. 0000399604 00000 n Because of the clinical results, AgP patients suffer social problems due to esthetic, phonetic and nutritional problems and their quality of life diminishes. No significant differences found in term of 40 bacteria species in Generalized CP and GAgP [40]. In this phase, the patient should be informed by the doctor about the role of the patient, the severity of the illness and the risk factors. The outcome of rapid and severe alveolar bone loss; gingival recession, pathological migration of teeth, mobility and eventual loss of teeth occur. [102] concluded that additional applied local (tetracycline fibers) and systemic (500 mg amoxicillin/clavulanic acid) antibiotics showed equally benefits in terms of clinical parameters. The disease is most commonly seen in African-Caribbean (80%) and least Norwegian (0.2%) [20]. Licensee IntechOpen. However symptoms of the gum in some systemic diseases/conditions may resemble AgP. Doxycycline is a semisynthetic tetracycline and is effective in the treatment of periodontitis. CRP is an acute phase response molecule and increases in an inflammatory condition such as heat, infection, hypoxia and tissue damage. bioactive glass, hydroxyapatite and beta-tricalcium phosphate) are alternatively used instead of autograft [107]. PMNL is an important component of the immune system and found in gingival lesions and in root surfaces of AgP cases [45]. Periodontal destruction in AgP occurs pathogenic microorganisms and host immune system interaction [14, 26] and this interaction is influenced by many local and systemic factors [27]. Aggressive periodontitis describes a type of periodontal disease and includes two of the seven classifications of periodontitis as defined by the 1999 classification system: Some of the bacteria found in periodontal pockets related to gingivitis, while some are related to periodontitis. Localized aggressive periodontitis affects the first molar teeth and/or incisors. In studies involving IL-4 which have anti-inflammatory properties, no association was found between AgP and genotype encoding this cytokine [69]. At this time there is a clear consensus that mechanical instrumentation should always precede antimicrobial therapy. Aggressive periodontitis is classified into localized and generalized forms. 0000412018 00000 n GAgP patient; (a) clinical view of the GAgP patient, (b, c) increased probing depth around the teeth, (d) radiographic view of the GAgP patient. Dieser Form der Parodontitis zeichnet sich durch einen besonders aggressiven Krankheitsverlauf aus. Defects of host defense system and complex factors like microbial flora play a role together in hostility and disease formation affecting severity of destruction, speed of disease progress and response to treatment. Peri‐implantitis was defined as a plaque‐associated pathologic condition occurring in the tissue around dental implants, characterized by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone. IgA is important because of its antiinflammatory function and reduces inflammation by inhibiting IgG and IgM production. The risk was greater for patients with aggressive periodontitis (RR: 4.04, 95% CI: 1.81-8.98, P = 0.0006) compared with patients with chronic periodontitis (RR: 1.59, 95% CI: 1.10-2.32, P = 0.01).When stratifying only those patients with chronic periodontitis, those with severe periodontitis had increased risks of implant loss (RR: 1.89, 95% CI: 1.16-3.07, P = 0.01). Aggressive periodontitis is characterized by rapid progression and destruction of periodontal tissues, which is often associated with the early onset of the disease, an elevated degree of therapy resistance, and a high tendency toward relapse. Once diagnosed, the sibling of the child or adolescent must also be investigated for the AgP. But hydroxyapatite/tetracycline showed a greater percentage of defect fill was comparing with beta-tricalcium phosphate/tetracycline [109]. According these results, AgP can be a health problem in some populations and/or races. About TLRs, there is limited information and studies are available. compared local chlorhexidine chip and ministration and systemic amoxicillin plus metronidazole combination in addition to SRP on clinical parameters in GAgP patients. 0000011400 00000 n Dogan et al. 68 0 obj <> endobj Human leukocyte antigens (HLA) are antigens that regulate the immune response. They also concluded P. intermedia was associated with GAgP. Local antibiotic applications may also used to complete the periodontal therapy. %PDF-1.4 %âãÏÓ In the form of LAgP there is little or no inflammation of the gums [5, 6]. Elevated proportions of Porphyromonas gingivalis (P. gingivalis) in some populations. This report defined some characteristic features of the AgP [2, 3]. Membranes have been grouped into two major categories: nonresorbable (high-density polytetrafluoroethylene (PTFE) membranes reinforced or not with a titanium framework (e.g. Characteristics of aggressive periodontitis are rapid progression and destruction of periodontal tissues, often associated with a high risk of disease relapse. By making research easy to access, and puts the academic needs of the researchers before the business interests of publishers. AgP classified into two categories named localized and generalized aggressive periodontitis. Due to the recurrence nature of AgP, maintenance is given to for prevention of additional tooth loss and disease recurrence. Der er et betydeligt antistofrespons mod det infektiøse agens (5), men tandplakken er ofte tynd og kun lidt mineraliseret (7). 0000405402 00000 n Nekrotisierende parodontale Erkrankungen 34 Generalized aggressive periodontitis is described as a clinical entity affecting both deciduous and permanent dentition with extensive alveolar bone loss, mobility, and exfoliation of all or many teeth. The possibility that the cement formation is defective and may also cause the lesions to be localized. the health condition of the placed implants are evaluated according to scale called health scale which include 5 categories in which probing depth, … Generalized aggressive periodontitis or GAP is the interproximal attachment loss that affects three or more permanent teeth other than incisors and the first molar. In line with this concept, it has been shown from the initial research attempts on early-onset periodontitis forms that affected individuals, suffer from metabolic imbalance or hereditary host response defects. Long half-life of and use of only once every 3 days of azithromycin, provides advantages for the patient and the physician. [79] and Park et al. In the areas where the destruction proceeds and continues, in high amounts, A. actinomycetemcomitans were detected. AGGRESSIVE PERIODONTITIS DR.AHMED TH4YEAR 2. Some of neutrophil malfunctions such as increased adhesion, reduced chemotaxis, increased superoxide and nitric oxide production and reduced phagocytosis were thought to be responsible for disease progression [46, 47, 48]. After 6 weeks and 6 months patients were reevaluated in term of CAL, BOP, PD. First group was received SRP plus 500 mg metronidazole +500 mg amoxicillin three times a day for 1 week, second group was received 200 mg for the first day loading, 100 mg doxycycline for the following 14 days, third group was received 500 mg metronidazole three times a day for 1 week, and the fourth group was evaluated as the control group. 0000410713 00000 n Journal of Periodontology 85(10): 1398-1407. [65] could not find any accociation.CD14 and Tolllike receptors (TLRs) are extra and intracellular receptors such as recognize pathogen-associated molecules on Gram(+) and Gram(−) bacteria and mediate the production of cytokines required for effective immune response. IL-8 is a chemokine and plays role of chemoattractant for the neutrophils. In South America, the prevalence of disease was vary among the countries: 0.32–2.6% in Brazil, 0.32% in Chile [19]. Brief introduction to this section that descibes Open Access especially from an IntechOpen perspective, Want to get in touch? 0000008010 00000 n Generalized Aggressive Periodontitis as a Risk Factor for Dental Implant Failure: A Systematic Review and Meta-Analysis Alberto Monje,* Gil Alcoforado,† Miguel Padial-Molina,* Fernando Suarez,* Guo-Hao Lin,* and Hom-Lay Wang* Background: Dental implant placement is a widely used treatment that provides functional and es- In a national survey which include US school children aged 13–19 years, the prevalence of AgP was found 0.40% in 13–15 years, 0.80% in 16–19 years, 0.06% in whites, 2.60% in blacks and 0.50% in Hispanics [16]. 0000000016 00000 n Studies have shown that the IgA ratio decreases significantly in AgP subjects [55]. 0000011903 00000 n Local antibiotic administration may be preferred to risky areas [116]. According to the workshop in 1999, if the involvement is less than 30%, the disease is localized, if it is not, considered as generalize [1]. "Generalized Aggressive Periodontitis as a Risk Factor for Dental Implant Failure: A Systematic Review and Metaâ Analysis." von Dr. med. Osseointegrierte Implantate bei Patienten mit behandelter generalisierter aggressiver Parodontitis und bei parodontal ... Chronische Parodontitis 29 1.2.3. 0 AGGRESSIVE PERIODONTITIS Aggressive periodontitis (AgP) comprises a group of rare, often severe, rapidly progressive forms of periodontitis often characterized by an early age of clinical manifestation and a distinctive tendency for cases to aggregate in families. In their study, serum IgG levels to A. Actinomycetemcomitans in GAgP patients is not differ from LAgP, Localized CP and Generalized CP but it is significantly increased to several species, including P. gingivalis, T. denticola, and C. rectus [56]. After the treatment performed and provided the health of periodontal tissues, patient should be included in the maintenance program. trailer 0000007221 00000 n The motivation and adaptation of the patient is very important in order to control the disease. Twenty randomly selected patients were given 500 mg metronidazole and 500 mg amoxicillin three times a day for 1 week in addition to mechanical treatment, and the remaining 21 patients were given placebo in addition to mechanical treatment. Surgical treatment may require for the remaining pockets after initial periodontal treatment of AgP. As PhD students, we found it difficult to access the research we needed, so we decided to create a new Open Access publisher that levels the playing field for scientists across the world. Hygiene Recare. 0000003884 00000 n Genetic studies can also be limited by geographic and ethnical differences. Usage of nonresorbable or resorbable membranes for treating intrabony defects in AgP has been shown to be effective in many studies [86, 111]. [18] found AgP with a high prevalence 6.5%, in Uganda. In this disease bone loss usually wider than CP [8] (Figure 1). %%EOF The radiographic image of GAgP, characterized by severe horizontal and vertical alveolar bone loss especially in the first molar and incisors. Aggressive periodontitis refers to periodontal disease of an aggressive and rapid nature that usually occurs in patients younger than 30 years. However, deep periodontal pockets are encountered in the probing. GAgP; is characterized by diffuse attachment and bone loss affecting at least three permanent teeth other than first molar and incisor teeth, usually seen in young adults, where poor serum antibody responses to infectious agents occur [10]. After the treatment performed and provided the health of periodontal tissues, patient should be included in the maintenance program. Antagonistic bacteria against to A. actinomycetemcomitans. Systemic use of amoxicillin plus metronidazole combination found to be statistically significant clinical improvements comparing the local chlorhexidine chip [101]. In a similar study Purucker et al. The main purpose of the treatment is to create a clinical condition that can hold the largest number of teeth in the mouth for as long as possible. No associations between the TNFA polymorphisms and AgP in a meta-analysis [72]. S3-Leitlinie "Systemische Antibiotikagabe bei subgingivaler Instrumentierung“ Kurzversion Stand November 2018 ©DG PARO, DGZMK 4 2 Einleitung Parodontitis zählt zu den häufigsten chronisch entzündlichen Erkrankungen in der Bevölkerung1. The use of this systems in LAgP may be more beneficial effect in term of the nature of the disease. Adjunctive use of metronidazole plus amoxicillin, metronidazole alone or clindamycin in patients with GAgP results in well clinical improvements comparing with the use of doxycycline for a similar amount of time or with SRP alone [88]. Two and six months re-evaluations were made. 7,11–13 In zahlreichen Studien wurde gezeigt, dass die entzündliche periimplantäre Flora sich der einer aggressiv verlaufenden Parodontitis gleicht. 0000001891 00000 n (Clinical Periodontology and Implant Dentistry 4th edition) 7. I recommended extraction of all remaining maxillary teeth and replacement with implants. Yukna and Sepe [108] demonstrated an average defect fill (80%) in 12 LAgP patients using freeze-dried bone allografts. Photodynamic antimicrobial therapy that photosensitizers (toluidine blue, methylene blue, malachite green) are used inside periodontal pockets for increasing the cytotoxic potential of laser light to potential periodontal pathogens. Rapid attachment loss and bone destruction. It is important to treat and obtain frequent controls of individuals with AgP which is seen in younger patients coexistent rapid attachment and alveolar bone loss. In a metaanalysis authors concluded that photodynamic antimicrobial therapy cannot be suggested as routine with nonsurgical treatment of patients with AgP according to lack of evidence based on the literature [112]. She has a generalized, aggressive form of periodontitis and many of her teeth are mobile and with a poor long term prognosis. Removal of agents causing periodontal disease, providing good oral hygiene to the patient, and reducing pre-existing gingival inflammation and periodontal pocket depths in advance of future phases are among the goals of non-surgical periodontal treatment. Disease Mechanism. Additional metronidazole + amoxicillin or metronidazole plus SRP have been effective comparing the other groups. HLA class II antigens are capable bind peptides derived from bacterial antigens and present them to T cells while HLA class I antigens generally present peptides derived from viruses and self-antigens to cytotoxic T cells. in other wards it evaluate the survival rate of the dental implants placed in aggressive periodontitis patients. startxref The use of azithromycin in recent years has become an issue in AgP treatment. The use of therapeutic agents especially systemic antibiotics have been widespread to be able to obtain predictable treatment responses due to conventional periodontal treatment and to support treatment for the specific microbial structure of the disease. Powerful serum antibody response to infecting agents and circumpubertal onset are among disease features [3]. In a study performed in population of Chilean patients with GAgP and CP, P. gingivalis, P. micra and C. rectus isolated from subgingival plaque and found to be related to disease progression [36]. Patients also had increased antibody response against A. Actinomycetemcomitans, P. intermedia and C. rectus [14]. An Fc receptor is a protein found on the surface of certain cells and part of immunoglobulin (FcγR) link cellular and humoral parts of the immune system that contribute to the protective functions of the immune system [76]. A study of 40-year follow-ups from patients with GAgP shows that even the most aggressive and most advanced periodontitis cases are treatable [87]. Aggressive periodontitis (AgP) occurs at an early age and causes rapid periodontal tissue destruction. A constantly uncontrolled periodontal infection activates neutrophils and make them more effectively stimulated to counteract microbial episodes. [17] found a high prevalence of AgP as 7.6% in Moroccan children aged 14–19 years. The prognosis of teeth that affected AgP depends on many factors such as the amount of missing bone, the presence or absence of furcation region, the morphology of bone defects, the degree of mobility, crown/root ratio, occlusal contacts, oral hygiene and general health. It differs from chronic periodontitis (CP) depending on age of onset of the disease, rate of progression of the disease, structure and composition of the associated subgingival microflora, changes in host response and familial predisposition. AgP is a multifactorial disease and many etiological factors are required for clinical presentation. INTRODUCTION. Controversy exists on dental implant use to Each graft material showed a decrease in defect and pocket depth although no significant differences between the different grafting materials were found in terms of hard-tissue or soft-tissue changes. Genetic variations may affect the host response to the disease. HLA-9 and HLA-15 antigens have been shown to be associated with AgP [8, 52]. To achieve effective levels of the drug on the day of the completion of SRP [90]. Also, GAgP has been implicated in the pathogenesis of systemic diseases such as uncontrolled diabetes mellitus, AIDS, leukemia, neutropenia, histiocytosis X, syndromes such as Papillon-Lefevre or Cheidak-Higashi, rare inherited diseases such as hypophosphatasia and intraoral symptom of acquired disorders such as granulocytopenia [13]. In some studies AgP was found to be more common in women than men with 3: 1 ratio [22, 23, 24, 25]. 0000396380 00000 n Submitted: February 5th 2018Reviewed: March 29th 2018Published: November 5th 2018, Home > Books > Periodontology and Dental Implantology. Susanne Perschbacher, in Oral Radiology (Seventh Edition), 2014. Fig. However, researches are also available that indicates AgP more common in men than women [18, 21]. The success of periodontal treatment depends on the removal of dental plaque and therefore pathogenic microorganisms in the dental plaque. The GAgP may begin as localized and become more generalized as more teeth are affected over time. Metronidazole is a nitroimidazole derivative antibiotic which has a strong bactericidal effect on obligate anaerob Gram(−) bacteria. In a recent metaanalysis authors concluded that there is no significant association between the polymorphisms rs2275913 and rs763780 in interleukins 17A and 17F genes and CP and AgP in the allelic evaluation [74]. Radiographic finding may include an arc shaped alveolar bone loss extending from the distal surface of the premolar to the mesial surface of the second molar. The age of onset of the disease can help us diagnose the disease [4]. LAgP progresses rapidly and bone loss is three to four times greater than CP. Looking for a dental specialist in Penang, look no further with FreedaWoonDental. Other clinical features of LAgP are distolabial migrations of the upper incisor teeth and consequent diestema formation, increased mobility in the first molars, tenderness on the uncovered root surfaces, deep pain spreading in every direction during chewing that does not last so long. Aggressive Parodontitis am Zahn 26. These results may explain the severity of the lesions by delaying the immunological response against to AgP. If this immune response is not capable to control the inflammation process, complex inflammatory cascades are activated. Gender factor and its role in development of AgP have not become clear. IL1B + 3954 (+3953) C → T gene polymorphisms and carriage rate of the rare (R) allele in Caucasians found associated with AgP in a study [65]. Enamel matrix proteins (amelogenin) which provides new cementum and the formation of new attachment in periodontal defects and growth factors/differentiation factors (platelet-derived growth factor, insulin-like growth factor, fibroblast growth factor, bone morphogenetic protein, transforming growth factor-beta) which play an import role in tissue development and healing are tools for gaining attachment. How? IgA plays an important role in the host defense system and, locally dominant in saliva. IL-17 plays an important role in natural and acquired immune response; there is a study in mice demonstrating that IL-17 receptor trigger bone loss in infectious conditions [73]. Zu diesem Schluss kommt eine aktuelle Studie der Philipps-Uni- Peri‐implantitis. The term “aggressive periodontitis” is used to describe specific types of periodontal disease. Wenn sich aufgrund ungenügender Zahnputztechnik Bakterienbeläge für längere Zeit am Zahnfleischrand ablagern, führen diese Beläge zu einer Entzündung des Zahnfleisches. In the extracted teeth affected by LAgP, electron microscopic observations showed that in the biofilm layer on the root surface formed Gram(−) cocci bacteria and other microorganisms [5]. As a result of 5-year follow-up, successful clinical results were obtained and radiological bone fill in angular bony defects. 0000004621 00000 n Tonetti and Mombelli (1999) listed the findings of A. actinomycetemcomitans in relation to LAgP [11]. The appearance of severe tissue destruction with a small amount of plaque in AgP suggests that microorganisms with high virulence in the etiology of the disease may play a role. Our team is growing all the time, so we’re always on the lookout for smart people who want to help us reshape the world of scientific publishing. In a case series performed by Buchmann et al. A. actinomycetemcomitans, P. gingivalis, and C. rectus were higher in GAgP than in healthy controls.