Gender factor and its role in development of AgP have not become clear. It has also been found that a low T-helper to T-suppressor ratio is found in aggressive periodontitis which may alter local immune regulation. The objective of treatment is to create a conducive clinical condition for retaining as many teeth, for as long as possible.[40]. Physicians can achieve very effective results if they are working with microbial tests during and after treatment. 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]. In the passive period, the clinical image is especially similar to that of healthy individuals in terms of color, shape and consistency. Human cytomegalovirus, Epstein–Barr virus type-1 and HSV-1 are also involved in the progression of the disease [41, 42]. PMNL is an important component of the immune system and found in gingival lesions and in root surfaces of AgP cases [45]. Yılmaz et al. 2. The treatment of these patients is quite challenging, due to the absence of a standard treatment protocol for this disease which its etiology is not fully understood, but also because of the rapid progression, severe periodontal tissue loss and recurrence of the disease. Removal of plaque retentive factors: Local plaque retentive factors such as mal-positioned teeth, overhanging restorations, crown and bridgework, partial dentures and fixed/removable orthodontic appliances can increase the risk of periodontal disease and prevent successful treatment and resolution of associated pockets. Most studies performed about polymorphisms were limited by sample size and had variations in case inclusion criteria. Commensurate with amount of etiological factors present. [57] investigated these two molecules in AgP patients. 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. In generalized aggressive periodontitis, radiographs may show generalized bone destruction ranging from mild crestal bone resorption to severe extensive alveolar bone destruction depending on the severity of the disease. Environmental factors such as oral hygiene/bacterial plaque, smoking, stress and systemic factors may exacerbate the inflammation and play an important role in the periodontitis progression. No associations between the TNFA polymorphisms and AgP in a meta-analysis [72]. It is important to treat and obtain frequent controls of individuals with AgP. APPOINTMENT REQUEST. [37] Careful interpretation of the history is required but it may provide vital evidence in diagnosing AgP. However, because some pathogens can invade into the tissue, or because periodontal instruments are not effective in deep and complex pockets, mechanical treatment is sometimes ineffective [89]. At the end of the study SRP alone unable to suppress A. actinomycetemcomitans in periodontal lesions, in contrast SRP plus soft tissue curettage and modified Widman flap surgery succeeded [103]. It is also important to perform microbial testing at every control session whenever possible. To date our community has made over 100 million downloads. [11] It has been suggested that these gingival crevicular fluid antibody levels could be potentially useful in the development of a vaccine. A. actinomycetemcomitans, short (0.4–1 μm), facultative anaerobic, immobile, Gram(−) rod. AgP patients who are smoking showed poor clinical respond the periodontal treatment [64]. These gram-negative microbes are considered the chief aetiological agent of aggressive periodontitis. To achieve effective levels of the drug on the day of the completion of SRP [90]. Tetracycline is known to have beneficial effects in wound healing regarding its anticollagenase activity [92] . Existing studies in literature demonstrated that there is no significant association between IL-8 polymorphisms and AgP [75]. Licensee IntechOpen. Smoking is a major risk factor for periodontal disease and it further adds to the susceptibility for severe aggressive disease. Built by scientists, for scientists. The patient reported a smoking habit of 15 cigarettes per day. Aggressive periodontitis (AgP) is a disease characterized by rapid loss of periodontal tissues affecting systemically healthy individuals under age of 30 years. Regular controls are useful for controlling the progression of the disease. [84] investigated metronidazole + amoxicillin, doxycycline, metronidazole efficacy in 43 GAgP patient clinically and microbiologically. compared local chlorhexidine chip and ministration and systemic amoxicillin plus metronidazole combination in addition to SRP on clinical parameters in GAgP patients. [2], Aggressive periodontitis is much less common than chronic periodontitis and generally affects younger patients than does the chronic form. [9][10], An impaired ability of peripheral blood lymphocytes to react to chemotactic stimuli is found in the majority of patients suffering from aggressive periodontitis. 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. Aysan Lektemur Alpan (November 5th 2018). [34][35] The presence of bleeding on probing (BOP) should be noted which is an indicator of active disease. GAgP patient; (a) clinical view of the GAgP patient, (b, c) increased probing depth around the teeth, (d) radiographic view of the GAgP patient. Patients were randomly divided into 4 groups. [106], SRP and modified Widman flap surgery plus systemic amoxicillin/metronidazole combination provide periodontal tissue stabilization at a rate 95% over 5 years. [79] and Park et al. Nibali et al. 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]. 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. The amount of bacteria is often indicated by the level of dental plaque. Aggressive periodontitis The practitioner should be aware that a small proportion of adolescents may suffer from aggressive periodontitis. It can be localized or generalized. These results may explain the severity of the lesions by delaying the immunological response against to AgP. Although resorbable membranes show lack of sufficient strength, unpredictable degradation rate and cause a greater inflammatory response [110]. 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. Local antibiotic applications may also used to complete the periodontal therapy. Tetracycline and SRP found to be more effective in term of elimination A. actinomycetemcomitans, Capnocytophaga and spirochetes comparing only SRP [91]. This stage involves discussion of the disease with the patient. provides evidence against the 1999 Workshop’s decision of weak serum antibody response in AgP. [2] On the other hand, in Asia, the prevalence rate of 1.2% for LAP and 0.6% for GAP in Baghdad and Iran population, and 0.47% in Japanese population. AgP classified into two categories named localized and generalized aggressive periodontitis. [17] For instance, diabetes is proved to be associated with periodontitis- it is a major risk factor when glycaemic control is poor.[18]. Common features generally present are: Patients are healthy except for periodontitis Dark red and ulcerated areas are characterized by severe acute inflammatory disease table is detected during the active phase. During this period gingival hyperplasia depending on dental plaque and/or calculus rarely appears [6]. Elevated fibrinogen levels can activate the inflammatory cascades. The prognosis for aggressive … Secondary features that are often, but not always, present include the following: The amounts of microbial deposits are inconsistent with the severity of periodontal tissue destruction. In some studies, P. gingivalis and T. Forsythia have been shown to be an etiological agent for AgP [10, 11]. Various studies have associated Aggregatibacter actinomycetemcomitans, formerly known as Actinobacillus actinomycetemcomitans, with aggressive periodontitis. Aggressive periodontitis (AgP) is a disease characterized by rapid loss of periodontal tissues affecting systemically healthy individuals during adolescence and adulthood, and forms a group of periodontal diseases . According to the 1999 International Workshop for the Classification of Periodontal Diseases, aggressive periodontitis was defined according to 3 primary features, in contrast to chronic periodontitis. In the form of LAgP there is little or no inflammation of the gums [5, 6]. It has been stated that Gram(−) microorganisms play a role mostly in microbial dental plaque (MDP). In the case where the disease is not stabilised, the cause of failure should be considered, and the treatment progresses on to the stage of definitive therapy, if the cause is correctable. Page et al. [5], Porphyromonas gingivalis is a Gram-negative anaerobe associated with the pathogenicity of periodontal disease,[8] and aggressive periodontitis is no exception. [7], Samaranayake notes the evidence for the specific involvement of Aggregatibacter actinomycetemcomitans includes: an increased incidence of it found in subgingival plaque obtained from lesional sites, high level of its antibody which tends to fall following successful treatment, its possession of a wide range of potentially pathogenic products and its elimination with concordant disease regression, following treatment with successful periodontal therapy and adjunctive tetracycline. [80] found an association with AgP but Bret et al. Metronidazole is a nitroimidazole derivative antibiotic which has a strong bactericidal effect on obligate anaerob Gram(−) bacteria. Due to the recurrence nature of AgP, maintenance is given to for prevention of additional tooth loss and disease recurrence. In a study smoking found to related disease activity and progression in GAgP but it is not associated with LAgP [62]. Radiographs should be taken separately from each tooth or area affected by the disease once a year. Unfortunately, second surgery for removal or membrane exposure take place among its disadvantages. Given the prevalence of AgP in Asia; it found 1.8% in Iraq, 0.86% in Israel, 0.47% in Japan and 0.42% in Saudi Arabia [19]. Platelets may play active role in host response in GAgP patients [58, 59]. In studies involving IL-4 which have anti-inflammatory properties, no association was found between AgP and genotype encoding this cytokine [69]. 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