The maintenance therapy starts soon after the phase I therapy or nonsurgical therapy and should be continued throughout the lifetime of the patient. bacteria to multiply and also the addition of the pro inflammatory mediators to cause periodontal destruction and eventually tooth loss. An individual's own immune response to the bacteria triggers this autoimmune condition. There was no history of any previous dental treatment. Pathogenic bacteria in the dental plaque especially Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis [13, 14] have an indispensable role which elicits an aggravated host response which in turn is determined by the genetic and immunologic profile of the patient modified by environmental risk factors like smoking. Systemic diseases like hematologic disorders and some genetic disorders also show periodontitis as a manifestation mimicking generalized aggressive periodontitis which can be ruled out by assessing the systemic status, hematologic data analysis, and immunologic profiling of the patient. One theory is that herpesviruses cooperate with specific bacteria in the etiopathogenesis of the disease. Localized aggressive periodontitis can, later on, develop into a generalized one, so assessment, diagnosis, and treatment should be prompt and consistent as well. The higher the level of the plaque, the higher the level of the disease. A comprehensive periodontal treatment consisting of mechanical/surgical and systemic antimicrobial therapy is found to be an appropriate treatment regimen for long-term stabilization of periodontal health with arrest of periodontal disease progression in 95% of the initially compromised lesions [107]. Aggressive periodontitis, 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 [1 1. Chronic periodontitis, on the other hand, usually affects all the adult teeth. A porcelain, resin, silicone, or copolyamide removable gingival prosthesis (gum veneer/gingival mask) can be fabricated to mask the recession and improve the appearance of the anterior teeth [95]. One theory is that herpesviruses cooperate with specific bacteria in the etiopathogenesis of the disease. Gingival margins were rounded, and exudation was present in relation to labial aspects of mandibular anterior teeth and maxillary central incisors. An orthodontic therapy with concomitant periodontal monitoring and prosthetic rehabilitation, if possible with the use of implants and psychologic counseling, may be needed for patients with advanced forms of the disease. Aa in most peoples' mouths do the same thing that other types of bacteria typically do in the mouth, which is to form the filmy tooth coating known as plaque. GTR has shown to have a greater effect on probing measures of periodontal treatment than open flap debridement alone, including improved attachment gain, reduced pocket depth, less increase in gingival recession, and more gain in hard tissue probing at reentry surgery [83]. It is interesting that the first ever reported detailed description of a recognized disease in early hominid evolution is a case of prepubertal periodontitis in an 2.5–3-million-year-old fossil remains of a juvenile Australopithecus africanus specimen which showed the typical pattern of alveolar bone destruction with migration of the affected deciduous molars [10, 11]. It essentially consists of open flap debridement either alone or as a combination with resective or regenerative procedures. Any of the above symptoms should be addressed with a qualified psychotherapist to improve the quality of life. B. Zhang et al., “Tobacco and smoking: environmental factors modify the host response (immune system) and have an impact on periodontal health,”, H. A. Schenkein, J. C. Gunsolley, T. E. Koertge, J. G. Schenkein, and J. G. Tew, “Smoking and its effects on early-onset periodontitis,”, D. A. Apatzidou and D. F. Kinane, “Quadrant root planing versus same-day full-mouth root planing. I. Gingiva may be tender, fiery red, edematous, soft, and boggy. The bacteria are often isolated from the subgingival, loosely adherent plaque inhabiting the pockets associated with the severe bone defects. The emotional effects of tooth loss are devastating for some patients and have a dramatic impact on their life, and they take longer time to come to terms with the tooth loss [100]. A subgingival scaling and root planing was performed following which a povidone iodine 5% irrigation was performed. A case report,”, D. M. Davis, J. Fiske, B. Scott, and D. R. Radford, “The emotional effects of tooth loss: a preliminary quantitative study,”, J. T. Newton and J. Fiske, “Breaking bad news: a guide for dental healthcare professionals,”, L. Leresche and S. F. Dworkin, “The role of stress in inflammatory disease, including periodontal disease: review of concepts and current findings,”, O. O. Dosumu, E. B. Dosumu, M. O. Arowojolu, and S. S. Babalola, “Rehabilitative management offered nigerian localized and generalized aggressive periodontitis patients,”, D. A. Sharma and D. A. Pradeep, “Clinical efficacy of 1% alendronate Gel in adjunct to mechanotherapy in the treatment of aggressive periodontitis-A randomized controlled clinical trial,”, H. A. Schenkein, “Finding genetic risk factors for periodontal diseases: is the climb worth the view?”, T. Roshna, R. Thomas, K. Nandakumar, and M. Banerjee, “A case-control study on the association of human leukocyte antigen-, R. Buchmann, M. E. Nunn, T. E. Van Dyke, and D. E. Lange, “Aggressive periodontitis: 5-year follow-up of treatment,”. Subantibacterial dose of Doxycycline has been approved for use in chronic periodontitis, but its use in aggressive periodontitis has to be confirmed by research. Sign up here as a reviewer to help fast-track new submissions. Aggressive periodontitis causes attachment loss of the teeth, bone destruction, and pain. In the periods of quiescence, patients are free of symptoms and the gingiva appears pink and healthy even though probing reveals deep periodontal pockets. The most commonly used among alloplastic graft materials is hydroxyapatite (HAP) which is osteoconductive and has shown to have similar clinical effect to FDBA [79]. Alphonse Gargiulo, DDS, MS, Rachel Degen, RDH, and Mark Val, CDT, present a case report of a 20-year-old African American female who was diagnosed at puberty with localized aggressive periodontitis, which developed into a generalized form of the disease as the patient entered late adolescence. Bone grafting is indicated in vertical defects, and the success of the procedure depends on the type of defect. gingivalis, and T. denticola were the predominant periodontopathic bacteria of aggressive periodontitis patients, Although A. actinomycetemcomitans was also detected in AgP patients, the prevalence of this bacterium was much lower than lower than that of P. gingivalis. Intraoral examination revealed a normal color of gingiva except in the labial aspect of 31, 32, and 33 where the marginal gingiva was slightly reddish. In addition, the defect at site 33 was treated with guided tissue regeneration (GTR) with bioresorbable collagen membrane in conjunction with synthetic bone graft (HAP) (Figures 12(a)–12(f)). An OPG and full-mouth IOPA X-ray were performed which revealed the generalized distribution of alveolar bone loss which was a combination of both horizontal and vertical bone loss (Figure 7). A systematic review,”, F. F. Duarte, R. F. Lotufo, and C. M. Pannuti, “Local delivery of chlorhexidine gluconate in patients with aggressive periodontitis,”, D. Kaner, J. P. Bernimoulin, W. Hopfenmüller, B. M. Kleber, and A. Friedmann, “Controlled-delivery chlorhexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial,”, D. Sakellari, I. Vouros, and A. Konstantinidis, “The use of tetracycline fibres in the treatment of generalised aggressive periodontitis: clinical and microbiological findings,”, P. Purucker, H. Mertes, J. M. Goodson, and J. P. Bernimoulin, “Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis,”, A. Saito, Y. Hosaka, T. Nakagawa, K. Seida, S. Yamada, and K. Okuda, “Locally delivered minocycline and guided tissue regeneration to treat post-juvenile periodontitis. This underlies the therapeutic effect of smoking cessation and cessation of other forms of tobacco, and patients should be advised of the benefits of smoking cessation and the potential risks of smoking in worsening their periodontal condition, and if needed expert counseling for cessation of the habit should be sought [32–36]. In order to maintain the optimal results got by surgery and to prevent the recurrence of the disease, a lifelong maintenance therapy is mandatory because of the strong genetic susceptibility of the individual to the disease. The disease which includes both localized and generalized forms was previously known as “early onset periodontitis” which included the three categories of periodontitis—prepubertal, juvenile, and rapidly progressing periodontitis [8, 9]. Although its prevalence has been reported to be much less than that of chronic periodontitis, it can result in early tooth loss in the affected individuals if not diagnosed in the early stages and treated appropriately [3]. Aggressive periodontitis: ... Necrotizing periodontal disease: Death of periodontal tissue caused by a lack of blood supply can pave the way for a severe infection, and this usually affects people with a suppressed immune system. 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