xref 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]. The combination of 250 mg of metronidazole and 375 mg of amoxicillin, three times a day for 7 days, as an adjunct to SRP, was found to be very effective in suppressing subgingival A. actinomycetemcomitans load [96]. Unfortunately, second surgery for removal or membrane exposure take place among its disadvantages. AgP is a complex disease and has multifactorial etiology. the health condition of the placed implants are evaluated according to scale called health scale which include 5 categories in which probing depth, … 0000004698 00000 n 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. Generalized aggressive periodontitis or GAP is the interproximal attachment loss that affects three or more permanent teeth other than incisors and the first molar. Patients are clinically healthy, except for the presence of periodontitis. 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. Kornman and Robertson [104] found modified Widman flap surgery plus tetracycline was effective in areas where the black pigmented bacteroides and A. actinomycetemcomitans load was high. Clinical trials have shown that improvement in clinical parameters with treatment is associated with a decrease in the level of A. actinomycetemcomitans in subgingival floras. "Generalized Aggressive Periodontitis as a Risk Factor for Dental Implant Failure: A Systematic Review and Metaâ Analysis." In areas where periodontal tissue destruction occurs in aggressive periodontitis patients, 90% of A. actinomycetemcomitans are found. Severe attachment and bone loss occur during this period of the disease [10, 11]. In clinical trials, the success of treatment is assessed by considering the probing depth (PD), clinical attachment level (CAL) and bleeding on probing (BOP) using conventional periodontal instruments. The researchers noted that the combination of platelet rich plasma and bovine derived xenograft for the treatment of GAgP, provided successful clinical results in large intrabony defects and that prognosis was affected positively even for teeth that were thought to have hopeless prognosis. 24. Patient Registration. Nekrotisierende parodontale Erkrankungen 34 The classic feature of LAgP is the vertical bone loss seen in alveolar bone in the first molar and incisor teeth in healthy teenagers. Haubek et al. 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. Aggressive periodontitis is classified into localized and generalized forms. The severity of the disease appears to be an exuberant reaction to a minimum amount of plaque accumulation and may result in early tooth loss. A. actinomycetemcomitans is considered to be the most effective etiologic agent in AgP for about 30 years [28]. Peri‐implantitis. Localized Aggressive Periodontitis Localized aggressive periodontitis manifests with a rapid progression of periodontal tissue loss that begins around the ag. How? Februar 2007. In a theory, viral peptide binding and presentation to T cells via HLA-A9 or HLA-B15 is not sufficient for activating immune response properly resulting AgP with severe periodontal destruction [53]. There are many methods to regain bone in vertical bone defects such as bone grafting, guided tissue regeneration by using membranes, the use of biologic modifiers and combinations of the above. According an epidemiologic study performed by Susin et al. In der modernen Zahnmedizin hat der funktionelle und ästhetische Strukturerhalt oberste Priorität. 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]. 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]. Help us write another book on this subject and reach those readers. It’s based on principles of collaboration, unobstructed discovery, and, most importantly, scientific progression. This group of diseases includes; neutropenia, hypophosphatasia, leukemias, Cheidak-Higashi syndrome, leukocyte adhesion deficiency, Papillon-Lefevre syndrome, trisomy 21, histiocytosis and agranulocytosis [1]. In this disease, there are at least two permanent teeth involvement, one of them must be the first molar, and involving no more than two teeth other than first molars and incisors [8]. 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). For unknown reasons, A. actinomycetemcomitans may lose its ability to produce leukotoxin. Additional metronidazole and amoxicillin may provide a statistically significant improvement in clinical parameters in the short term. © 2018 The Author(s). [97] evaluated SRP plus systemic metronidazole and amoxicillin in use on clinical parameters, in total of 41 individuals with GAgP. Guerrero et al. Open Access is an initiative that aims to make scientific research freely available to all. Studies have shown that there is a positive correlation between AgP and stress [60]. IL-10 is an anti-inflammatory cytokine which down-regulates the pro-inflammatory immune response of monocytes and macrophages. First phase; initial therapy or non-surgical periodontal treatment. 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]. Based on the literature GAgP responds good clinical results to scaling and root planning (SRP) in the short term (up to 6 months). 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]. To achieve maximum efficacy, drugs must provide some criteria such as; the drug must reach the targeted site of action, remain at an effective concentration and last for an adequate period of time [99]. The use of azithromycin in recent years has become an issue in AgP treatment. IgA is important because of its antiinflammatory function and reduces inflammation by inhibiting IgG and IgM production. 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]. Two and six months re-evaluations were made. AgP classified into two categories named localized and generalized aggressive periodontitis. After the treatment performed and provided the health of periodontal tissues, patient should be included in the maintenance program. In general, the least amount of work on this issue and it is not long to observe the final results. People with the same clinical characteristics may have different bacterial flora, or people with different clinical characteristics may have the same bacterial flora. A. actinomycetemcomitans, short (0.4–1 μm), facultative anaerobic, immobile, Gram(−) rod. They also concluded P. intermedia was associated with GAgP. Aggressive periodontitis (AgP) occurs at an early age and causes rapid periodontal tissue destruction. 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. provides evidence against the 1999 Workshop’s decision of weak serum antibody response in AgP. 0000002103 00000 n 0000001891 00000 n All parameters for the patients should be assessed and the treatment decision should be given. 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. Parodontitis kann zu Implantatverlust führen (© Dr. Becherer) Parodontitis ist eine bakterielle Infektion des Zahnhalteapparates. Usage of nonresorbable or resorbable membranes for treating intrabony defects in AgP has been shown to be effective in many studies [86, 111]. In the studies, the methods which have been used to diagnosis of disease such as; whether radiographies is taken or not, differences in diagnostic equipment, different indexing systems etc. Hence, it is important to find out whether patients with aggressive periodontal disease possess a higher risk of developing peri-implant diseases. No associations between the TNFA polymorphisms and AgP in a meta-analysis [72]. Elevated fibrinogen levels can activate the inflammatory cascades. These include metronidazole, chlorhexidine, minocycline, doxycycline and tetracycline. In a study different graft materials were evaluated in 10 patients with LAgP. Root planning are also included. According to Kantarci et al. The second periodontal treatment phase is surgical periodontal treatment, third phase prosthetic treatment and fourth phase maintenance periodontal treatment. Among these, orange complex bacteria: P. intermedia, Prevotella nigrescense (P. nigrescense), Parvimonas micra (P. micra), Fusobacterium nucleatum (F. nucleatum), C. rectus, Eubacterium nodatum (E. nodatum) and Campylobacter showae (C. showae) build a bridge between the pathogens seen in the early period of periodontal disease named red complex bacteria. (Clinical Periodontology and Implant Dentistry 4th edition) 7. In every control session; PD and CAL should be assessed. Three studies have reported no association between the carriage rates of the IL1A − 889 (+4845) C → T gene and AgP [65, 66, 67], but one study have found an association with this gene and AgP in Chinese Population [68]. 0000011034 00000 n No significant differences found in term of 40 bacteria species in Generalized CP and GAgP [40]. 928. aggressiv parodontitis (3,6). In some studies platelet size and function found to decrease in GAgP patients due to the consumption of large platelets at sites of periodontal inflammation. Patients also had increased antibody response against A. Actinomycetemcomitans, Prevotella intermedia (P. intermedia) and Campylobacter rectus (C. rectus) [14]. Contact our London head office or media team here. [50] LAgP has been associated with various abnormalities of host cell function such as; neutrophil abnormalities, reduced chemotaxis, increased superoxide production, reduced receptor expression, reduced phagocytosis and killing of A. Actinomycetemcomitans, impaired leukotriene B4 and signal transduction abnormalities. Care should be taken when considering dental implant in AgP patients. 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]. The responses of patients with LAgP to initial periodontal care vary in studies. Aysan Lektemur Alpan (November 5th 2018). 0000405725 00000 n 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). For this reason, the prevalence of the disease in a given population can be determined by the distribution of the population according to the type and proportion of the race and ethnic group. PMNL is an important component of the immune system and found in gingival lesions and in root surfaces of AgP cases [45]. Non-surgical and surgical periodontal treatments combined with systemic antibiotics are recommended for the complete eradication of deep periodontal pockets. Aggressive periodontitis (AgP) comprises a rare, rapidly progressing form of periodontitis, characterized by severe destruction of periodontal attachment apparatus and tooth loss at an early age. Implantate bei Patienten mit aggressiver Parodontitis. Allein in Deutschland sind 10 bis 12 Mio. 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]. Since tooth loss is frequently seen in AgP patients, dental implant applications can be applied. Periodontal treatment is considered in four main phases. 0000008594 00000 n Fig. The anti-infective treatments applied in this context directly affect the success of the treatment. The presence of microorganisms is essential for the initiation of the inflammatory process in periodontal diseases and the factors related to the host are involved in the progress of the disease. 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]. Wenn sich aufgrund ungenügender Zahnputztechnik Bakterienbeläge für längere Zeit am Zahnfleischrand ablagern, führen diese Beläge zu einer Entzündung des Zahnfleisches. 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. Doxycycline is a semisynthetic tetracycline and is effective in the treatment of periodontitis. ISSN: 0022-3492, 1943-3670 Osseointegrierte Implantate bei Patienten mit behandelter generalisierter aggressiver Parodontitis und bei parodontal ... Chronische Parodontitis 29 1.2.3. Die aggressive Parodontitis muss lebenslang in Schach gehalten werden- gerade wenn man an eine Implantattherapie denkt. 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]. Red complex bacteria named P. gingivalis, T. forsythia and Treponema denticola (T. denticola) were associated with periodontal tissue destruction [31]. Lee et al. At the end of the study no significant differences were found in term of PD, BOP [93]. [106], SRP and modified Widman flap surgery plus systemic amoxicillin/metronidazole combination provide periodontal tissue stabilization at a rate 95% over 5 years. INTRODUCTION. This chapter is distributed under the terms of the Creative Commons Attribution 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The virulence factor is serotypically variable and some serotypes are known to be invasive epithelial cells and gingival tissue. To date our community has made over 100 million downloads. Some researchers suggested monthly checks during the first 6 months after the treatment finished. 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]. There is a positive association with HLA-A9 and negative relationship with HLA-A2 and HLA-B5 have shown in patients with AgP [54]. Parodontitis gefährdet Implantate | Kristin Jahn Eine behandelte generalisierte aggressive Parodontitis (GAgP) ist ein wesentlicher Risikofaktor für periimplantäre Infektionen. These controls should be lifelong, but there is no definitive protocol for frequency. The outcome of rapid and severe alveolar bone loss; gingival recession, pathological migration of teeth, mobility and eventual loss of teeth occur. Also, when necessary, SRP should be performed. A clinical examination and periodontal evaluation (ie, assessment of mobility, probing depth, bleeding on probing, plaque score, and clinical attachment loss) revealed severe horizontal and vertical bone loss, deep probing depth with bleeding, class II mobility, a widened periodontal ligament, traumatic occlusion, and the formation of a diastema bet… These results may explain the severity of the lesions by delaying the immunological response against to AgP. This report defined some characteristic features of the AgP [2, 3]. 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]. By Ana-Maria Seciu, Oana Craciunescu and Otilia Zarnescu. Controversy exists on dental implant use to restore missing dentition in younger patients. Patients who are diagnosed with aggressive periodontitis at an early stage and who are able to enter therapy may have a better outcome than those who are diagnosed at an advanced stage of destruction. Christoph Becherer am 14.07.2016. Tetracycline is known to have beneficial effects in wound healing regarding its anticollagenase activity [92] . As a result of 5-year follow-up, successful clinical results were obtained and radiological bone fill in angular bony defects. 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. According to the 1999 workshop, the main feature in diagnosing of AgP is that the individual should be medically healthy [1]. A constantly uncontrolled periodontal infection activates neutrophils and make them more effectively stimulated to counteract microbial episodes. Hwang et al. In a similar study Purucker et al. Twenty-five periodontal lesions in seven patients with LAgP divided into three treatment groups: SRP; SRP plus soft tissue curettage; SRP plus modified Widman flap surgery. In kurzer Zeit kommt es zu erheblichem Verlust von parodontalen Strukturen. Once diagnosed, the sibling of the child or adolescent must also be investigated for the AgP. 0000396380 00000 n In a case series performed by Buchmann et al. 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]. Dieser Form der Parodontitis zeichnet sich durch einen besonders aggressiven Krankheitsverlauf aus. The tetracycline group is considered first in systemic treatment. Due to the recurrence nature of AgP, maintenance is given to for prevention of additional tooth loss and disease recurrence. Periodontitis comprises a variety of pathologic conditions that affect the health of the periodontium and is commonly seen in its chronic form.8 In general, patients exhibit gingival inflammation with destruction of tooth-supporting structures including the periodontal ligament, connective tissue, and bone.8,9 Aggressive periodontitis (AP) forms are characterized by rapid attachment loss and alveolar bone destruction in otherwise s… %PDF-1.4 %âãÏÓ The following reasons have been proposed regarding the limited localization of lesions in AgP [8]. Journal of Periodontology 85(10): 1398-1407. Elevated CRP and fibrinogen levels found in CP patients not in AgP and healthy controls. The hypoplasia or aplastic cement formation was seen in the examinations performed on teeth withdrawn from patients with LAgP. Additional metronidazole + amoxicillin or metronidazole plus SRP have been effective comparing the other groups. Disease Mechanism. Controversy exists on dental implant use to Parodontitis als Manifestation von systemischen Erkrankungen 31 1.2.5. Yeasts also were found in samples. Antagonistic bacteria against to A. actinomycetemcomitans. Lindhe and Liljenberg [105] treated 16 patients with modified Widman flAgP surgery plus tetracycline (14 days). Frequent follow-ups should not be neglected in these patients. Human cytomegalovirus, Epstein–Barr virus type-1 and HSV-1 are also involved in the progression of the disease [41, 42]. 0000011903 00000 n There is no certain protocol for the use of adjunctive systemic antimicrobials with SRP, but in general suggests that antibiotic intake should start on the day of debridement completion; debridement should be completed within a short time (preferably <1 week) [94]. HLA-9 and HLA-15 antigens have been shown to be associated with AgP [8, 52]. Localized aggressive periodontitis affects the first molar teeth and/or incisors. It includes the following classifications: Localized aggressive periodontitis (LAP) Generalized aggressive periodontitis (GAP) Localized aggressive periodontitis or LAP is localized to first molar or incisor interproximal attachment loss. 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- Characteristics of aggressive periodontitis are rapid progression and destruction of periodontal tissues, often associated with a high risk of disease relapse. Yukna and Sepe [108] demonstrated an average defect fill (80%) in 12 LAgP patients using freeze-dried bone allografts. 0000001036 00000 n Lesions are mostly associated with the biofilm layer. Die viel seltenere, schnell fortschreitende "aggressive Parodontitis" wurde hauptsächlich bei Kindern und jungen Erwachsenen diagnostiziert. 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]. Available from: Localized aggressive periodontitis (LAgP), Generalized aggressive periodontitis (GAgP), Physical Sciences, Engineering and Technology, Biochemistry, Genetics and Molecular Biology, Pharmacology, Toxicology and Pharmaceutical Science, Faculty of Dentistry, Department of Periodontology, Pamukkale University, Denizli, Turkey. Background: 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 prevalence of AgP changes significantly different between geographical regions and between different racial/ethnic origins. It was demonstrated in many studies, biofilm showed high levels of resistance against tetracycline, minocycline, amoxicillin, doxycycline and amoxicillin/clavulanate. In a controlled study patients in the GAgP group were significantly more depressed and lonely than patients in the CP and control groups [60]. Treatment should be evaluated according to the initial condition. Today, the microbiological profile of AgP has changed from the presence of specific microorganisms to the presence of more complex microbiota [30]. 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. 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. %%EOF 0000004450 00000 n [79] and Park et al. LAgP patient; (a)-clinical view of the LAgP patient, (b) 7 mm probing depth at distal of the incisor tooth, (c) radiographic view of the LAgP patient. Hence, it is important to find out whether patients with aggressive periodontal disease possess a higher risk of developing peri‐implant diseases. Also environmental and behavioral factors determine the final clinical outcome. A hyper-responsive macrophage phenotype, including elevated levels of prostaglandin E2 and interleukin-1β. In addition, high-degree of antibiotic tolerance has been demonstrated in mature biofilms [94] when tetracycline was unable to suppress A. actinomycetemcomitans, it has been raised a combined use of antibiotics for the treatment of AgP. Surgical and non-surgical techniques are applied in the treatment of AgP [84]. Login to your personal dashboard for more detailed statistics on your publications. It is also important to perform microbial testing at every control session whenever possible. In the response to dental plaque accumulation, which leads to gingivitis, substantial evidence has been collected to propose large differences between individuals. Dark red and ulcerated areas are characterized by severe acute inflammatory disease table is detected during the active phase. Aggressive periodontitis: Types and symptoms. 0000005022 00000 n 68 0 obj <> endobj CRP is an acute phase response molecule and increases in an inflammatory condition such as heat, infection, hypoxia and tissue damage. 0000008010 00000 n Yılmaz et al. 0000010091 00000 n A positive correlation found between the amount of plaque and GAgP, but not in LAgP [61]. In the areas where the destruction proceeds and continues, in high amounts, A. actinomycetemcomitans were detected. Aggressive Parodontitis am Zahn 26. Dental implants are a widely used treatment edentulism and provides functional and esthetic resolutions. [39] found the bacteria in diseased sites in Korean AgP patients, descending percentages; Fusobacterium sp., P. gingivalis, Treponema sp., T. forsythensis, P. intermedia and A. actinomycetemcomitans. Twelve months after treatment, approximately 1 mm reduction in PD and higher percentage of teeth with attachment gain was observed in test group [98]. However, marginal bone loss and implant survival rates in AgP patients significantly higher than those of CP and healthy subjects [113, 114]. 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. 0000009377 00000 n Complex pathogens are involved in the etiology of AgP. Generaliseret aggressiv parodontitis Aggressive Parodontitis 30 1.2.4. Die Menge bakterieller Beläge korreliert nicht mit der Schwere der klinischen Befunde. 0000002503 00000 n 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]. freeze-dried bone allograft), xenografts (bovine or corral derived) and alloplastic materials (e.g. Surgical and non-surgical techniques can be applied in the treatment of AgP. At this time there is a clear consensus that mechanical instrumentation should always precede antimicrobial therapy. 28. Smoking is also a risk factor for AgP [54]. dent. But hydroxyapatite/tetracycline showed a greater percentage of defect fill was comparing with beta-tricalcium phosphate/tetracycline [109].