Treatment of aggressive periodontitis

Abstract

Despite etiological differences between aggressive and chronic periodontitis, the treatment concept for aggressive periodontitis is largely similar to that for chronic periodontitis. The goal of treatment is to create a clinical condition that is conducive to retaining as many teeth as possible for as long as possible. When a diagnosis has been made and risk factors have been identified, active treatment is commenced. The initial phase of active treatment consists of mechanical debridement, either alone or supplemented with antimicrobial drugs. Scaling and root planing has been shown to be effective in improving clinical indices, but does not always guarantee long-term stability. Antimicrobials can play a significant role in controlling aggressive periodontitis. Few studies have been published on this subject for localized aggressive periodontitis, but generalized aggressive periodontitis has been subject to more scrutiny. Studies have demonstrated that systemic antibiotics as an adjuvant to scaling and root planing are more effective in controlling disease compared with scaling and root planing alone or with supplemental application of local antibiotics or antiseptics. It has also become apparent that antibiotics ought to be administered with, or just after, mechanical debridement. Several studies have shown that regimens of amoxicillin combined with metronidazole or regimens of clindamycin are the most effective and are preferable to regimens containing doxycycline. Azithromycin has been shown to be a valid alternative to the regimen of amoxicillin plus metronidazole. A limited number of studies have been published on surgical treatment in patients with aggressive periodontitis, but the studies available show that the effect can be comparable with the effect on patients with chronic periodontitis, provided that proper oral hygiene is maintained, a strict maintenance program is followed and modifiable risk factors are controlled. Both access surgery and regenerative techniques have shown good results in patients with aggressive periodontitis. Once good periodontal health has been obtained, patients must be enrolled in a strict maintenance program that is directed toward controlling risk factors for disease recurrence and tooth loss. The most significant risk factors are noncompliance with regular maintenance care, smoking, high gingival bleeding index and poor plaque control. There is no evidence to suggest that daily use of antiseptic agents should be part of the supportive periodontal therapy for aggressive periodontitis.

Eficacia de la terapia periodontal no quirúrgica en una periodontitis agresiva

“…Algunas de las características clínicas principales son: la cantidad de placa bacteriana no está directamente proporcional a la pérdida de inserción, manifestándose principalmente a nivel de los incisivos superiores y primeras molares de manera simétrica 9 . Durante un año de seguimiento de haber aplicado el tratamiento periodontal no quirúrgico en el paciente, basado en las directrices de la Academia Americana de Periodoncia, se observó una mejora de los signos clínicos de inflamación y en el control de placa bacteriana con una disminución del índice de O'leary de 24% a 11% tal como lo manifiestan Petersilka et al 10 donde afirma que el control mecánico de placa bacteriana mejora los resultados clínicos de la enfermedad periodontal.…”

“…El diagnóstico del paciente debido a las características clínicas y los hallazgos radiográficos es de periodontitis agresiva generalizada. Se realizó el tratamiento periodontal no quirúrgico comenzando con la motivación e instrucción de higiene oral, se le instruyo con la técnica de cepillado de bass modificado, uso de cepillos interproximales dos veces al día, raspado y alisado radicular manual con curetas Gracey en dos sesiones, enjuagues de clorhexidina 0.12% 15ml cada 12 horas por 30 segundos por siete días y se decidió continuar con la terapia antibiótica con la que vino el paciente de clindamicina de 300mg cada 8h por siete días para evitar así la resistencia antibiótica 9,10 .…”

Diagnóstico y tratamiento de la periodontitis agresiva

“…Studies show that access or regenerative surgical treatments may have good results in patients with aggressive periodontitis, and that the effect may be similar to the ones obtained in chronic periodontitis; provided it is complemented with proper oral hygiene, risk factors are controlled and a rigorous maintenance program is followed (60) .…”

“…-Monitor probing depth, clinical attachment level, gingival bleeding, tooth mobility (55) , patient's oral hygiene and risk factors (60) -Conduct annual radiographic examination of changes in the bone tissue of teeth at risk -Perform scaling, root planing and polishing of residual pockets (55) - (32) and therapeutic routines for aggressive periodontitis…”

Clinical and Microbiological Characterization of Patients with Generalized Aggressive Periodontitis

“…The occurrence of clinical inflammation in generalized aggressive periodontitis (GAgP) emerges to be comparable to that perceived in chronic periodontitis. In GAgP condition, age of commencement and familial aggregation are significant supplementary criteria for either diagnosis or classification (Teughels et al, 2014). Patients with ≥3 mm of clinical attachment loss in four or more teeth and in whom at least two of the affected teeth were second molars, cuspids or premolars, have been classified as having the generalized form of aggressive periodontitis.…”