Localized Aggressive Periodontitis (LAP)

1. Dr Jaffar Raza Syed Page 1
Aggressive Periodontitis
“characterized by the rapid loss of attachment and bone loss occurring in an otherwise
clinically healthy patient with the amount of microbial deposits inconsistent with
disease severity and familial aggregation of diseased individuals formerly classified as
early onset periodontitis”
localized juvenile periodontitis (LJP) has been changed to localized aggressive
periodontitis (LAP)
generalized aggressive periodontitis was previously classified as generalized juvenile
periodontitis (GJP) and rapidly progressive periodontitis (RPP).

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Clinical Features of LAP:
Age and Sex Distribution
between puberty and 20 years of age
both sexes but predilection to female patients.
Distribution of Lesions
Three areas of localization of bone loss have been described:
1. First molar and/or incisors.
2. First molar and/or incisors + additional teeth (not exceeding 14 teeth).
3. Generalized involvement

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Clinical Findings
most striking feature is lack of clinical inflammation despite the presence of deep
periodontal pockets
mobility and migration of first molars and incisors
other symptoms like root surface sensitivity, deep dull radiating pain, periodontal
abscess formation and regional lymph node enlargement may occur
Radiographic Findings
Arc-shaped loss of alveolar bone extending from distal surface of 2nd premolar to
mesial surface of 2nd molar.
Frequently, bilaterally symmetrical patterns of bone loss occurs, called as “mirror
image pattern”

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Pathogenesis
Specific microbiology of subgingival plaque,
A. actinomycetemcomitans,
Capnocytophaga sputigena
others
defects in cementum,
hereditary factors,
impaired PMNs function
disorders of the immune system.

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Virulence factors associated withassociated with A. actinomycetemcomitans are
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Treatment
Extraction of involved teeth
Transplantation of developing third molars into the sockets of previously extracted
1st molars
Standard periodontal therapy: Includes
scaling, root planing,
curettage,
flap surgery with/without bone grafts,
root amputation,
hemisection,
occlusal adjustment and strict plaque control has been tried

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Antibiotic therapy
scaling and root planing and tetracycline 250 mg qid for 14 days every 8 weeks.
excellent bone fill noted in cases of LAP treated with tetracycline, flap surgery
and placement of grafts
Doxycycline 100 mg/day may also be used.
Chlorhexidine rinses should be prescribed.
In refractory cases,
tetracycline resistant Actinobacillus species have been suspected.
In such cases, a combination of amoxicillin and metronidazole has
Been suggested

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GENERALIZED AGGRESSIVE PERIODONTITIS
“characterized by generalized interproximal attachment loss affecting atleast three
permanent teeth other than first molars and incisors”
most pathogenic organisms may be associated, e.g.
Porphyromonas gingivalis,
A. actinomycetemcomitans,
Bacteroids forsythus

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Clinical Characteristics
Age and sex distribution:
It affects persons between puberty and 35 years (but may be older).
No sex discrimination is seen.
Distribution of lesion:
No specific pattern is observed,
all or most of the teeth are affected.
Some of the patients may have systemic manifestations such as
weight loss,
mental depression and
general malaise.

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Treatment of Aggressive Periodontitis
full mouth disinfection which has been proposed by Quirynen et al.
Since it was observed that A. a has the ability to translocate from one person to another
and from site to site, full mouth disinfection was implemented.
It includes the following steps:
Full mouth scaling and root planing (in 2 sessions within 24 hours).
Brushing the dorsum of the tongue with an antimicrobial agent
(1% chlorhexidine gel) for one minute.
Mouthrinsing with antimicrobial agents.
Home irrigation systems.
Other Treatment Options
• Local drug delivery system.
• Host modulation therapy