This study aimed to characterize the microbial community and metabolic profiles in generalized aggressive periodontitis (AgP) using 16S ribosomal RNA (rRNA) gene high-throughput sequencing and gas chromatography-mass spectrometry (GC-MS). A recall visit after 2 weeks showed reduction in inflammation and percentage of sites showing bleeding on probing. A postoperative radiograph 6 months later showed a significant bone fill in the molar regions where grafting was done with an increase in bone density of the alveolar crest with corticated bone formations in the crest at the other areas (Figure 8(g)). Several local anti-infective agents combined with SRP appear to provide additional benefits in PD reduction and CAL gain compared to SRP alone. Aggressive periodontitis can be differentiated from chronic periodontitis by the age of onset, rapid rate of disease progression, the nature and composition of the associated subgingival microflora, alterations in host immune response, and a familial aggregation of the diseased individuals . New bone formation with autografts and allografts determined by strontium-85,”, M. R. Urist and B. S. Strates, “Bone formation in implants of partially and wholly demineralized bone matrix. Biomodification of the root surface (Root conditioning) with citric acid, tetracycline, or fibronectin is preferable when performing bone grafting or GTR for better clinical results . Some patients may show systemic manifestations such as weight loss, mental depression and general malaise . Several reports are there which have successfully used osseointegrated implants in oral rehabilitation of partially edentulous patients treated for GAgP [97–99]. rapidly-progressing (aggressive) diseases.1,2 The AAP 1999 workshop group concluded that many similarities were seen when chronic periodontitis (CP) and aggressive periodontitis were compared (Figure 1A; highlights of early literature). Sites with persisting pockets >5 mm depth, vertical bone defects which need regenerative therapy, difficult to instrument areas like furcation involvement, and areas which need recontouring or resective osteoplasty are indications for surgery. The list of antibiotic regimens with evidence of superior clinical outcome when used as an adjuvant to SRP in GAgP [, Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature, Department of Periodontics, People’s Dental Academy, Bhopal 462010, India, Department of Periodontics, Azeezia Dental College, Kollam 691537, India, G. C. Armitage, “Development of a classification system for periodontal diseases and conditions,”, American Academy of Periodontology, “Parameter on aggressive periodontitis,”, R. T. Demmer and P. N. Papapanou, “Epidemiologic patterns of chronic and aggressive periodontitis,”, J. M. Albandar, M. B. Muranga, and T. E. Rams, “Prevalence of aggressive periodontitis in school attendees in Uganda,”, C. Susin and J. M. Albandar, “Aggressive periodontitis in an urban population in southern Brazil,”, B. Gottlieb, “Die diffuse atrophy des alveolarknochens,”, E. Guzeldemir and H. U. Toygar, “From alveolar diffuse atrophy to aggressive periodontitis: a brief history,”, R. R. Ranney, “Classification of periodontal diseases,”, J. Caton, “Periodontal diagnosis and diagnostic aids: consensus report,” in, U. Ripamonti, “Paleopathology in Australopithecus africanus: a suggested case of a 3-million-year-old prepubertal periodontitis,”, U. Ripamonti, “The hard evidence of alveolar bone loss in early hominids of southern Africa. This interaction leads to the destruction of the periodontal tissues Review articles are excluded from this waiver policy. Oral bacteria are highly associated with oral diseases, and periodontitis is a strongly prevalent disease, presenting a substantial economical burden. Sign up here as a reviewer to help fast-track new submissions. Aggressive periodontitis causes attachment loss of the teeth, bone destruction, and pain.  Aggressive periodontitis is often characterised by a rapid loss of periodontal attachment associated with highly pathogenic bacteria and an impaired immune response. This disease is often localized, affecting only a few teeth. Proximal contacts were lost between the teeth 14 and 13, 13 and 12, 21 and 22 and 22 and 23, 22 and 24 and between lower anterior teeth. Including observations on acetone-fixed intra and extracellular proteins,”, T. W. Mabry, R. A. Yukna, and W. W. Sepe, “Freeze-dried bone allografts combined with tetracycline in the treatment of juvenile periodontitis,”, J. T. Mellonig, “Human histologic evaluation of a bovine-derived bone xenograft in the treatment of periodontal osseous defects,”, M. Camelo, M. L. Nevins, R. K. Schenk et al., “Clinical, radiographic, and histologic evaluation of human periodontal defects treated with bio-oss and bio-gide,”, B. Owczarek, M. Kiernicka, E. Gałkowska, and J. Wysokińska-Miszczuk, “The application of Bio-Oss and Bio-Gide as implant materials in the complex treatment of aggressive periodontitis,”, M. L. Nevins, M. Camelo, S. E. Lynch, R. K. Schenk, and M. Nevins, “Evaluation of periodontal regeneration following grafting intrabony defects with Bio-Oss Collagen: a human histologic report,”, R. A. Yukna, J. T. Krauser, D. P. Callan, G. H. Evans, R. Cruz, and M. Martin, “Multi-center clinical comparison of combination anorganic bovine-derived hydroxyapatite matrix (ABM)/cell binding peptide (P-15) and ABM in human periodontal osseous defects. An individual's own immune response to the bacteria triggers this autoimmune condition. Decalcification of the graft exposes the complex bone morphogenic proteins (BMPs) from its matrix which can induce osteoblastic proliferation in the recipient site. Aggressive Periodontitis is a unique disease affecting the periodontium causing irreparable damage. Tooth 26 was grossly decayed with just root stump present. Symptoms can vary widely, however, from one person to the next. The criteria for selection of antibiotics are not clear in AgP; the choice depends on the case, disease-related factors and patient-related factors like compliance, allergies, and potential side effects. Or in other words, “maintenance therapy never ends” for a GAgP patient. T. Roshna, K. Nandakumar, "Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature", Case Reports in Medicine, vol. GAP responds well to SRP in short term (upto 6 months). Patients with generalized aggressive periodontitis usually present with intense gingival inflammation, but that may or may not be the case with localized aggressive periodontitis. Poor oral hygiene and smoking may play a role. For example, periodontitis is linked with respiratory disease, rheumatoid arthritis, coronary artery disease and problems controlling blood sugar in diabetes. Pockets were especially deeper in the molar and incisor regions with slightly lesser involvement in the premolar region. A 32-year-old female patient presented with the complaint of a recently noticed spacing between the upper front teeth. Another approach to mechanical antimicrobial therapy is a one-stage full mouth disinfection therapy devised by Quirynen et al., which was found to result in an improved clinical outcome and microbial improvement in early onset periodontitis compared to quadrant-wise SRP [38, 39]. Takeuchi Y, Umeda M, Ishizuka M, Huang Y, Ishikawa I. Aggressive periodontitis (AgP) is one of the most severe forms of periodontal diseases. Though there is more evidence on its application in chronic periodontitis, till future researches are available; the same agents can be employed in aggressive periodontitis patients as well empirically. The patient was put on maintenance therapy during which he continued with the topical antimicrobial agents and desensitizing agents and was evaluated for surgical therapy. In its early stage, called gingivitis, the gums become swollen, red, and may bleed. Flap techniques like modified Widman flap , modified flap operation/Kirkland flap (sulcular incision flap)  achieve this aim without eliminating the pockets. Both PDT and SRP have been shown to have similar clinical results in the nonsurgical treatment of aggressive periodontitis [42, 43]. Generalized aggressive periodontitis affects almost all of the patient’s teeth. View at: Google Scholar See in References , 2 1. The key to successful treatment is early diagnosis. Aggressive periodontitis is a type of periodontal disease that usually differs greatly from chronic periodontitis. Furthermore the response to periodontal therapy, both nonsurgical and surgical, regenerative therapy, and implant therapy is less than in nonsmokers, but former smokers respond similar to nonsmokers. A periodontal pack was placed, and antibiotics and analgesics were prescribed for the patient for 5 days. I. Earlier tetracyclines were used extensively for this purpose since systemic tetracycline was found to be a useful adjunct to mechanical periodontal therapy in patients with aggressive periodontitis [46–48], but the concern for tetracycline resistance has shifted the focus to the use of other antibiotics both as combination therapy or serial antibiotic therapy .The preferred combination antibiotic therapy at present for treatment of GAgP is 250 mg of amoxicillin thrice daily along with metronidazole 250 mg twice daily for 8 days [24, 49]. The above facts suggest that psychotherapy be incorporated for the future protocols for treatment of GAgP patients suffering from emotional effects of tooth loss. The most common reported complaints are a recently noticed flaring and progressing spacing of anterior teeth and bleeding from gums comparatively in a young patient but patients can be older as well (Figures 1(a)–1(c)). This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Generalized aggressive periodontitis affects almost all of the patient’s teeth. Abstract and Figures Aggressive periodontitis is a low-prevalence, multifactorial disease, of rapid progression and with no systemic compromise. Adjunctive use of LDD agents like controlled release biodegradable chlorhexidine gluconate chip [61, 62], tetracycline fibers [63, 64], and minocycline-Hcl gel  has been tried in aggressive periodontitis with superior clinical outcomes. It can be subdivided according to whether it begins before or after puberty. Aggressive periodontitis refers to multifactorial, severe, & rapidly progressive form of periodontitis, which primarily but not exclusively … The defects may be a combination of vertical and horizontal defects (Figures 4(a) and 4(b)). The graft was a xenograft (Bovine graft—Ossopan), which was mixed with the blood from the surgical site and placed into the defect after presuturing the site with silk sutures. Severe pain is rarely experienced by the patients except in situations where a periodontal abscess develops or a periodontal-endodontic infection occurs via accessory canals or tooth apex. There was no history of any previous dental treatment. The flap was reflected following which sulcular incision and interdental incision were made to remove the wedge of tissue. 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. 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. During this period, there will be active bone destruction and attachment loss. A modified Widman flap surgery  in conjunction with bone replacement graft was performed in the molar regions (Figures 8(a)–8(e)) whereas a sulcular incision flap (Kirkland flap) was performed in the maxillary and mandibular anterior region to minimize the recession after healing for esthetic purposes. However, Localized Aggressive Periodontitis (LAP) manifests when one’s genetic make-up is in concurrence with certain environmental factors and the exposure to pathogenic bacteria causing LAP occurs. The bacteria are often isolated from the subgingival, loosely adherent plaque inhabiting the pockets associated with the severe bone defects. The study bacteria occurred in 78-83% (P. gingivalis, T. forsythia, C. rectus) and in 44% (P. intermedia, A. actinomycetemcomitans) of the periodontitis samples, and in 0-19% of the samples from healthy periodontal sites. 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. The majority of the patients refer to dental consultation at this stage of the disease (Figures 3(a)–3(c)). Bleeding on probing or even spontaneous bleeding and purulent exudation may be evident. A preprocedural rinse with antimicrobial agent was done to minimize the bacterial count in the mouth. Clinical findings,”, M. Aimetti, F. Romano, N. Guzzi, and G. Carnevale, “One-stage full-mouth disinfection as a therapeutic approach for generalized aggressive periodontitis,”, C. Mongardini, D. Van Steenberghe, C. Dekeyser, and M. Quirynen, “One stage full-versus partial-mouth disinfection in the treatment of chronic adult or generalized early-onset periodontitis. The procedure was performed every 3 days for the next 2 weeks. Early diagnosis and the specific treatment is the key to the success of therapy. I. With the current treatment modalities, successful long-term maintenance of the dentition in a healthy and functional state can be achieved. 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. 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