Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature
Identifieur interne : 000B64 ( Ncbi/Merge ); précédent : 000B63; suivant : 000B65Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature
Auteurs : T. Roshna [Inde] ; K. Nandakumar [Inde]Source :
- Case Reports in Medicine [ 1687-9627 ] ; 2012.
Abstract
Generalized aggressive periodontitis results in rapid destruction of the periodontium and can lead to early tooth loss in the affected individuals if not diagnosed early and treated appropriately. The diagnostic features of the disease are characteristic, but the clinical presentation and patterns of destructions may vary between patients. Successful management of the disease is challenging especially if diagnosed at advanced stages of the disease, but not impossible with the current therapeutic choices for the disease. A vast array of treatment modalities is available which can be employed in the treatment of generalized aggressive periodontitis with varying success rates, but a definite guideline for the management is yet to be formulated. However, with the exponential rate of developments in periodontal research, regenerative therapy, tissue engineering, and genetic technologies, the future seems promising in regard to options at managing the disease. This paper attempts to describe the clinical and radiographic diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of generalized aggressive periodontitis patients with case reports and a brief review.
Url:
DOI: 10.1155/2012/535321
PubMed: 22291715
PubMed Central: 3265097
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature</title><author><name sortKey="Roshna, T" sort="Roshna, T" uniqKey="Roshna T" first="T." last="Roshna">T. Roshna</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Periodontics, People's Dental Academy, Bhopal 462010, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Periodontics, People's Dental Academy, Bhopal 462010</wicri:regionArea><wicri:noRegion>Bhopal 462010</wicri:noRegion></affiliation></author><author><name sortKey="Nandakumar, K" sort="Nandakumar, K" uniqKey="Nandakumar K" first="K." last="Nandakumar">K. Nandakumar</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Periodontics, Azeezia Dental College, Kollam 691537, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Periodontics, Azeezia Dental College, Kollam 691537</wicri:regionArea><wicri:noRegion>Kollam 691537</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22291715</idno><idno type="pmc">3265097</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265097</idno><idno type="RBID">PMC:3265097</idno><idno type="doi">10.1155/2012/535321</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">000247</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000247</idno><idno type="wicri:Area/Pmc/Curation">000247</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000247</idno><idno type="wicri:Area/Pmc/Checkpoint">000157</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000157</idno><idno type="wicri:Area/Ncbi/Merge">000B64</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature</title><author><name sortKey="Roshna, T" sort="Roshna, T" uniqKey="Roshna T" first="T." last="Roshna">T. Roshna</name><affiliation wicri:level="1"><nlm:aff id="I1">Department of Periodontics, People's Dental Academy, Bhopal 462010, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Periodontics, People's Dental Academy, Bhopal 462010</wicri:regionArea><wicri:noRegion>Bhopal 462010</wicri:noRegion></affiliation></author><author><name sortKey="Nandakumar, K" sort="Nandakumar, K" uniqKey="Nandakumar K" first="K." last="Nandakumar">K. Nandakumar</name><affiliation wicri:level="1"><nlm:aff id="I2">Department of Periodontics, Azeezia Dental College, Kollam 691537, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Department of Periodontics, Azeezia Dental College, Kollam 691537</wicri:regionArea><wicri:noRegion>Kollam 691537</wicri:noRegion></affiliation></author></analytic><series><title level="j">Case Reports in Medicine</title><idno type="ISSN">1687-9627</idno><idno type="eISSN">1687-9635</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Generalized aggressive periodontitis results in rapid destruction of the periodontium and can lead to early tooth loss in the affected individuals if not diagnosed early and treated appropriately. The diagnostic features of the disease are characteristic, but the clinical presentation and patterns of destructions may vary between patients. Successful management of the disease is challenging especially if diagnosed at advanced stages of the disease, but not impossible with the current therapeutic choices for the disease. A vast array of treatment modalities is available which can be employed in the treatment of generalized aggressive periodontitis with varying success rates, but a definite guideline for the management is yet to be formulated. However, with the exponential rate of developments in periodontal research, regenerative therapy, tissue engineering, and genetic technologies, the future seems promising in regard to options at managing the disease. This paper attempts to describe the clinical and radiographic diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of generalized aggressive periodontitis patients with case reports and a brief review.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Armitage, Gc" uniqKey="Armitage G">GC Armitage</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Demmer, Rt" uniqKey="Demmer R">RT Demmer</name></author><author><name sortKey="Papapanou, Pn" uniqKey="Papapanou P">PN Papapanou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Albandar, Jm" uniqKey="Albandar J">JM Albandar</name></author><author><name sortKey="Muranga, Mb" uniqKey="Muranga M">MB Muranga</name></author><author><name sortKey="Rams, Te" uniqKey="Rams T">TE 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Med</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Med</journal-id><journal-id journal-id-type="publisher-id">CRIM</journal-id><journal-title-group><journal-title>Case Reports in Medicine</journal-title></journal-title-group><issn pub-type="ppub">1687-9627</issn><issn pub-type="epub">1687-9635</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22291715</article-id><article-id pub-id-type="pmc">3265097</article-id><article-id pub-id-type="doi">10.1155/2012/535321</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Roshna</surname><given-names>T.</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Nandakumar</surname><given-names>K.</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Periodontics, People's Dental Academy, Bhopal 462010, India</aff><aff id="I2"><sup>2</sup>Department of Periodontics, Azeezia Dental College, Kollam 691537, India</aff><author-notes><corresp id="cor1">*T. Roshna: <email>roshna_t@yahoo.com</email></corresp><fn fn-type="other"><p>Academic Editor: Remo Panaccione</p></fn></author-notes><pub-date pub-type="ppub"><year>2012</year></pub-date><pub-date pub-type="epub"><day>12</day><month>1</month><year>2012</year></pub-date><volume>2012</volume><elocation-id>535321</elocation-id><history><date date-type="received"><day>28</day><month>7</month><year>2011</year></date><date date-type="rev-recd"><day>4</day><month>10</month><year>2011</year></date><date date-type="accepted"><day>7</day><month>10</month><year>2011</year></date></history><permissions><copyright-statement>Copyright © 2012 T. Roshna and K. Nandakumar.</copyright-statement><copyright-year>2012</copyright-year><license license-type="open-access"><license-p>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.</license-p></license></permissions><abstract><p>Generalized aggressive periodontitis results in rapid destruction of the periodontium and can lead to early tooth loss in the affected individuals if not diagnosed early and treated appropriately. The diagnostic features of the disease are characteristic, but the clinical presentation and patterns of destructions may vary between patients. Successful management of the disease is challenging especially if diagnosed at advanced stages of the disease, but not impossible with the current therapeutic choices for the disease. A vast array of treatment modalities is available which can be employed in the treatment of generalized aggressive periodontitis with varying success rates, but a definite guideline for the management is yet to be formulated. However, with the exponential rate of developments in periodontal research, regenerative therapy, tissue engineering, and genetic technologies, the future seems promising in regard to options at managing the disease. This paper attempts to describe the clinical and radiographic diagnostic features and the current treatment options along with a suggested protocol for comprehensive management of generalized aggressive periodontitis patients with case reports and a brief review.</p></abstract></article-meta></front><floats-group><fig id="fig1" position="float"><label>Figure 1</label><caption><p>(a) Patient presenting with flaring of the anterior teeth. (b) and (c) Deep pockets revealed by probing in a periodontium with lack of clinical inflammation.</p></caption><graphic xlink:href="CRIM2012-535321.001"></graphic></fig><fig id="fig2" position="float"><label>Figure 2</label><caption><p>(a)–(d) Clinical and radiographic appearance of GAgP in a 25-year-old smoker with poor oral hygiene. (e) A 19-year-old smoker with GAgP demonstrating severe periodontal destruction.</p></caption><graphic xlink:href="CRIM2012-535321.002"></graphic></fig><fig id="fig3" position="float"><label>Figure 3</label><caption><p>(a)–(c) Features of severe gingival inflammation presented at the stage of active disease.</p></caption><graphic xlink:href="CRIM2012-535321.003"></graphic></fig><fig id="fig4" position="float"><label>Figure 4</label><caption><p>(a) Arc-shaped radiolucency at the 1st molar region in localized aggressive periodontitis. (b) Generalized distribution of bone loss seen in GAgP with vertical defects.</p></caption><graphic xlink:href="CRIM2012-535321.004"></graphic></fig><fig id="fig5" position="float"><label>Figure 5</label><caption><p>(a)–(d) Deep pockets were present even though signs of gingival inflammation other than bleeding on probing were absent.</p></caption><graphic xlink:href="CRIM2012-535321.005"></graphic></fig><fig id="fig6" position="float"><label>Figure 6</label><caption><p>Periodontal charting showing generalized deep pockets and clinical attachment loss.</p></caption><graphic xlink:href="CRIM2012-535321.006"></graphic></fig><fig id="fig7" position="float"><label>Figure 7</label><caption><p>Orthopantomogram of the patient demonstrating generalized distribution of bone loss.</p></caption><graphic xlink:href="CRIM2012-535321.007"></graphic></fig><fig id="fig8" position="float"><label>Figure 8</label><caption><p>(a)–(e) Modified Widman flap in conjunction with bone grafting performed. (f) Postoperative evaluation showing probing depth within normal limits. (g) 6-Month postoperative intraoral periapical radiographs.</p></caption><graphic xlink:href="CRIM2012-535321.008"></graphic></fig><fig id="fig9" position="float"><label>Figure 9</label><caption><p>(a) and (b) Clinical presentation with deep pockets, recession, and pathologic migration of teeth.</p></caption><graphic xlink:href="CRIM2012-535321.009"></graphic></fig><fig id="fig10" position="float"><label>Figure 10</label><caption><p>Pretreatment periodontal charting shows deep pockets with generalized clinical attachment loss.</p></caption><graphic xlink:href="CRIM2012-535321.010"></graphic></fig><fig id="fig11" position="float"><label>Figure 11</label><caption><p>Orthopantomogram showing generalized bone loss with advanced vertical defect in 13 and 33 regions.</p></caption><graphic xlink:href="CRIM2012-535321.011"></graphic></fig><fig id="fig12" position="float"><label>Figure 12</label><caption><p>(a)–(c) Flap surgery in conjunction with bone grafting (HAP) and papilla preservation flap between 11 and 21. (d)–(f) Deep circumferential defect treated with bone grafting in conjunction with guided tissue regeneration.</p></caption><graphic xlink:href="CRIM2012-535321.012"></graphic></fig><fig id="fig13" position="float"><label>Figure 13</label><caption><p>(a) and (b) Postoperative photographs showing probing depths within normal limits with excellent gingival condition; however, there was slight increase in recession after healing. (c) and (d) Comparison of preoperative and 1 year postoperative radiographs shows good bone fill at the defect in relation to 33.</p></caption><graphic xlink:href="CRIM2012-535321.013"></graphic></fig><fig id="fig14" position="float"><label>Figure 14</label><caption><p>The treatment commences with a nonsurgical phase following which psychotherapy sessions are started for the needy patients, and patients are put on maintenance therapy/supportive periodontal therapy thereafter. While the patient is on maintenance therapy, one or more of the 3 modalities of surgical periodontal therapy can be performed depending upon the indication and once periodontium has been stabilized, an interdisciplinary treatment for the restoration of lost teeth and correction of cosmetic problems is completed following which the patient continues for a “lifelong” maintenance therapy.</p></caption><graphic xlink:href="CRIM2012-535321.014"></graphic></fig><table-wrap id="tab1" position="float"><label>Table 1</label><caption><p>The list of antibiotic regimens with evidence of superior clinical outcome when used as an adjuvant to SRP in GAgP [<xref ref-type="bibr" rid="B24">24</xref>, <xref ref-type="bibr" rid="B47">45</xref>–<xref ref-type="bibr" rid="B59">57</xref>].</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1"> Mode of therapy</th><th align="center" rowspan="1" colspan="1">Antibiotics used</th><th align="left" rowspan="1" colspan="1">Usual recommended dosage</th></tr></thead><tbody><tr><td align="left" rowspan="2" colspan="1"> Combination therapy</td><td align="center" rowspan="1" colspan="1">Metronidazole + Amoxicillin</td><td align="left" rowspan="1" colspan="1">250 mg of each thrice daily for 8 days</td></tr><tr><td align="center" rowspan="1" colspan="1">Metronidazole + Ciprofloxacin</td><td align="left" rowspan="1" colspan="1">500 mg of each twice daily for 8 days</td></tr><tr><td align="center" colspan="3" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="5" colspan="1">Single-Agent therapy</td><td align="center" rowspan="1" colspan="1">Doxycycline or Minocycline</td><td align="left" rowspan="1" colspan="1">100–200 mg once daily for 21 days</td></tr><tr><td align="center" rowspan="1" colspan="1">Metronidazole</td><td align="left" rowspan="1" colspan="1">500 mg thrice daily for 8 days</td></tr><tr><td align="center" rowspan="1" colspan="1">Tetracycline</td><td align="left" rowspan="1" colspan="1">250 mg 4 times daily for 1 week</td></tr><tr><td align="center" rowspan="1" colspan="1">Azithromycin</td><td align="left" rowspan="1" colspan="1">500 mg once daily for 3 days</td></tr><tr><td align="center" rowspan="1" colspan="1">Clindamycin</td><td align="left" rowspan="1" colspan="1">300 mg thrice daily for 10 days</td></tr></tbody></table></table-wrap></floats-group></pmc><affiliations><list><country><li>Inde</li></country></list><tree><country name="Inde"><noRegion><name sortKey="Roshna, T" sort="Roshna, T" uniqKey="Roshna T" first="T." last="Roshna">T. Roshna</name></noRegion><name sortKey="Nandakumar, K" sort="Nandakumar, K" uniqKey="Nandakumar K" first="K." last="Nandakumar">K. Nandakumar</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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