Interdisciplinary Treatment of Aggressive Periodontitis: Three-Dimensional Cone-Beam X-Ray Computed Tomography Evaluation

Periodontitis is characterized by an inflammatory reaction that affects tooth attachment tissues and can be classified as chronic periodontitis or aggressive periodontitis (AgP) according to clinical characteristics and rate of progression. The current classification of periodontal disease describes two clinically distinct forms of periodontitis. AgP is characterized by rapid progression and severe periodontal destruction, mainly seen in younger individuals (Meng et al., 2007). Chronic periodontitis is characterized by a lower rate of progression (Schätzle et al., 2009). AgP constitutes a group of rare and rapidly progressing forms of periodontitis that are frequently characterized by an early age of clinical onset (Genco et al., 1986). AgP is defined as a destructive periodontal disease affecting more than 14 teeth in young individuals. Its etiology has been linked to the presence of Aggregatibacter actinomycetemcomitans (Fine et al., 2007; Haraszthy et al., 2000; Di Rienzo et al., 1994), host response defects (Page et al., 1984, 1985; Lavine et al., 1979), and possibly to genetic inheritance (Hart & Kornman, 1997; Kinane et al., 2000; Boleghman et al., 1992; Beaty et al., 1987; Hart et al., 1992; Melnick et al., 1976; Page et al., 1985). In contrast, chronic periodontitis is characterized by a lower rate of progression (Schätzle et al., 2009), although like AgP it can reach a severe stage, leading to tooth loss and edentualism. Many clinicians report difficulty in establishing a differential diagnosis for AgP and chronic periodontitis due to an overlapping “gray area” that often negates a clear-cut diagnosis. Such issues raise the question of whether these are actually two distinct clinical entities.