Author- Dr Aparna Pandya( Mrs India Vivacious 2019) 

Aggressive periodontitis describes a type of periodontal complaint as defined by the 1999 Classification system. It's of 2 types-

1. Localized aggressive periodontitis (LAP Type)
2. Generalized aggressive periodontitis (GAP)

LAP as the name suggests is localized. It is generally seen in first molar or incisor interproximal attachment loss, whereas GAP is the interproximal attachment loss affecting at least three teeth other than incisors and first molar. Aggressive periodontitis is much less common than generalized aggressive periodontitis and generally affects younth cases than does the older individuals.

Aggressive periodontitis is frequently characterised by a rapid loss of periodontal attachment associated with largely pathogenic bacteria and causes lot of attachment loss in vulnerable individuals. Various studies have associated Aggregatibacter actinomycetemcomitans, formerly known as Actinobacillus actinomycetemcomitans, with aggressive periodontitis.

According to the 1999 International Workshop for the classification of Periodontal conditions, aggressive periodontitis was defined according to 3 primary features, These features are common for both localized and generalized form of aggressive periodontitis.

• Cases are clinically healthy.
• The rate of loss of attachment and bone loss is rapid.
•  Aggressive periodontitis runs in the case's family.

The LAP form begins around the age of puberty where there's interproximal loss of attachment of the first molar, and or incisors. on at least two teeth( one which is a first molar) and no involvement teeth other than the first molars and incisors, lack of inflammation and deep periodontal pockets with advanced bone loss. There's also a fairly fast progression of periodontal attachment loss.

Following the original assessment, a treatment plan is generally developed for each individual . As the overall treatment generalities and pretensions for AgP aren't significantly different from that of GAP, the different treatment phases ( cause related remedy; reappraisal for response to remedy; definitive remedy; and conservation) are analogous for both types of periodontitis.

Nonetheless, the considerable quantum of bone loss relative to the youthful age of the existent in AgP necessitates  frequently more aggressive treatment approach, to halt farther periodontal destruction and recapture as important periodontal attachment as possible. The ideal of treatment is to produce a conducive clinical condition for retaining as numerous teeth, for as long as possible.

This stage involves discussion of the complaint with the case.

• Oral Hygiene instructions are advised to the patient. Proper brusing and flossing fashion is tutored and the significance of oral hygiene is made apprehensive to the cases and the complications that might follow in the lacking.
• Smoking is a significant threat factor for AgP, with cases who exhibit having more affected teeth with loss of clinical attachment and further bone loss than non-smoking cases with AgP. Hence case is advised to stop smoking.
• Scaling and root planing to remove original factors is performed.
• The periodontal remedy carried out at this stage is of a non-surgical approach, which is aimed at the junking of supra- and sub-gingival  deposits, to drop the microbial load, bacteria biofilm, and from the periodontally involved spots.
• Antibiotics- There's substantiation that the fresh use of systemic antibiotics in confluence with non-surgical periodontal treatment results in a further favourable clinical response, as compared to just periodontal treatment alone, as it helps to suppress pathogenic bacteria and produce a health- associated biofilm. There have been numerous antibiotic administrations proposed for the treatment of AgP. Still, the combination of choice according to current exploration is a combination of amoxicillin( 500 mg, thrice/ day) and metronidazole( 200 mg, thrice/ day), for 7 days, starting on the day of the final debridement. Doxycycline( 100 mg, formerly/ day, with a starting first cure of 200 mg) is the choice of antibiotics for cases resistant to penicillin.
• Periodontal surgery- If it's a localised problem and if the case is non-response to non-surgical treatment despite the oral hygiene being constantly excellent. This could involve an open  debridement with or without regenerative procedures, for gaining access and visibility to root and furcation areas so that a thorough instrumentation and debridement can be carried out.

Conclusion

 Aggressive periodontitis has a high vulnerability for progression of complaint in individuals with high threat and hence it's important to keep the case on frequent recall check up and maintaining periodontal health after active periodontal remedy.