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10 March 2020

Why classify the localized aggressive periodontitis as a separate sub-category of periodontitis

Lara Figini


The aggressive localized periodontitis (LAgP) is localized and mainly affects the first molars and permanent incisors. It has an early onset in adolescents or young adults, often with rapid progression, for which adequate treatment in advance of the disease can arrest or reverse the progression of the disease. The main accomplices of LAgP are the hormonal changes that occur during puberty and the fact that the first molars and incisors are the first permanent teeth to erupt, so the microbial environment may differ compared to when the next teeth emerge.
Pathophysiological studies of the disease have also revealed substantial differences between LAgP and chronic periodontitis CP in both microbiological and immunological responses, although much additional research is needed to fully understand the mechanisms of diseases.

Materials and methods
In a critical non-systematic review, published on JADA November 2019, the authors evaluated the study published in literature about localized aggressive periodontitis (LAgP) compared to chronic periodontitis (CP), specifically analyzing the potential differences in epidemiology, microbiology, immunology, genetics and response to therapy. The purpose of this review is to summarize the vast body of solid evidence supporting the recognition and classification of LAgP as a separate and distinct sub-category from periodontitis in order to stimulate more and more specific research and studies on LAgP.

Results
LAgP differs from CP by localization to incisors and first molars, early onset and rapid progression in adolescents and young adults, and a 10-fold higher prevalence in populations of African or Middle Eastern origin, often with strong familial aggregation. The bacterium Aggregatibacter actinomycetemcomitans and hyperresponsive neutrophils are frequently observed. Antibiotic and nonsurgical therapies are highly effective.

Conclusions
From the data of this review, which must be confirmed in other reviews and similar studies, it can be concluded that LAgP differs in many ways from chronic periodontitis (CP) which is much more common and affects the elderly.
The substantial evidence of differences summarized in this review strongly supports the classification of LAgP as a distinct form of periodontitis.

Classifying LAgP as a distinct subcategory of periodontitis will encourage future research and does not conflict with the newly proposed “staging and grading” system. The silent onset and rapid progression of LAgP make early diagnosis and frequent follow-up with patients essential for effective treatment.

For additional informations: Unique etiologic, demographic, and pathologic characteristics of localized aggressive periodontitis support classification as a distinct subcategory of periodontitis.

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