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03 June 2020

Aggressive Periodontitis: which is the best therapy?

Alessandra Abbà

Aggressive periodontitis (AgP) is a periodontal disease characterized by loss of periodontal tissue, early onset and a relatively rapid progression in the absence of significant plaque. Various factors are involved in its pathogenesis, first of all microbial, genetic and immunologic alteration. The major pathogen responsible in aggressive periodontitis is Aggregatibacter actinomycetemcomitans which is found in high frequency in microbial deposits on the teeth affected. Prevalence of aggressive periodontitis varies widely among various races and ethnicities from 0.1% to 15%.
The aim of the therapy of AgP is to stop the progression of the disease, to maintain health and to regenerate the lost periodontium; both surgical and non-surgical therapy are treatment options for this condition, but there is lack of information about the most effective approach.   The present study aims to compare, through clinical and microbiological parameters, the effect of surgical and non-surgical therapy in the treatment of generalized AgP (GAgP), with a 12-month follow-up.

 Sixteen individuals were selected for this randomized controlled clinical trial with a split-mouth experimental design. All selected patients received a complete periodontal examination and underwent initial periodontal therapy, which included oral hygiene instructions, extraction of hopeless teeth, supragingival scaling, prophylaxis and removal of biofilm retentive factors. The uppers jaws selected to be treated were allocated to groups according to a computer-generated list. Fourteen days after initial therapy, treatments were conducted according to the groups:
 - Non-surgical Therapy (NST) Group: ultrasonic instrumentation associated with scaling and root planing using Gracey and Mini-five curettes.
 - Surgical Therapy (ST) Group: intrasulcular incision and elevation of a mucoperiosteal flap to access root surfaces; and then ultrasonic instrumentation, associated with scaling and root planing using Gracey and Mini-five curettes. Clinical parameters were assessed in 6 points around each tooth as follows: 1) full-mouth plaque index (FMPI), and full-mouth bleeding score (FMBS),probing depth (PD), distance from the bottom of pocket to gingival margin, gingival margin position (GMP), distance from the gingival margin to enamel cement junction (CEJ), clinical attachment level (CAL), distance from the bottom of the pocket to the CEJ.  
 Then, subgingival biofilm samples were obtained to determine Concentrations of Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa). Clinical and microbiological parameters were assessed at baseline (n=16), 3 (n=15), 6 (n=15) and 12 months (n=8) after treatment.

 ST was able to promote higher PD reduction compared to NST in deep pockets at 12 months (p<0.05) and in posterior teeth at 6 months (p<0.05). In addition, higher gingival recession was observed in posterior teeth of the ST group at the 6th month (p<0.05).
However, ST failed to promoted additional CAL gain in any timepoint (p>0.05). Considering bleeding on probing (BoP), there was a significant reduction for all pockets from baseline to 3 months, with no differences between groups. However, in deep pockets, a trend to increase was observed in both groups. There were no statistically significant changes in plaque index (PI), considering different times and different groups.
 Considering all pockets, both treatments promoted significant reduction in PD and CAL gain (p<0.05), with no differences between groups (p>0.05). However, in deep pockets, the ST group presented at the 12th month of follow-up a statistically significant difference in PD (5.9±1.2 mm and 4.8±0.6 mm in NST and ST, respectively, p=0.047). Higher gingival recession was observed in posterior teeth of the ST group at the 6th month (p<0.05). However, ST failed to promoted additional CAL gain in any timepoint (p>0.05). In the end, although significant clinical changes occurred, microbiological evaluation showed no statistical difference in levels of Aa and Pg for both groups at all follow-up periods.

 Based on the results of the present study, it can be concluded that patients suffering from GAgP can undergo surgical therapy with the same benefits than non-surgical therapy. However in both case, levels of Aa and Pg remain unchanged without any reduction in time.  

For additional information: Clinical and Microbiological Evaluation of Surgical and Nonsurgical Treatment of Aggressive Periodontitis 

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