関: LAgP

WordNet

having or showing determination and energetic pursuit of your ends; "an aggressive businessman"; "an aggressive basketball player"; "he was aggressive and imperious; positive in his convictions"; "aggressive drivers"
characteristic of an enemy or one eager to fight; "aggressive acts against another country"; "a belligerent tone" (同)belligerent
tending to spread quickly; "an aggressive tumor" (同)fast-growing, strong-growing
made local or oriented locally; "a decentralized and localized political authority" (同)localised
confined or restricted to a particular location; "the localized infection formed a definite abscess" (同)localised
concentrate on a particular place or spot; "The infection has localized in the left eye" (同)localise, focalize, focalise
restrict something to a particular area (同)localise

PrepTutorEJDIC

侵略的な,攻撃的な / 積極的な,反対を恐れない

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/09/08 09:43:41」(JST)

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Aggressive periodontitis describes a type of periodontal disease and includes two of the seven classifications of periodontitis:^[1]

Localized aggressive periodontitis (LAP)
Generalized aggressive periodontitis (GAP)

Aggressive periodontitis is much less common than chronic periodontitis and generally affects younger patients than does the chronic form.^[2]^[3]

The localized and generalized forms are not merely different in extent; they differ in etiology and pathogenesis.

Characteristics

In contrast to chronic periodontitis, primary features that are common to both LAP and GAP are as follows:^[4]

except for the presence of periodontal disease, patients are otherwise healthy
rapid loss of attachment and bone destruction
familial aggregation

The first feature mentioned is to say that patients may not exhibit any disorder that predisposes one to another form of periodontitis.

Moreover, aggressive periodontitis often presents with the following secondary features:^[4]

Amounts of microbial deposits are inconsistent with the severity of the periodontal tissue destruction
elevated proportions of Aggregatibacter actinomycetemcomitans, and in some cases, of Porphyromonas gingivalis as well
phagocyte abnormalities
hyperresponsive macrophage phenotype, including elevated levels of prostaglandin E₂ (PGE₂) and interleukin 1β
progression of pathogenesis may be self-limiting

Localized vs. generalized forms of aggressive periodontitis

The 1999 Consensus Report published by the American Academy of Periodontology permitted the subdivision of aggressive periodontal disease into localized and generalized forms based on enough individually specific features, as follows:^[4]

Localized aggressive periodontitis
- circumpubertal (around the time of puberty) onset
- robust serum antibody response to infective agents: the dominant serotype antibody is IgG2^[5]
- localized first molar/incisor presentation
- Gingival inflammation, edematous, bleeding, pocketing
Generalized aggressive periodontitis
- usually affects patients under 30 years of age
- poor serum antibody response to infective agents
- pronounced episodic nature of periodontal destruction
- generalized presentation affecting at least 3 permanent teeth other than first molars and incisors.
- More bony destruction and more rapid than the LAP
- Bleeding, deep pocketing (BPE 4), Periodontal abscess. No gingival inflammation

Severity of periodontal tissue destruction is subclassified in the same fashion as is chronic periodontitis.

Treatment

Treatment generally involves mechanical therapy (non-surgical or surgical debridement) in conjunction with antibiotics. Several studies suggest that these types of cases respond best to a combination of surgical debridement and antibiotics. Regenerative therapy with bone grafting procedures are often selected in these cases due to the favorable morphology of the bony defects which result from the disease.

Aggregatibacter actinomycetemcomitans (Aa) is one of the most efficient causative pathogens in this disease, Tetracycline seems affecting Aa better (250 mg 3 times daily for 2 weeks). However some suggests the use of Metronidazole 400 mg and Amoxicillin 250 mg 4 times daily for 1 week in severe cases. Root planing and maintaining good oral hygiene is required and Periodontal surgery to gain more access to the roots is needed occasionally.

References

^ Armitage GC (December 1999). "Development of a classification system for periodontal diseases and conditions". Ann. Periodontol. 4 (1): 1–6. doi:10.1902/annals.1999.4.1.1. PMID 10863370.
^ Albandar JM, Tinoco EM (2002). "Global epidemiology of periodontal diseases in children and young persons". Periodontol. 2000 29: 153–76. PMID 12102707.
^ Papapanou PN (November 1996). "Periodontal diseases: epidemiology". Ann. Periodontol. 1 (1): 1–36. PMID 9118256.
^ ^a ^b ^c American Academy of Periodontology (1999). "Consensus report: Aggressive Periodontitis". Ann. Periodontol. 4 (1): 53. doi:10.1902/annals.1999.4.1.53.
^ AAP In-Service Exam, 2008-B40

UpToDate Contents

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1. 小児や青年の歯肉炎と歯周炎 gingivitis and periodontitis in children and adolescents
2. 成人における歯肉炎および歯周炎：分類と歯科治療 gingivitis and periodontitis in adults classification and dental treatment
3. 貧食細胞機能の原発性疾患：概要 primary disorders of phagocytic function an overview
4. 歯性感染症の合併症、診断、および治療 complications diagnosis and treatment of odontogenic infections
5. カプノサイトファーガ・カニモルサス感染症 capnocytophaga

English Journal

Congenital adrenal hyperplasia with localized aggressive periodontitis and amelogenesis imperfecta.

Ajlan SA1.
Congenital anomalies.Congenit Anom (Kyoto).2015 Nov;55(4):186-90. doi: 10.1111/cga.12122.
Congenital adrenal hyperplasia (CAH) is an inherited medical condition that implies defects in steroid biosynthesis. The dental findings of a female patient with CAH are reported. The patient suffered from severe periodontal tissue destruction, obvious enamel defects, as well as some occlusal proble
PMID 26191638

16S rRNA based microarray analysis of ten periodontal bacteria in patients with different forms of periodontitis.

Topcuoglu N1, Kulekci G2.
Anaerobe.Anaerobe.2015 Oct;35(Pt A):35-40. doi: 10.1016/j.anaerobe.2015.01.011. Epub 2015 Jan 29.
DNA microarray analysis is a computer based technology, that a reverse capture, which targets 10 periodontal bacteria (ParoCheck) is available for rapid semi-quantitative determination. The aim of this three-year retrospective study was to display the microarray analysis results for the subgingival
PMID 25638399

Reconstruction of advanced bone defect associated with severely compromised maxillary anterior teeth in aggressive periodontitis: a case report.

Kamil W1, Al Bayati L2, Hussin AS3, Hassan H4.
Journal of medical case reports.J Med Case Rep.2015 Sep 25;9:211. doi: 10.1186/s13256-015-0677-6.
INTRODUCTION: Aggressive periodontitis is characterized by a rapid rate of attachment loss and bone resorption. Regenerative therapy offers reconstruction of the periodontium; however, certain advanced cases with a questionable prognosis might remain a challenge. We report a successful intervention
PMID 26404671