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This case report describes the management of an 18-year-old female who presented with generalized aggressive periodontitis, gingival enlargement and a mesiodens. Diagnosis for aggressive periodontitis was determined based on history, clinical findings and radiographic examination. Treatment included oral prophylaxis, extraction of the mesiodens and elimination of infectious micro-organisms, using a combination of surgical intervention and antimicrobial therapy with long-term maintenance.
Clinical Relevance: Presence of gingival enlargement in cases of aggressive periodontitis may be clinically confusing; hence, the diagnosis should always be based on the patient's history as well as the clinical and radiographic findings.
Article
Aggressive periodontitis is an inflammatory disease, with onset during early adult years, and is characterized by rapid, severe destruction of periodontal tissues, including the alveolar bone, in apparently healthy young adults.1 Aggressive periodontitis usually presents with gingival tissues that are free of inflammation, despite the presence of deep periodontal pockets.1 Diagnosis in cases of aggressive periodontitis is important as bone loss progresses rapidly, and these cases do not respond to conventional therapy. Supernumerary teeth with aggressive periodontitis have been noted in case reports.2–7 Gingival enlargementassociated with aggressive periodontitis is rare.8–10 In this case report, we present the management of a patient with generalized aggressive periodontitis associated with generalized gingival enlargement and mesiodens.
Aggressive periodontitis occurs in localized and generalized forms. Localized aggressive periodontitis usually has a circumpubertal onset with periodontal damage being localized to permanent first molars and incisors.1 However, atypical patterns are possible. The disease is frequently associated with the periodontal pathogen Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) and neutrophil function abnormalities. A robust serum antibody response to infecting agents is frequently detected. Generalized aggressive periodontitis usually affects people under 30 years of age, but patients may be older. There is generalized interproximal attachment loss affecting at least three permanent teeth other than the first molars and incisors.1 Attachment loss occurs in pronounced episodic periods of destruction.
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