Localized Aggressive Periodontitis

Patient: This was a 17 year old male patient who recently immigrated to the United States from one of the Baltic states. His dental care in his home country was inconsistent and this was his first visit to the dentist in the United States.  His medical history indicated exercise-induced asthma. This patient was seen by me in my previous practice just prior to opening my new office.

Description: He presented for an exam and cleaning with routine imaging for a 17 year old.  This included bitewings and a panoramic x-ray.  On viewing the bitewings, the hygienist consulted me and we took a periapical x-ray of #19.

Dental X-ray bitewing showing bone loss on #19 mesial with localized aggressive periodontitisPeriapical dental x-ray showing bone loss on #19 mesial associated with localized aggressive periodontitis

Clinical exam showed probing depths of 6 mm on the mesio-buccal and mesio-lingual surfaces of #19 with moderate bleeding on probing.   As seen in the above radiographs, there is significant radiographic bone loss on #19 mesial.  Soft tissue elsewhere was within normal limits.  Incipient radiographic bone loss was noted on the contralateral side (#30 mesial) but probing was normal.  This is best seen on the panoramic x-ray:

Panoramic X-ray of patient with localized aggressive periodontitis. Bone loss is visible only on #19 mesial.

The patient was lucky as only #19 was affected by the localized aggressive periodontitis, unlike the classic presentation in which six year molars and incisors are affected.

The patient was treated with localized scaling and root planing around #19 as well as a 10 day regime of Amoxicillin 250mg and Metronidazole 400mg 4 times daily for 1 week.  The patient was seen for a follow-up 1 month later and the tissue was re-evaluated.  There was less bleeding on probing, but 5 mm pocketing still persisted.  The patient was referred to a periodontist.

The periodontist examined the patient and recommended surgery.  Surgery was performed in the area and a 3 walled defect was noted during surgery.  During the surgical procedure, a bone graft of bovine bone (Bio-Oss) along with a collagen membrane were placed.  The patient was seen for follow-ups but no probing was performed.  Six months later, routine probing was done, and the probing depths were at 3 mm with no inflammation. An updated periapical x-ray was taken:

Periapical X-ray showing complete bony fill after bone graft as treatment for localized aggressive periodontitis

The x-ray shows nearly complete bony fill into the bony defect. Based upon the x-ray and the clinical findings, the tooth now has an excellent prognosis.