Abstract
The present study aimed to evaluate clinical and microbiological effects of surgical and nonsurgical periodontal therapy in generalized aggressive periodontitis (GAgP) treatment. Sixteen GAgP patients were included in this randomized split-mouth design clinical trial. Maxillary quadrants were allocated into two groups: Nonsurgical Therapy (NST) and Surgical Therapy (ST). The following clinical parameters were assessed: plaque index (PI), bleeding on probing index (BoP), probing depth (PD), clinical attachment level (CAL) and gingival margin position (GMP). Concentrations of Porphyromonas gingivalis (Pg) and Aggregatibacter actinomycetemcomitans (Aa) in the subgingival biofilm were also determined. 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). Moreover, microbiological evaluation showed no statistical difference in levels of Aa and Pg for both groups at all follow-up periods. Surgical therapy promoted similar clinical benefits to GAgP therapy. Moreover, both therapies failed to reduce Aa and Pg levels at different follow-up times.
Highlights
Aggressive periodontitis (AgP) is a complex disease with various factors involved in its pathogenesis
There remains a challenge for clinicians in the treatment of AgP, due to its rapid progression and the paradigm of worse response
The findings of the present study demonstrated that the surgical approach promoted additional probing depth reduction in deep pockets (1.1 mm at 12-month follow-up) and posterior teeth (0.7 mm at 6-month follow-up), it promoted higher gingival recession in all pockets (0.3 mm) and posterior teeth (0.5 mm)
Summary
Aggressive periodontitis (AgP) is a complex disease with various factors involved in its pathogenesis. Microbial challenge is a primary etiological factor for the onset and progression of AgP. In addition to genetic and immunologic factors, which were not yet fully established, some microbiological characteristics have been described as determinant and important for the onset and progression of this disease. Biocompatibilization of the root surface is essential for reestablishment of periodontal health. In this context, mechanic therapy is the treatment of choice and has been the target of several studies aiming to reach better treatment protocols that could promote predictable results for AgP control. Nonsurgical periodontal therapy appears an option for the treatment of this condition, it is associated with a reduced clinical response [7] and a high percentage of residual sites [8] which reinforces the need for other approaches to reach better results
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