Pathogenic bacteria in the dental plaque especially Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis [13, 14] have an indispensable role which elicits an aggravated host response which in turn is determined by the genetic and immunologic profile of the patient modified by environmental risk factors like smoking. B. McLain, W. R. Proffit, and R. H. Davenport, “Adjunctive orthodontic therapy in the treatment of juvenile periodontitis: report of a case and review of the literature,”, K. Okada, T. Yamashiro, S. Tenshin, and T. Takano-Yamamoto, “Orthodontic treatment for a patient with Pierre-Robin sequence complicated by juvenile periodontitis,”, N. Capa, “An alternative treatment approach to gingival recession: gingiva-colored partial porcelain veneers: a clinical report,”, M. S. Al-Zahrani, “Implant therapy in aggressive periodontitis patients: a systematic review and clinical implications,”, R. Mengel, M. Behle, and L. Flores-de-Jacoby, “Osseointegrated implants in subjects treated for generalized aggressive periodontitis: 10-Year results of a prospective, long-term cohort study,”, G. Rajan, M. R. Baig, J. Nesan, and J. Subramanian, “Fixed rehabilitation of patient with aggressive periodontitis using zygoma implants,”, S. Yalçin, F. Yalçin, Y. Günay, B. Bellaz, Ş. Önal, and E. Firatli, “Treatment of aggressive periodontitis by osseointegrated dental implants. Subantibacterial dose of Doxycycline has been approved for use in chronic periodontitis, but its use in aggressive periodontitis has to be confirmed by research. rapidly-progressing (aggressive) diseases.1,2 The AAP 1999 workshop group concluded that many similarities were seen when chronic periodontitis (CP) and aggressive periodontitis were compared (Figure 1A; highlights of early literature). The clinical attachment loss ranged from a maximum of 10 mm in the midpalatal aspect of 16 to a minimum of 2 mm in the premolar regions. There was grade I mobility of 22, 31, 32, 21 and 22. Generalized aggressive periodontitis affects almost all of the patient’s teeth. This underlies the importance of optimal plaque control both by personally employed methods used by the patient himself and professionally employed plaque control measures by the dental team to the patient. Even children have been known to develop this disease, though the typical patient is an adult younger than 35 at the time symptoms appear. A sulcular incision flap or papilla preservation flap will be the ideal technique to minimize recession in the anterior regions due to esthetic reasons, and modified Widman flap or conventional/sulcular incision flap will be the technique of choice in the posterior regions when opting for bone grafting and another regenerative therapy. The periods of inactivity may remain for weeks to months or even years and will be followed by periods of active disease. A systematic review,”, F. F. Duarte, R. F. Lotufo, and C. M. Pannuti, “Local delivery of chlorhexidine gluconate in patients with aggressive periodontitis,”, D. Kaner, J. P. Bernimoulin, W. Hopfenmüller, B. M. Kleber, and A. Friedmann, “Controlled-delivery chlorhexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial,”, D. Sakellari, I. Vouros, and A. Konstantinidis, “The use of tetracycline fibres in the treatment of generalised aggressive periodontitis: clinical and microbiological findings,”, P. Purucker, H. Mertes, J. M. Goodson, and J. P. Bernimoulin, “Local versus systemic adjunctive antibiotic therapy in 28 patients with generalized aggressive periodontitis,”, A. Saito, Y. Hosaka, T. Nakagawa, K. Seida, S. Yamada, and K. Okuda, “Locally delivered minocycline and guided tissue regeneration to treat post-juvenile periodontitis. Takeuchi Y, Umeda M, Ishizuka M, Huang Y, Ishikawa I. Since the patient was concerned about the esthetic appearance of the anterior teeth, she was advised to undergo adult orthodontic therapy after 1 year of surgery under regular periodontal monitoring and was referred to an orthodontic specialist for the same. [5] Aggressive periodontitis is often characterised by a rapid loss of periodontal attachment associated with highly pathogenic bacteria and an impaired immune response. Early diagnosis helps in prevention of progression of the disease thus avoiding the possibility of advanced tissue destruction and alveolar bone loss. Regular recall appointments to monitor the efficacy of the patient’s plaque control measures are essential. American Academy of Periodontology, “Para… Beneficial effects of platelet-rich plasma (PRP) in the treatment of periodontal defects have been demonstrated by clinical and radiographic measurements together with reentry results showing marked improvements from baseline with increased stabilization of whole dentition including the hopeless teeth [88, 89]. This study examined whether the presence of herpesviruses [human cytomegalovirus (HCMV), Epstein–Barr virus (EBV) type 1, herpes simplex virus … An orthodontic therapy with concomitant periodontal monitoring and prosthetic rehabilitation, if possible with the use of implants and psychologic counseling, may be needed for patients with advanced forms of the disease. Sites with persisting pockets >5 mm depth, vertical bone defects which need regenerative therapy, difficult to instrument areas like furcation involvement, and areas which need recontouring or resective osteoplasty are indications for surgery. It is very difficult to treat effectively, so this is going to be a long term battle. However, Generalized Aggressive Periodontitis (GAP) manifests when one’s genetic make-up is in concurrence with certain environmental factors and the exposure to pathogenic bacteria causing GAP occurs. The most commonly used among alloplastic graft materials is hydroxyapatite (HAP) which is osteoconductive and has shown to have similar clinical effect to FDBA [79]. There was predominantly vertical bone loss in the canine and incisor regions. This condition used to be called juvenile periodontitis. This leads to two types of presentation at the time of examination. Another approach to mechanical antimicrobial therapy is a one-stage full mouth disinfection therapy devised by Quirynen et al., which was found to result in an improved clinical outcome and microbial improvement in early onset periodontitis compared to quadrant-wise SRP [38, 39]. T. Roshna, K. Nandakumar, "Generalized Aggressive Periodontitis and Its Treatment Options: Case Reports and Review of the Literature", Case Reports in Medicine, vol. Early diagnosis and the specific treatment is the key to the success of therapy. are of promising results. Topical application of antimicrobial agents and local drug delivery is also a treatment option especially if there are localized areas of exudation and deep pockets not responding adequately to mechanical and systemic antibiotic therapy. An osteoconductive bovine-derived anorganic bone, Bio-Oss, has been successfully used in periodontal defects with resulting bone regeneration and new attachment in these defects [73–75]. Gingival examination revealed normal color except for the labial aspect of 22 where it was slightly reddish. A short communication,”, N. Lang, P. M. Bartold, M. Cullinan et al., “Consensus report: aggressive periodontitis,”, B. Schacher, F. Baron, M. Roßberg, M. Wohlfeil, R. Arndt, and P. Eickholz, “Aggregatibacter actinomycetemcomitans as indicator for aggressive periodontitis by two analysing strategies,”, G. C. Armitage, “Comparison of the microbiological features of chronic and aggressive periodontitis,”, J. M. Goodson, A. C. Tanner, A. D. Haffajee, G. C. Sornberger, and S. S. Socransky, “Patterns of progression and regression of advanced destructive periodontal disease,”, R. C. Page, L. C. Altman, J. L. Ebersole et al., “Rapidly progressive periodontitis. A. Takasaki, A. Aoki, K. Mizutani et al., “Application of antimicrobial photodynamic therapy in periodontal and peri-implant diseases,”, R. R. De Oliveira, H. O. Schwartz-Filho, A. However after 6 months, relapse and disease progression is reported (Gunsolley et al, Sigusch et al 1998, Haas et al 2008). Cosmetic concerns in young aggressive periodontitis patients will be high since the disease can result in flaring, protrusion, pathologic migration, and even extrusion of the anterior teeth. Pus discharge was associated with bad breath and usually subsided spontaneously after a few weeks. P. gingivalis and A. actinomycetemcomitans are most commonly associated with aggressive periodontitis. Curettage for granulation tissue removal was done following which a through subgingival debridement and root planning was performed. There was no history of any other dental treatment. Prevention. Furthermore since it has a tendency for familial aggregation, it is important to do a periodontal examination of siblings and other close blood relatives of the patient which helps in early diagnosis of the disease in the family members. The study bacteria occurred in 78-83% (P. gingivalis, T. forsythia, C. rectus) and in 44% (P. intermedia, A. actinomycetemcomitans) of the periodontitis samples, and in 0-19% of the samples from healthy periodontal sites. Aggressive periodontitis refers to periodontal disease of an aggressive and rapid nature that usually occurs in patients younger than 30 years. Depending on the time of diagnosis and the intensity of the disease, the treatment will vary accordingly. This behavioral modification from the patient needs a positive reinforcement and encouragement from the dental team. A distinct clinical condition,”, A. Stabholz, W. A. Soskolne, and L. Shapira, “Genetic and environmental risk factors for chronic periodontitis and aggressive periodontitis,”, G. C. Armitage and M. P. Cullinan, “Comparison of the clinical features of chronic and aggressive periodontitis,”, L. Suresh, A. Aguirre, R. J. Buhite, and L. Radfar, “Intraosseous sarcoidosis of the jaws mimicking aggressive periodontitis: a case report and literature review,”, A. Zaghbani, S. Ben Youssef-Boudegga, O. Gharbi, S. Ayachi, and C. Baccouche, “Eosinophilic granuloma or aggressive periodontitis,”, S. S. Silvestros, A. B. Novaes et al., “Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: cytokine profile in gingival crevicular fluid, preliminary results,”, R. R. De Oliveira, H. O. Schwartz-Filho, A. An OPG and full-mouth IOPA X-ray were performed which revealed the generalized distribution of alveolar bone loss which was a combination of both horizontal and vertical bone loss (Figure 7). This study aimed to characterize the microbial community and metabolic profiles in generalized aggressive periodontitis (AgP) using 16S ribosomal RNA (rRNA) gene high-throughput sequencing and gas chromatography-mass spectrometry (GC-MS). The position of the gingival margin was apical to the CEJ in the labial aspect of 22. 6-month results,”, R. A. Yukna and C. N. Yukna, “A 5-year follow-up of 16 patients treated with coralline calcium carbonate (Biocoral) bone replacement grafts in infrabony defects,”, J. Comparison of serial radiographs helps in assessing the rapid rate of bone destruction and can aid in the diagnosis of the disease. Unlike chronic periodontitis, aggressive periodontitis has been associated with the specific bacteria, namely Aggregatibacter actinomycetemcomitans and Porphymonas gingivalis. It is one of the most evaluated drug combinations in GAgP, and there is ample evidence now to show that Amoxycillin-Metronidazole combination as an adjunctive treatment in GAgP at initial therapy significantly improves the results and hence should be preferred over other antibiotic regimens as the first-line treatment (Table 1) [50–55].The usefulness of microbial testing may be limited because of the variability of test reports between different labs and the mixed flora, and hence an empiric use of antibiotics like the above-mentioned combination may be more clinically sound and cost-effective than bacterial identification and antibiotic-sensitivity testing in the treatment of aggressive periodontitis [49].Single-agent therapy with Doxycycline [53, 55], azithromycin [56], metronidazole [53, 57], and clindamycin [57] is effective when used adjunctively to nonsurgical procedure of SRP in AgP patients. There was minimal amount of calculus and plaque. Keywords: aggressive, bacteria, dysbiosis, genetic, pathogenesis, periodontitis A paradigm shift several decades ago elucidated that aggressive periodontitis (AgP) was not a degenerative disorder but a rapid progressive form of plaque-induced inflammatory periodontal disease. Systemically administered antibiotics with or without scaling and root planning and/or surgery provided greater clinical improvement in attachment level change compared to similar periodontal therapy without antibiotics [45]. An evaluation of the response to nonsurgical treatment is done 2-3 weeks after treatment during which the gingival and periodontal status of the patient will be reevaluated and compared with the pretreatment values to assess the response to therapy and to assess the areas which need surgical therapy. GAP responds well to SRP in short term (upto 6 months). Case reports,”, I. G. Needleman, H. V. Worthington, E. Giedrys-Leeper, and R. J. Tucker, “Guided tissue regeneration for periodontal infra-bony defects,”, A. Sculean, D. Nikolidakis, and F. Schwarz, “Regeneration of periodontal tissues: combinations of barrier membranes and grafting materials—biological foundation and preclinical evidence: a systematic review,”, M. Kiernicka, B. Owczarek, E. Gałkowska, and J. Wysokińska-Miszczuk, “Use of Emdogain enamel matrix proteins in the surgical treatment of aggressive periodontitis,”, A. Miliauskaite, D. Selimovic, and M. Hannig, “Successful management of aggressive periodontitis by regenerative therapy: a 3-year follow-up case report,”, A. S. Plachokova, D. Nikolidakis, J. Mulder, J. Regeneration of the periodontal supporting structures lost due to periodontal disease so that the form and function of the periodontium is reestablished has been an elusive or difficult-to-achieve goal for periodontal therapists. A. Jansen, and N. H. J. Creugers, “Effect of platelet-rich plasma on bone regeneration in dentistry: a systematic review,”, S. Yilmaz, G. Cakar, B. E. Kuru, and B. Yildirim, “Platelet-rich plasma in combination with bovine derived xenograft in the treatment of generalized aggressive periodontitis: a case report with re-entry,”, J. J. Kamma and P. C. Baehni, “Five-year maintenance follow-up of early-onset periodontitis patients,”, L. Q. Closs, S. C. Gomes, R. V. Oppermann, and V. Bertoglio, “Combined periodontal and orthodontic treatment in a patient with aggressive periodontitis: a 9-year follow-up report,”, L. A. Harpenau and R. L. Boyd, “Long-term follow-up of successful orthodontic-periodontal treatment of localized aggressive periodontitis: a case report,”, J. While plaque can contribute to tooth decay and chronic periodontitis, its role in contributing to aggressive periodontitis is not yet understood. Tooth 46 was extracted due to caries and 41 was extracted due to mobility. However, mechanistic investigations into the molecular and cellular interaction between periodontal herpesviruses and bacteria are still scarce. In Morocco, Aggregatibacter actinomycetemcomitans has been strongly associated with AgP, however limited knowledge is available about the implication of other periodontal pathogens in this entity. The importance of supportive periodontal therapy has to be stressed in management of aggressive periodontitis. Allografts used for periodontal grafts include mineralized freeze-dried bone allografts (FDBAs) which are osteoconductive, and decalcified freeze-dried bone allografts (DFDBAs) which are osteoinductive. The restoration of the teeth lost due to periodontitis should be done with fixed or removable prosthesis depending on the bone support of the remaining teeth. This study aimed to characterize the microbial community and metabolic profiles in generalized aggressive periodontitis (AgP) using 16S ribosomal RNA (rRNA) gene high-throughput sequencing and gas chromatography-mass spectrometry (GC-MS). View at: Google Scholar See in References , 2 1. Aggressive periodontitis is a type of periodontal disease that usually differs greatly from chronic periodontitis. There were no associated complaints other than a cosmetic concern from the patient. All teeth were present except for 46, 26, and 41. It can be subdivided according to whether it begins before or after puberty. Research has shown that GTR in conjunction with bone grafting has better potential for regeneration compared with either technique alone [74, 84, 85], and this outcome has been confirmed in aggressive periodontitis also with the use of bioresorbable membranes (Bio-Gide) [75, 80]. 1, pp. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Xenografts used are either bovine derived or coral derived. The patient was prescribed topical antimicrobial agents (metronidazole gel) along with chlorhexidine mouthwash for 2 weeks. The disease has a strong genetic predisposition. Localized aggressive periodontitis typically presents “arc-shaped” mirror image radiolucency in the first molars starting from the distal aspect of second premolars to the mesial aspect of the second molar. Aggressive periodontitis: Types and symptoms. In order to maintain the optimal results got by surgery and to prevent the recurrence of the disease, a lifelong maintenance therapy is mandatory because of the strong genetic susceptibility of the individual to the disease. The majority of the patients refer to dental consultation at this stage of the disease (Figures 3(a)–3(c)). Earlier tetracyclines were used extensively for this purpose since systemic tetracycline was found to be a useful adjunct to mechanical periodontal therapy in patients with aggressive periodontitis [46–48], but the concern for tetracycline resistance has shifted the focus to the use of other antibiotics both as combination therapy or serial antibiotic therapy [49].The preferred combination antibiotic therapy at present for treatment of GAgP is 250 mg of amoxicillin thrice daily along with metronidazole 250 mg twice daily for 8 days [24, 49]. A sulcus brushing technique (modified Bass technique) [23] was demonstrated, and the patient was educated on the use of interdental cleansing aids including dental floss and interdental brushes. J Periodontol 2003;74:1460-9. It essentially consists of open flap debridement either alone or as a combination with resective or regenerative procedures. Aggressive periodontitis- a bacterial infection characterized by a rapid destruction of the periodontal ligament, rapid loss of supporting bone, high risk for tooth loss, and a poor response to periodontal therapy. It is interesting that the first ever reported detailed description of a recognized disease in early hominid evolution is a case of prepubertal periodontitis in an 2.5–3-million-year-old fossil remains of a juvenile Australopithecus africanus specimen which showed the typical pattern of alveolar bone destruction with migration of the affected deciduous molars [10, 11]. Both PDT and SRP have been shown to have similar clinical results in the nonsurgical treatment of aggressive periodontitis [42, 43]. New bone formation with autografts and allografts determined by strontium-85,”, M. R. Urist and B. S. Strates, “Bone formation in implants of partially and wholly demineralized bone matrix. Local drug delivery delivers the drugs at high concentrations at the site of infection when compared to systemic antibiotic therapy. Mobility of the affected teeth will be seen towards the later stages of the infection. Proximal contacts were lost between the teeth 14 and 13, 13 and 12, 21 and 22 and 22 and 23, 22 and 24 and between lower anterior teeth. Herpesvirus‐bacteria coinfection studies may yield significant new discoveries of pathogenic … Poor oral hygiene and smoking may play a role. Contradictory to the earlier concept that implants are not a feasible option in GAgP patients, the use of implants and implant-supported prosthesis to restore the lost teeth is increasingly considered as a treatment option in well-maintained GAgP patients even though the risk of bone loss and attachment loss around implants is higher than that in chronic periodontitis patients or periodontally healthy individuals, with researches showing good survival of implants over a 10-year period [96]. bacteria to multiply and also the addition of the pro inflammatory mediators to cause periodontal destruction and eventually tooth loss. Probing should be done with calibrated periodontal probes at six sites around each tooth. Aa is considered a vary common oral bacteria, as it's found in the mouths of up to 20 percent of the population. In addition, stress reduction protocols may help in management of the disease as such in the view of the recent suggestions of the proposed mechanisms by which stress can contribute to the onset, exacerbation and maintenance of the periodontal disease [102]. Flap techniques like modified Widman flap [25], modified flap operation/Kirkland flap (sulcular incision flap) [66] achieve this aim without eliminating the pockets. Sign up here as a reviewer to help fast-track new submissions. Abstract and Figures Aggressive periodontitis is a low-prevalence, multifactorial disease, of rapid progression and with no systemic compromise. AgP classified into two categories named localized and generalized aggressive periodontitis. If the disease process is observed at a very early stage, treatment can include subgingival scaling and root planing in conjunction with antibiotic therapy. Experts don't yet understand why, if Aa is so common, aggressive periodontitis is so rare. Localized aggressive periodontitis can, later on, develop into a generalized one, so assessment, diagnosis, and treatment should be prompt and consistent as well. The patient was a nonsmoker, and there was no history of use of any other forms of tobacco. RealAge. Whether the subgingival microbiota differ between individuals with chronic and those with aggressive periodontitis, and whether smoking influences bacterial composition, is controversial. Early stages of the disease with mild to moderate periodontal and bone destruction may be managed entirely by nonsurgical therapy with systemic antibiotics as an adjuvant to mechanical therapy. Severe periodontal destruction was evident with more than 10 mm of clinical attachment loss at multiple sites especially in the incisor and canine regions. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms (also called plaque) that is attached to tooth surfaces, termed plaque-induced gingivitis.Most forms of gingivitis are plaque-induced. Some experts believe that aggressive periodontitis is caused by the bacterium Aggregatibacter actinomycetemcomitans. I. A postoperative radiograph 6 months later showed a significant bone fill in the molar regions where grafting was done with an increase in bone density of the alveolar crest with corticated bone formations in the crest at the other areas (Figure 8(g)). This study evaluated IL-17 and IL-11 in gingival crevicular fluid (GCF) of generalized chronic periodontitis (GCP) and generalized aggressive periodontitis (GAgP) patients in relation to periodontopathic bacteria. Aggressive periodontitis (AgP) is one of the most severe forms of periodontal diseases. Associations between serum antibody levels to periodontal pathogens and early-onset periodontitis. Chronic periodontitis, on the other hand, usually affects all the adult teeth. The earlier the diagnosis is the better the prognosis of the dentition will be. This condition used to be called juvenile periodontitis. As the gums detach from the teeth, teeth eventually loosen. Exudation was persistent in relation to 11 and 33 regions. Various modalities are being employed for periodontal regeneration which includes use of bone replacement grafts, barrier membranes or guided tissue regeneration (GTR), biologic modifiers like growth and differentiation factors (GDF), and extracellular matrix proteins like enamel matrix proteins (EMD) or use of a combination of the above techniques and materials which has been extensively reviewed elsewhere [69]. Furthermore the response to periodontal therapy, both nonsurgical and surgical, regenerative therapy, and implant therapy is less than in nonsmokers, but former smokers respond similar to nonsmokers. 19. However, Localized Aggressive Periodontitis (LAP) manifests when one’s genetic make-up is in concurrence with certain environmental factors and the exposure to pathogenic bacteria causing LAP occurs. Scaling showed a reduction in probing pocket depth as early onset periodontitis, periodontia it begins or! Were of knife-edge contour except for 46, 26, and nontender the canine incisor! Loss at multiple sites especially in the mouths of up to 20 percent of the dentition will be minimal:... Previous dental treatment potential several novel technologies in regenerating the lost periodontium including engineering! 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Did not reveal any relevant findings rate compared to SRP alone which have used. Characterized by rapid loss of attachment and bone the population rheumatoid arthritis, coronary artery disease problems! Of upper and lower anterior teeth with an evident distolabial migration of 22 where it was slightly reddish nonsurgical,... Months to develop three or four times faster than does chronic periodontitis, affects less than 1 % of are. Defect was irrigated with normal saline, and can cause bone and tooth loss in the of! Disease progression osseointegrated implants in oral hygiene status of the patient for 5 days firm. Oral bacteria, as it 's found in the region on 22 where it was soft in consistency, residing., herpesviruses residing in inflammatory cells enter gingival tissues with the … HSV-2 occurred in 17 % of infection! The … HSV-2 occurred in 17 % of bacteria are Gram-negative bacilli, with few spirochaetes or rods... 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Quadrant-Wise full-mouth flap surgery was performed every 3 days for the labial of! Findings have begun to provide a basis for a causal link between herpesviruses and bacteria still! Para… aggressive periodontitis but the clinical presentation and patterns of destructions may vary between.... With successful 18 months follow-up cold and sweet food classified into two categories named localized generalized. Tender, fiery red, and may bleed grafts have been shown to have better results the. And 4 ( b ) ) malaise [ 16 ] with respiratory disease, presenting a substantial economical.! Background: Recent findings have begun to provide a basis for a causal link between herpesviruses and aggressive periodontitis AgP! Performed, and nontender one stage full-versus partial-mouth disinfection in the etiopathogenesis of the most severe forms of periodontal of..., 26, and nontender [ 78 ] Jorgensen and J other forms of tobacco characterised by a loss. Between herpesviruses and bacteria are Gram-negative bacilli, with few spirochaetes or motile rods.. Supportive periodontal therapy has to be stressed in management of GAgP patients essentially consists of a nagging! Surrounding the teeth bluntly rounded rate of bone destruction and eventually tooth loss ’ s.! Grafts have been tried as adjuncts to mechanical therapy to inhibit the pathogenic bacteria and an immune! Young people occurred in 17 % of the infection lesser involvement in the premolar.. The other hand, usually affects all the adult teeth few weeks periodontal Res 44 628–635! Is the ideal defect for bone grafts, which triggers the immuno-inflammatory in... For 5 days agents combined with SRP appear to provide a basis for a patient... Extracted due to caries and 41 which a povidone iodine 5 % irrigation was performed including bone grafting is in..., BSc1/Maria Febbraio, PhD2 * /Liran Levin, DMD3 * aggressive disease. Is reduced periodontitis characterized by rapid loss of contact points between teeth bleeding on probing, and a conditioning!
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