Palabras clave
periodontitis agresiva, diagnóstico, terapia, agente antibacteriano, microbiología
Cómo citar
Diagnóstico y tratamiento de la periodontitis agresiva. (2019). Odontoestomatología, 19(30), 29-39. https://odon.edu.uy/ojs/index.php/ode/article/view/171
Resumen
La periodontitis agresiva es una enfermedad de baja prevalencia, multifactorial, de avance rápido, sin compromiso sistémico, con alteraciones inmunológicas, con fuerte influencia genética, agregación familiar y generalmente de instalación temprana. Tiene dos formas: una localizada, y otra generalizada. No está debidamente aclarado, si se trata de una enfermedad periodontal diferente a otras o si es la expresión fenotípica de una periodontitis crónica en pacientes susceptibles. Su protocolo diagnóstico incluye una historia médica dental, examen clínico periodontal y examen radiológico. El tratamiento de la periodontitis agresiva incluye principalmente, control de higiene bucal, raspaje y alisado radicular, complementado con terapia antibiótica sistémica y local. La terapia quirúrgica depende de los casos. La terapia de mantenimiento es imprescindible para lograr mejores resultados. El objetivo de este artículo fue revisar
los protocolos diagnósticos y terapéuticos y proponer un flujograma de tratamiento en base a evidencias científcas recientes.
Referencias
1. Botero JE, Bedoya E. Determinantes del diagnóstico periodontal. Rev. Clin. Periodoncia Implantol Rehabil Oral [en línea] 2010; [citado:13 de junio 2016]; 3 (2): 94-99. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S071901072010000200007&lng=es.
2. Armitage GC, Cullinan MP. Comparison of the clinical features of chronic and aggressive periodontitis. Periodontol 2000. 2010; 53 (1): 12-27.
3. Armitage, GC. Development of a classifcation system for periodontal diseases and conditions. Ann. Periodontol.1999; 4 (1): 1-6.
4. American Academy of Periodontology. Parameters on aggressive periodontitis. J periodontol. 2000; 71 (5): 867-869.
5. Meng, H, Xu, L, Li Q, Han J, Zhao Y. Determinants of host susceptibility in aggressive periodontitis. Periodontol 2000. 2007; 43 (1): 133-159.
6. Carvalho RP, Mesquita JS, Bonomo A, Elsas PX, Colombo AP. Relationship of neutrophil phagocytosis and oxidative burst with the subgingival microbiota of generalized aggressive periodontitis. Oral Microbiol Immunol. 2009; 24 (2): 124-132.
7. Fine DH, Markowitz K, Furgang D, Fairlie K, Ferrandiz J, Nasri C, McKieran M, Gunsolley J. Aggregatibacter actinomycetemcomitans and its relationship to Initiation of localized aggressive periodontitis: Longitudinal cohort study ofDiagnóstico y tratamiento de la periodontitis agresiva 37 initially healthy adolescents. J Clin Microbiol. 2007; 45 (12): 3859-3869.
8. Faveri M, Mayer MP, Feres M, de Figueiredo LC, Dewhirst FE, Paster BJ. Microbiological diversity of generalized aggressive periodontitis by 16S rRNA clonal analysis. Oral Microbiol Immunol. 2008; 23 (2): 112-118.
9. Armitage GC, Cullinan MP, Seymour GJ. Comparative biology of chronic and aggressive periodontitis: Introduction. Periodontol 2000. 2010; 53(1): 7-11. doi:10.1111/j.1600-0757.2010.00359.x.
10. Kinane DF, Hart TC. Genes and gene polymorphisms associated with periodontal disease. Crit Rev Oral Biol Med. 2003; 14 (6): 430-49.
11. Kantarci A, Oyaizu K, Van Dyke TE. Neutrophilmediated tissue injury in periodontal disease pathogenesis: Findings from localized aggressive periodontitis. J Periodontol. 2003; 74 (1):66-75.
12. Srinivas M, Chethana KC, Padma R, Suragimath G, Anil M, Pai BS. Walvekar A. A study to assess and compare the peripheral blood neutrophil chemotaxis in smokers and non smokers with healthy periodontium, gingivitis, and chronic periodontitis. J. Indian Soc. Periodontol. [internet] 2012. [cited: 10 de mayo de
2016]; 16 (1): 54-58. Available from: http://doi.org/10.4103/0972-124X.94605.
13. Barbieri Petrelli G, Flores Guillén J, Vignoletti F. El neutróflo y su importancia en la enfermedad periodontal. Av Periodon Implantol. 2005; 17 (1): 11-16.
14. Daniel MA, McDonald G, Offenbacher S, Van Dyke TE. Defective chemotaxis and calcium response in Localized juvenile periodontitis neutrophils. J Periodontol.1993 ; 64 (7): 617-621.
15. Shibata K, Warbington ML, Gordon BJ, Kurihara H, Van Dyke TE. Defective calcium influx factor activity in neutrophils from patients with localized juvenile periodontitis. J Periodontol. 2000; 71 (5): 797-802.
16. Kurihara H, Murayama Y, Warbington ML, Champagne CM, Van Dyke TE. Calcium-dependent proteinkinase C activity of neutrophils in localized juvenile periodontitis. Infect Immun.1993; 61 (8): 3137-3142.
17. Albandar JM, Tinoco EM. Global epidemiology of periodontal diseases in children and young persons. Periodontol 2000. 2002; 29 (1): 153-76.
18. Albandar JM, Rams TE. Risk factors for periodontitis in children and young persons. Periodontol 2000. 2002; 29 (1): 207-22.
19. Lopez R, Baelum V. Classifying periodontitis among adolescents: Implications for epidemiological research. Community Dent Oral Epidemiol. 2003; 31 (2): 136-
20. Pérez Luzardo Benigna. Periodontitis agresiva: Clasifcación, características clínicas y etiopatogenia. Acta odontol venez [en línea] 2009; 47 (5): 135-160. Citado 26 de junio 2016. Disponible en: http://www.scielo.org.ve/scielo.php?script=sci_arttext&pid=S0001-63652009000300020&lng=es.
21. Allin N, Cruz-Almeida Y, Velsko I, Vovk A, Hovemcamp N, Harrison P, Huang H, Aukhil I, Wallet SM, Shaddox LM. Inflammatory Response Influences Treatment of Localized Aggressive Periodontitis. J Dent Res 2016; 95 (6): 635-41. doi: 10.1177/0022034516631973.
22. Albandar JM, Brown LJ, Löe H. Clinical features of early-onset periodontitis. J Am Dent Assoc 1997; 128 (10): 393-1399.
23. Löe H, Brown LJ. Early onset periodontitis in the United States of America. J Periodontol 1991; 62 (10): 608-616.
24. Kissa J, Chemlali S, El Houari B, Amine K, Khlil N, Mikou S. et al.Aggressive and chronic periodontitis in a population of Moroccan school students. J Clin Periodontol. 2016; 43(11): 934-939. doi: 10.1111/jcpe.12584.
25. Arowojolu MO, Nwokorie CU. Juvenile periodontitis in Ibadan, Nigeria. East Afr Med J. 1997; 74 (6): 372-375.
26. Albandar JM, Muranga MB, Rams TE. Prevalence of aggressive periodontitis in school attendees in Uganda. J Clin Periodontol. 2002; 29 (9): 823-831.
27. Hodge PJ, Teague PW, Wright AF, Kinane DF. Clinical and genetic analysis of a large North European Caucasian family affected by early onset periodontitis. J Dent Res. 2000; 79 (3):857-863.
28. Stabholz A, Soskolne WA, Shapira L. Genetic and environmental risk factors for chronic periodontitisand aggressive periodontitis. Periodontology 2000. 2010; 53 (1): 138-153.
29. Noack B, Hoffmann T. Aggressive periodontitis. Perio. 2004; 1 (4): 335-344.
30. Smith M, Seymour GJ, Cullinan MP. Histopathological features of chronic and aggressive periodontitis. Periodontology 2000. 2010; 53 (1): 45-54.
31. Discepoli N, Bascones-Martínez A. Controversias etiológicas, diagnósticas y terapéuticas de la periodontitis agresiva. Av Periodon Implantol. 2008; 20 (1): 39-47.
32. Albandar J. Aggressive periodontitis: case defnition and diagnostic criteria. Periodontol 2000. 2014; 65(1): 13–26.
33. Guerrero A, Grifths GS, Nibali L, Suvan J, Moles DR, Laurell L, Tonetti MS. Adjunctive benefts of systemic amoxicillin and metronidazole in non‐surgical treatment of generalized aggressive periodontitis: a randomized placebo‐controlled clinical trial. J Clin Periodontol. 2005; 32 (10): 1096-1107.
34. B. Sigusch, M. Beier, G. Klinger, W. Pfster, E. Glockmann. A 2-Step Non-Surgical Procedure and Systemic Antibiotics in the Treatment of Rapidly Progressive Periodontitis. J Periodontol. 2001; 72 (3): 275-283. doi: 10.1902/jop.2001.72.3.275.
35. Deas DE, Mealey BL. Response of chronic and aggressive periodontitis to treatment. Periodontol 2000. 2012; 53 (1): 154-166.
36. Collins JR, Arredondo A, Roa A, Valdez Y, León R, Blanc V. Periodontal pathogens and tetracycline resistance genes in subgingival bioflm of periodontally healthy and diseased Dominican adults. Clin Oral Investig [en línea] 2016; 20 (2): 349–356. Citado: el 14 de junio 2016. Disponible en: http://doi.org/10.1007/
s00784-015-1516-2.
37. Haffajee AD, Socransky SS, Gunsolley JC. Systemicanti-infective periodontal therapy. A systematic review. Ann Periodontol. 2003; 8 (1): 115-181.
38. Herrera D, Sanz M, Jepsen S, Needleman I, Roldan S. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol. 2002; 29 (3): 136-159.
39. Listgarten MA, Lai CH, Young V. Microbial composition and pattern of antibiotic resistance in subgingival microbial samples from patients with refractory periodontitis. J Periodontol.1993; 64 (3): 155-161.
40. Mejia GI, Botero A, Rojas W, Robledo JA. Refractory periodontitis in a Colombian population: Predominant anaerobic bacterial flora and antibiotic susceptibility. Clin Infect Dis.1995; 20 (2): 311-313.
41. Faveri M, Figueiredo LS, Duarte PM, Mestnik MJ, Mayer MP, Feres M. Microbiological profle of untreated subjects with localized aggressive periodontitis. J Clin Periodontol. 2009; 36 (9): 739-49. doi: 10.1111/j.1600-051X.2009.01449.x.
42. Cortelli JR, Cortelli SC, Jordan S, Haraszthy VI, Zambon JJ. Prevalence of periodontal pathogens in Brazilians with aggressive or chronic periodontitis. J Clin Periodontol. 2005; 32 (8): 860-6.
43. Könönen E, Müller HP. Microbiology of aggressive periodontitis. Periodontol 2000. 2014; 65 (1): 46-78. doi: 10.1111/prd.12016.
44. Souza Silveira VR, Bessa Nogueira MV, Pinto Nogueira NA, Lima V, Chaves Furlaneto FA, Otavio Rego R. Leukotoxicity of Aggregatibacter
actinomycetemcomitans in generalized aggressive periodontitis in Brazilians and their family members. Journal of Applied Oral Science [en línea] 2013; 21 (5): 430-436. Citado: 18 de mayo 2016. Disponible en: http://doi.org/10.1590/1679-775720130252.
45. Fine DH, Kaplan JB, Kachlany SC, Schreiner HC. How we got attached to Actinobacillus actinomycetemcomitans: a model for infectious diseases. Periodontol 2000. 2006; 42 (1): 114-57.
46. Contreras A, Rusitanonta T, Chen C, Wagner WG, Michalowicz BS, Slots J. Frequency of 530-bpdeletion in actinobacillus actinomycetemcomitans leukotoxin promoter region. Oral Microbiol Immunol. 2000; 15 (5): 338-40.
47. Lourenço TG, Heller D, do Souto RM, SilvaSenem MX, Varela VM, Torres MC, Colombo AP. Long-term evaluation of the antimicrobial susceptibility and microbial profle of subgingival bioflms in individuals with aggressive periodontitis. Braz J Microbiol [en línea] 2015; 46 (2): 493–500. Citado: 6 de abril 2016. Disponible en: http://doi.org/10.1590/S1517-838246220131037.
48. Brogan JM, Lally ET, Poulsen K, Kilian M, Demuth DR. Regulation of Actinobacillus actinomycetemcomitans leukotoxin expression:analysis of the promoter regions of leukotoxic and minimally leukotoxic strains. Infect Immun. 1994; 62 (2): 501-8
49. Bueno LC, Mayer MP, DiRienzo JM. Relationship between conversion of localized juvenile periodontitis-susceptible children from health to disease and Actinobacillus actinomycetemcomitans leukotoxin promoter structure. J Periodontol.1998; 69 (9): 998-1007.
50. Haraszthy VI, Hariharan G, Tinoco EM, Cortelli JR, Lally ET, Davis E, et al. Evidence for the role of highly leukotoxic Actinobacillus actinomycetemcomitans in the pathogenesis of localized juvenile and other forms of early-onset periodontitis. J Periodontol. 2000; 71 (6): 912-22.
51. Haubek D, Ennibi OK, Poulsen K, Poulsen S, Benzarti N, Kilian M. Early-onset periodontitis in Morocco is associated with the highly leukotoxic clone of Actinobacillus actinomycetemcomitans. J Dent Res. 2001; 80 (6): 1580-3.
52. Xajigeorgiou C, Sakellari D, Slini T, Baka A, Konstantinidis A. Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis. J Clin Periodontol. 2006; 33 (4): 254-264.
53. Buchmann R, Nunn ME, Van Dyke TE, Lange DE. Aggressive periodontitis: 5-year follow-up of treatment. J Periodontol. 2002; 73 (6): 675-683.
54. Jepsen, K. and Jepsen, S. Antibiotics/antimicrobials: systemic and local administration in the therapy of mild to moderately advanced periodontitis. Periodontol 2000. 2016; 71 (1): 82-112. doi: 10.1111/prd.12121.
55. American Academy of Periodontology. Parameter on Periodontal Maintenance. J Periodontol. 2000; 71 (5): 849-850.
56. Rabelo CC, Feres M, Gonçalves C, Figueiredo LC, Faveri M, Tu Y-K, Chambrone L. Systemic antibiotics in the treatment of aggressive
periodontitis. A systematic review and a Bayesian Network meta-analysis. J Clin Periodontol. 2015; 42 (7): 647–657.
57. Matesanz-Pérez P, García-Gargallo M, Figuero E, Bascones-Martínez A, Sanz M, Herrera D. A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis. J Clin Periodontol. 2013; 40 (3): 227-241.
58. Garcia Canas P, Khouly I, Sanz J, Loomer PM. Effectiveness of systemic antimicrobial therapy in combination with scaling and root planing in the treatment of periodontitis: a systematic review. J Am Dent Assoc. 2015; 146 (3): 150-63. doi:10.1016/j.adaj.2014.12.015.
59. Bouziane A, Benrachadi L, Abouqal R, Ennibi O. Outcomes of nonsurgical periodontal therapy in severe generalized aggressive periodontitis. J Periodontal Implant Sci. 2014; 44 (4): 201-206. doi.org/10.5051/jpis.2014.44.4.201.
60. Teughels W, Dhondt R, Dekeyser C, Quirynen M. Treatment of aggressive periodontitis. Periodontol 2000. 2014; 65 (1): 107-133. doi:10.1111/prd.12020.
2. Armitage GC, Cullinan MP. Comparison of the clinical features of chronic and aggressive periodontitis. Periodontol 2000. 2010; 53 (1): 12-27.
3. Armitage, GC. Development of a classifcation system for periodontal diseases and conditions. Ann. Periodontol.1999; 4 (1): 1-6.
4. American Academy of Periodontology. Parameters on aggressive periodontitis. J periodontol. 2000; 71 (5): 867-869.
5. Meng, H, Xu, L, Li Q, Han J, Zhao Y. Determinants of host susceptibility in aggressive periodontitis. Periodontol 2000. 2007; 43 (1): 133-159.
6. Carvalho RP, Mesquita JS, Bonomo A, Elsas PX, Colombo AP. Relationship of neutrophil phagocytosis and oxidative burst with the subgingival microbiota of generalized aggressive periodontitis. Oral Microbiol Immunol. 2009; 24 (2): 124-132.
7. Fine DH, Markowitz K, Furgang D, Fairlie K, Ferrandiz J, Nasri C, McKieran M, Gunsolley J. Aggregatibacter actinomycetemcomitans and its relationship to Initiation of localized aggressive periodontitis: Longitudinal cohort study ofDiagnóstico y tratamiento de la periodontitis agresiva 37 initially healthy adolescents. J Clin Microbiol. 2007; 45 (12): 3859-3869.
8. Faveri M, Mayer MP, Feres M, de Figueiredo LC, Dewhirst FE, Paster BJ. Microbiological diversity of generalized aggressive periodontitis by 16S rRNA clonal analysis. Oral Microbiol Immunol. 2008; 23 (2): 112-118.
9. Armitage GC, Cullinan MP, Seymour GJ. Comparative biology of chronic and aggressive periodontitis: Introduction. Periodontol 2000. 2010; 53(1): 7-11. doi:10.1111/j.1600-0757.2010.00359.x.
10. Kinane DF, Hart TC. Genes and gene polymorphisms associated with periodontal disease. Crit Rev Oral Biol Med. 2003; 14 (6): 430-49.
11. Kantarci A, Oyaizu K, Van Dyke TE. Neutrophilmediated tissue injury in periodontal disease pathogenesis: Findings from localized aggressive periodontitis. J Periodontol. 2003; 74 (1):66-75.
12. Srinivas M, Chethana KC, Padma R, Suragimath G, Anil M, Pai BS. Walvekar A. A study to assess and compare the peripheral blood neutrophil chemotaxis in smokers and non smokers with healthy periodontium, gingivitis, and chronic periodontitis. J. Indian Soc. Periodontol. [internet] 2012. [cited: 10 de mayo de
2016]; 16 (1): 54-58. Available from: http://doi.org/10.4103/0972-124X.94605.
13. Barbieri Petrelli G, Flores Guillén J, Vignoletti F. El neutróflo y su importancia en la enfermedad periodontal. Av Periodon Implantol. 2005; 17 (1): 11-16.
14. Daniel MA, McDonald G, Offenbacher S, Van Dyke TE. Defective chemotaxis and calcium response in Localized juvenile periodontitis neutrophils. J Periodontol.1993 ; 64 (7): 617-621.
15. Shibata K, Warbington ML, Gordon BJ, Kurihara H, Van Dyke TE. Defective calcium influx factor activity in neutrophils from patients with localized juvenile periodontitis. J Periodontol. 2000; 71 (5): 797-802.
16. Kurihara H, Murayama Y, Warbington ML, Champagne CM, Van Dyke TE. Calcium-dependent proteinkinase C activity of neutrophils in localized juvenile periodontitis. Infect Immun.1993; 61 (8): 3137-3142.
17. Albandar JM, Tinoco EM. Global epidemiology of periodontal diseases in children and young persons. Periodontol 2000. 2002; 29 (1): 153-76.
18. Albandar JM, Rams TE. Risk factors for periodontitis in children and young persons. Periodontol 2000. 2002; 29 (1): 207-22.
19. Lopez R, Baelum V. Classifying periodontitis among adolescents: Implications for epidemiological research. Community Dent Oral Epidemiol. 2003; 31 (2): 136-
20. Pérez Luzardo Benigna. Periodontitis agresiva: Clasifcación, características clínicas y etiopatogenia. Acta odontol venez [en línea] 2009; 47 (5): 135-160. Citado 26 de junio 2016. Disponible en: http://www.scielo.org.ve/scielo.php?script=sci_arttext&pid=S0001-63652009000300020&lng=es.
21. Allin N, Cruz-Almeida Y, Velsko I, Vovk A, Hovemcamp N, Harrison P, Huang H, Aukhil I, Wallet SM, Shaddox LM. Inflammatory Response Influences Treatment of Localized Aggressive Periodontitis. J Dent Res 2016; 95 (6): 635-41. doi: 10.1177/0022034516631973.
22. Albandar JM, Brown LJ, Löe H. Clinical features of early-onset periodontitis. J Am Dent Assoc 1997; 128 (10): 393-1399.
23. Löe H, Brown LJ. Early onset periodontitis in the United States of America. J Periodontol 1991; 62 (10): 608-616.
24. Kissa J, Chemlali S, El Houari B, Amine K, Khlil N, Mikou S. et al.Aggressive and chronic periodontitis in a population of Moroccan school students. J Clin Periodontol. 2016; 43(11): 934-939. doi: 10.1111/jcpe.12584.
25. Arowojolu MO, Nwokorie CU. Juvenile periodontitis in Ibadan, Nigeria. East Afr Med J. 1997; 74 (6): 372-375.
26. Albandar JM, Muranga MB, Rams TE. Prevalence of aggressive periodontitis in school attendees in Uganda. J Clin Periodontol. 2002; 29 (9): 823-831.
27. Hodge PJ, Teague PW, Wright AF, Kinane DF. Clinical and genetic analysis of a large North European Caucasian family affected by early onset periodontitis. J Dent Res. 2000; 79 (3):857-863.
28. Stabholz A, Soskolne WA, Shapira L. Genetic and environmental risk factors for chronic periodontitisand aggressive periodontitis. Periodontology 2000. 2010; 53 (1): 138-153.
29. Noack B, Hoffmann T. Aggressive periodontitis. Perio. 2004; 1 (4): 335-344.
30. Smith M, Seymour GJ, Cullinan MP. Histopathological features of chronic and aggressive periodontitis. Periodontology 2000. 2010; 53 (1): 45-54.
31. Discepoli N, Bascones-Martínez A. Controversias etiológicas, diagnósticas y terapéuticas de la periodontitis agresiva. Av Periodon Implantol. 2008; 20 (1): 39-47.
32. Albandar J. Aggressive periodontitis: case defnition and diagnostic criteria. Periodontol 2000. 2014; 65(1): 13–26.
33. Guerrero A, Grifths GS, Nibali L, Suvan J, Moles DR, Laurell L, Tonetti MS. Adjunctive benefts of systemic amoxicillin and metronidazole in non‐surgical treatment of generalized aggressive periodontitis: a randomized placebo‐controlled clinical trial. J Clin Periodontol. 2005; 32 (10): 1096-1107.
34. B. Sigusch, M. Beier, G. Klinger, W. Pfster, E. Glockmann. A 2-Step Non-Surgical Procedure and Systemic Antibiotics in the Treatment of Rapidly Progressive Periodontitis. J Periodontol. 2001; 72 (3): 275-283. doi: 10.1902/jop.2001.72.3.275.
35. Deas DE, Mealey BL. Response of chronic and aggressive periodontitis to treatment. Periodontol 2000. 2012; 53 (1): 154-166.
36. Collins JR, Arredondo A, Roa A, Valdez Y, León R, Blanc V. Periodontal pathogens and tetracycline resistance genes in subgingival bioflm of periodontally healthy and diseased Dominican adults. Clin Oral Investig [en línea] 2016; 20 (2): 349–356. Citado: el 14 de junio 2016. Disponible en: http://doi.org/10.1007/
s00784-015-1516-2.
37. Haffajee AD, Socransky SS, Gunsolley JC. Systemicanti-infective periodontal therapy. A systematic review. Ann Periodontol. 2003; 8 (1): 115-181.
38. Herrera D, Sanz M, Jepsen S, Needleman I, Roldan S. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol. 2002; 29 (3): 136-159.
39. Listgarten MA, Lai CH, Young V. Microbial composition and pattern of antibiotic resistance in subgingival microbial samples from patients with refractory periodontitis. J Periodontol.1993; 64 (3): 155-161.
40. Mejia GI, Botero A, Rojas W, Robledo JA. Refractory periodontitis in a Colombian population: Predominant anaerobic bacterial flora and antibiotic susceptibility. Clin Infect Dis.1995; 20 (2): 311-313.
41. Faveri M, Figueiredo LS, Duarte PM, Mestnik MJ, Mayer MP, Feres M. Microbiological profle of untreated subjects with localized aggressive periodontitis. J Clin Periodontol. 2009; 36 (9): 739-49. doi: 10.1111/j.1600-051X.2009.01449.x.
42. Cortelli JR, Cortelli SC, Jordan S, Haraszthy VI, Zambon JJ. Prevalence of periodontal pathogens in Brazilians with aggressive or chronic periodontitis. J Clin Periodontol. 2005; 32 (8): 860-6.
43. Könönen E, Müller HP. Microbiology of aggressive periodontitis. Periodontol 2000. 2014; 65 (1): 46-78. doi: 10.1111/prd.12016.
44. Souza Silveira VR, Bessa Nogueira MV, Pinto Nogueira NA, Lima V, Chaves Furlaneto FA, Otavio Rego R. Leukotoxicity of Aggregatibacter
actinomycetemcomitans in generalized aggressive periodontitis in Brazilians and their family members. Journal of Applied Oral Science [en línea] 2013; 21 (5): 430-436. Citado: 18 de mayo 2016. Disponible en: http://doi.org/10.1590/1679-775720130252.
45. Fine DH, Kaplan JB, Kachlany SC, Schreiner HC. How we got attached to Actinobacillus actinomycetemcomitans: a model for infectious diseases. Periodontol 2000. 2006; 42 (1): 114-57.
46. Contreras A, Rusitanonta T, Chen C, Wagner WG, Michalowicz BS, Slots J. Frequency of 530-bpdeletion in actinobacillus actinomycetemcomitans leukotoxin promoter region. Oral Microbiol Immunol. 2000; 15 (5): 338-40.
47. Lourenço TG, Heller D, do Souto RM, SilvaSenem MX, Varela VM, Torres MC, Colombo AP. Long-term evaluation of the antimicrobial susceptibility and microbial profle of subgingival bioflms in individuals with aggressive periodontitis. Braz J Microbiol [en línea] 2015; 46 (2): 493–500. Citado: 6 de abril 2016. Disponible en: http://doi.org/10.1590/S1517-838246220131037.
48. Brogan JM, Lally ET, Poulsen K, Kilian M, Demuth DR. Regulation of Actinobacillus actinomycetemcomitans leukotoxin expression:analysis of the promoter regions of leukotoxic and minimally leukotoxic strains. Infect Immun. 1994; 62 (2): 501-8
49. Bueno LC, Mayer MP, DiRienzo JM. Relationship between conversion of localized juvenile periodontitis-susceptible children from health to disease and Actinobacillus actinomycetemcomitans leukotoxin promoter structure. J Periodontol.1998; 69 (9): 998-1007.
50. Haraszthy VI, Hariharan G, Tinoco EM, Cortelli JR, Lally ET, Davis E, et al. Evidence for the role of highly leukotoxic Actinobacillus actinomycetemcomitans in the pathogenesis of localized juvenile and other forms of early-onset periodontitis. J Periodontol. 2000; 71 (6): 912-22.
51. Haubek D, Ennibi OK, Poulsen K, Poulsen S, Benzarti N, Kilian M. Early-onset periodontitis in Morocco is associated with the highly leukotoxic clone of Actinobacillus actinomycetemcomitans. J Dent Res. 2001; 80 (6): 1580-3.
52. Xajigeorgiou C, Sakellari D, Slini T, Baka A, Konstantinidis A. Clinical and microbiological effects of different antimicrobials on generalized aggressive periodontitis. J Clin Periodontol. 2006; 33 (4): 254-264.
53. Buchmann R, Nunn ME, Van Dyke TE, Lange DE. Aggressive periodontitis: 5-year follow-up of treatment. J Periodontol. 2002; 73 (6): 675-683.
54. Jepsen, K. and Jepsen, S. Antibiotics/antimicrobials: systemic and local administration in the therapy of mild to moderately advanced periodontitis. Periodontol 2000. 2016; 71 (1): 82-112. doi: 10.1111/prd.12121.
55. American Academy of Periodontology. Parameter on Periodontal Maintenance. J Periodontol. 2000; 71 (5): 849-850.
56. Rabelo CC, Feres M, Gonçalves C, Figueiredo LC, Faveri M, Tu Y-K, Chambrone L. Systemic antibiotics in the treatment of aggressive
periodontitis. A systematic review and a Bayesian Network meta-analysis. J Clin Periodontol. 2015; 42 (7): 647–657.
57. Matesanz-Pérez P, García-Gargallo M, Figuero E, Bascones-Martínez A, Sanz M, Herrera D. A systematic review on the effects of local antimicrobials as adjuncts to subgingival debridement, compared with subgingival debridement alone, in the treatment of chronic periodontitis. J Clin Periodontol. 2013; 40 (3): 227-241.
58. Garcia Canas P, Khouly I, Sanz J, Loomer PM. Effectiveness of systemic antimicrobial therapy in combination with scaling and root planing in the treatment of periodontitis: a systematic review. J Am Dent Assoc. 2015; 146 (3): 150-63. doi:10.1016/j.adaj.2014.12.015.
59. Bouziane A, Benrachadi L, Abouqal R, Ennibi O. Outcomes of nonsurgical periodontal therapy in severe generalized aggressive periodontitis. J Periodontal Implant Sci. 2014; 44 (4): 201-206. doi.org/10.5051/jpis.2014.44.4.201.
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