Treatment of aggressive periodontitis W IM T EUGHELS ,R UTGER D HONDT ,C HRISTEL D EKEYSER &M ARC Q UIRYNEN Aggressive periodontitis comprises a group of rapidly progressing forms of periodontal disease that occur in otherwise clinically healthy individuals. It is accepted that, compared with patients with chronic periodontitis, patients with aggressive periodontitis show a more rapid attachment loss and bone destruction that occurs earlier in life. The patient’s age when attachment loss is detected is often the criterion used by clinicians to diagnose aggressive periodontitis and to distinguish aggressive periodon- titis from chronic adult periodontitis [reviewed by Albandar in this volume of Periodontology 2000 (3)]. Typically, aggressive periodontitis runs in families (familial aggregation), pointing towards a genetic predisposition. These three features (i.e. rapid attachment loss, bone destruction that occurs early in life and familial aggregation) are considered to be the primary features of this disease. In the Workshop for a Classification of Periodontal Diseases and Con- ditions, the secondary features of aggressive period- ontitis were identified as (i) relatively low amounts of bacterial deposits despite severe periodontal destruction, (ii) presence of hyper-responsive macro- phage phenotypes, and (iii) increased portions of Aggregatibacter actinomycetemcomitans and Porphy- romonas gingivalis (46). Recently an entire volume of Periodontology 2000 was devoted to the differences in clinical (5) and histopathological (93) features, epidemiological patterns (24), microbiological (4) and immunological (29, 81) aspects, and genetic and envi- ronmental risk factors (94) between aggressive peri- odontitis and chronic periodontitis. From these reviews it becomes clear that there are indeed major differences between aggressive periodontitis and chronic periodontitis. Despite these major differences, it is not always easy to differentiate these two disease entities clinically. However, from a research perspective, it is essential that these diseases can be, and are, clearly distinguished in order to gain a complete understanding of their etiology and pathogenesis (5). Also, as pointed out throughout this review, from a treatment perspective, distinction is of major importance. Additionally, patients with aggressive periodontitis are often diagnosed as having a localized form or a generalized form of disease. Each form has its own typical clinical features. The relative lack of clinical inflammation, often associated with the localized molar-and-incisor form of aggressive periodontitis, has been recognized for almost 100 years. It is generally accepted that this form of the disease is most often associated with a thin biofilm, at least in its early stages. In con- trast, the presence of clinical inflammation in gener- alized aggressive periodontitis appears to be similar to that observed in chronic periodontitis. In this situation, age of onset and familial aggregation are important additional criteria for either diagnosis or classification. It is also becoming more commonly recognized that chronic periodontitis may occur simultaneously with both localized and generalized forms of aggressive periodontitis (reviewed in refer- ence 5). The overall treatment concepts and goals in patients with aggressive periodontitis are not mark- edly different from those in patients with chronic periodontitis. Therefore, the different treatment phases (systemic, initial, re-evaluation, surgical, maintenance and restorative) are similar for both types of periodontitis. However, the considerable amount of bone loss relative to the young age of the patient and the high rate of bone loss warrants a well-thought-through treatment plan and an often more aggressive treatment approach, in order to halt further periodontal destruction and regain as much periodontal attachment as possible. The ultimate goal of treatment is to create a clinical condition that is conducive to retaining as many teeth as possible for as long as possible. 107 Periodontology 2000, Vol. 65, 2014, 107–133 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Printed in Singapore. All rights reserved PERIODONTOLOGY 2000