Aggressive periodontitis (AgP) has presented a classification challenge since its initial description in the early 20th century. The evolving understanding of this condition necessitates a continuous re-evaluation of its definitions and diagnostic criteria. This article aims to delve into the existing body of literature to provide a comprehensive review, revisiting the fundamental aspects of Aggressive Periodontitis Diagnosis and proposing pathways for enhanced detection and classification.
This review is based on an extensive analysis of existing research. A thorough literature search was conducted across prominent databases including PubMed, Medline, Cochrane, Scopus, and Web of Science. From an initial pool of 4930 articles, a rigorous screening process led to the exclusion of 4737 studies based on predefined criteria. These exclusion criteria included studies focusing on individuals older than 30 years, abstracts, review articles, studies lacking control groups, and those with insufficient sample sizes (fewer than 200 subjects for genetic studies and fewer than 20 subjects for other study types). Studies meeting these stringent inclusion criteria were meticulously categorized and summarized in tables, focusing on both localized and generalized forms of AgP. The analysis encompassed key areas such as epidemiology, microbial profiles, host response factors, and genetic predispositions. The studies considered to have the highest value were those employing case-controlled or cohort designs, incorporating multiple time-point assessments, and evaluating a range of microbial or host factors across various sites.
The analysis of epidemiological studies revealed valuable insights into the influence of ethnic and societal factors on the prevalence and manifestation of aggressive periodontitis. Microbial DNA analysis, while demonstrating some level of consistency across studies, also highlighted significant variability in the specific microbial profiles associated with AgP. Host factor analysis proved to be less consistent in identifying definitive markers. While numerous genetic studies have been conducted in the field of aggressive periodontitis, a significant proportion suffered from limitations in statistical power or a restricted focus on a limited number of genes, hindering the comprehensive understanding of genetic contributions to AgP.
The challenges in achieving consistent findings across studies can be attributed to several key factors. Firstly, the historical classification of aggressive periodontitis may have been overly broad, encompassing a heterogeneous group of conditions under a single diagnostic umbrella. Secondly, the disease’s progression and characteristics have not always been studied from its earliest stages, nor have investigations consistently considered the temporal evolution or topographic variations of AgP. However, advancements in technology, coupled with a more refined and specific definition of the disease, offer a promising path forward. These advancements will facilitate unbiased analyses of genetic, host, and microbial factors. We anticipate that this refined approach will pave the way for significant progress in identifying a robust panel of genetic, host, and microbial risk-markers associated with periodontal disease. Such markers hold the potential to significantly enhance diagnostic capabilities, particularly in identifying and managing periodontal disease in juveniles, adolescents, and young adults.
In conclusion, the diagnosis of aggressive periodontitis remains a complex area. This review underscores the need for a more nuanced and refined approach to classification and diagnosis. By leveraging new technologies and focusing on well-defined criteria, the field is poised to make substantial strides in understanding the multifaceted nature of aggressive periodontitis and ultimately improving diagnostic accuracy and early intervention strategies, especially for younger populations at risk.
