Periodontitis is common, but aggressive periodontitis (AgP) is thought to progress faster than chronic periodontitis (CP). Reviews suggest that tooth loss as a result of periodontitis is in the order of 1.5-9.8%. The aim of this current review was to investigate tooth loss and disease progression in aggressive periodontitis cases.

The Medline and Embase databases were searched.  Longitudinal studies in patents with AgP and having at least 5 years follow up and a minimum of 10 patients were considered.  Studies had to report at least one of the following outcomes, tooth loss, plaque or gingival index, probing depth, attachment loss, bone loss, and suppuration. Selection was conducted independently by two reviewers with risk of bias being assessed using the Newcastle- Ottawa Quality Assessment Scale.

• 13 studies (reported in 16 articles) were included, 9 retrospective cohorts and 4 prospective cohorts.
•  There was heterogeneity of disease definition and clinical data reporting
•  Based on 9 studies the average tooth loss for AgP was 0.09 per patient-year (95% CI: 0.06 to 0.16)
• Based on only a small number of studies the value for
  • Localized aggressive periodontitis (LAgP) was  0.05 per patient-year (95% CI: 0.02 to 0.11)
  • Generalized aggressive periodontitis (GAgP) was  0.14 per patient-year, (95% CI: 0.07 to 0.2)

The authors concluded

most studies report good long-term stability of treated AgP cases.

Comment

The included studies spanned 5 decades, this contributes to the problems with the disease definition, which has changed over the years and still suffers with some subjectivity. The authors also note that reasons for tooth loss were rarely reported. While the review brings together a number of studies the number of patients included is still relatively small at 354 with the included studies ranging in size from 11-84 patients.  The majority of the included studies are retrospective in nature so may suffer from selection and reporting bias. What is needed are well-designed long-term prospective cohort studies to answer important questions about prognosis for patients with periodontal disease.

Links

L. Nibali, B.C. Farias, A. Vajgel, Y.K. Tu and N. Donos.  Tooth Loss in Aggressive Periodontitis: A Systematic Review.  J DENT RES published online 16 August 2013 DOI: 10.1177/0022034513501878

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