Prognosis Periodontitis Agresif

Transcript

Aggress Aggressive ive period periodon ontiti titiss can presen presentt in a localiz localized ed or a general generalized ized form. form. Two common features of both forms are (1) rapid attachment loss and bone destruction in a otherw otherwise ise clinical clinically ly health healthy y patient patient and (2) a familia familiall aggreg aggregati ation. on. These These patien patients ts often often  present with limited microbial deposits that seem inconsistent with the severity of tissues dest destru ruct ctio ion. n. Howe Howeve verr the the depo deposi sits ts that that are are pres presen entt ofte often n have have elev elevat ated ed leve levels ls of   Actinobacillus Actinomycelcommitans or Poryphormonas or Poryphormonas Gingivalis. Gingivalis. These patients also may  present with phagocyte abnormalities and a hyperresponsive monocyte ! macrophage  phenotype. These clinical microbiologic and immunologic features would suggest that  patients diagnosed with aggressive periodontitis would have poor poor prognosis. However the clinician should consider additional specific features of the localized form of disease when determining the prognosis. "ocalized aggresive periodontitis usually occurs around the age of puberty and is localized to first molars and incisor. The patient often e#hibits a strong serum antibody response to the infecting agents which may contribute to localization of the lessions. $hen diagnosed early these eases can be treated conservatively with with oral oral hygien hygienee instru instructio ction n and system systemic ic antibi antibioti oticc therap theraphy hy result resulting ing in an e#celle e#cellent nt  prognosis. $hen more advanced disease occurs the prognosis can still be good if the lesions are treated with debridement local and systemic antibiotics and regenerative theraphy. %n contrast although patients with generalized aggressive periodontitis also are young  patients (usually under age &') they the y present pres ent with generalized interpro#imal attachment loss and poor poor antibo antibody dy respons responsee to infecti infecting ng agents agents.. econda econdary ry contrib contributi uting ng factors factors such as cigaret cigarette te smoin smoing g are often often presen present. t. These These factors factors couple coupled d with with the alterat alteration ionss in host host defense seen in many of these patients may result in a case that does not respond well to conventional periodontal therapy (scaling with root planning oral hygiene instruction and surgi surgical cal interv intervent ention ion). ). Theref Therefore ore these these patien patients ts often often have have a fair fair poor poor or *uestio *uestionab nable le  prognosis and the use of systemic antibiotics should be considered to help control the disease. +eriodontiti +eriodontitiss agresif dibagi dalam localized form dan generalized generalized form. ,ua macam tersebut tersebut memilii memilii sifat (1) ehilangan ehilangan yang yang cepat dan dan destrusi destrusi tulang tulang pada pasien pasien yang secara linis sehat dan (2) famlial agregasi. agregasi. +asien tersebut memilii memilii deposit deposit miroba miroba yang terbata terbatass yang yang tampa tampanya nya tida tida onsist onsisten en dengan dengan tinga tingatt eparah eparahan an erusa erusaan an -aringa -aringan. n.  amun deposit yang ada sering mengalami peningatan adar  Actinobacillus  Actinomycelcommitans   atau  Actinomycelcommitans atau  Poryphormonas Gingivalis. +asien Gingivalis.  +asien ini -uga mungin memilii elainan fagosit dan hiperresponsif monosit ! fenotipe marofag. ecara linis dari segi mirobiologi dan imunologi menyaranan bahwa pasien yang didiagnosis dengan agresif   periodontitis aan memilii prognosis buru.  amun doter harus mempertimbangan tambahan segi tertentu dari bentu  localized form  form  penyait tersebut etia menentuan prognosis. +eriodontitis agresif loal  biasanya ter-adi seitar usia pubertas dan terloalisasi untu molar pertama dan insisiv. +asien sering menun-uan serum antibodi uat yang menanggapi agen infesius yang dapat  berontribusi terhadap loalisasi lesi. /etia didiagnosa awal emudahan ini dapat diobati secara secara onserv onservatif atif dengan dengan instru instrusi si oral oral hygie hygiene ne dan terapi terapi antibi antibioti oti sistemi sistemi  sehing sehingga ga menghasilan prognosis yang bai. /etia dilauan sebelum terena penyaitnya prognosis masih bisa bai -ia lesi diperlauan dengan debridemen antibioti loal dan sistemi dan terapi regeneratif. ebalinya mesipun pasien dengan periodontitis agresif generalized form -uga diderita pasien0pasien muda (biasanya di bawah usia &') merea -uga menun-uan hilangnya interprosimal attachment dan respon antibodi yang buru untu menginfesi agen. ator seunder seperti meroo sering sebagai pemicu. ator0fator tersebut ditambah dengan perubahan0perubahan dalam pertahanan host  yang sering terlihat pada  penderita terserbut sehingga dapat mengaibatan respon yang urang bai pada terapi  periodontal onvensional ( scaling dengan root planning  instrusi oral hygiene dan intervensi  bedah). leh arena itu pasien ini sering memilii prognosis yang adil buru atau dipertanyaan dan penggunaan antibioti sistemi harus dipertimbangan untu membantu mengendalian penyait.