aggressive periodontitis
DESCRIPTION
Conference on Aggressive Periodontitis. Prof. Ricardo Benza Bedoya DDS. Annual Academic Programm 2009 of the Peruvian Association of Periodontology and Osseointegration. Subtitled filmation can be download in youtubeTRANSCRIPT
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RBBRBBMacchu Picchu. City of the Incas. Cuzco-Perù Song: “Under the Incas Sky” Interpret: Raùl Garcìa Zàrate
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Asociaciòn Peruana de Periodoncia y Oseointegraciòn
Programa acadèmico anual 2009
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Periodontitis Agresivas.
Symposium Prof. Ricardo Benza Bedoya
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Universidad de San Martìn de Porres. Facultad de Odontologìa. Asignatura de Periodoncia II. Pràctica Clìnica. Prof. Resp. de la Asignatura: Ricardo Benza Bedoya
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IV Curso de Post-Grado de Implantologìa Oral Bàsica de la Federaciòn Odontològica del Perù. Pràctica Pre-Clìnica. Workshop del Sistema Conexao. Prof. Resp. del Curso: Ricardo Benza Bedoya
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Colegio Odontològico Regional de Lima. Conferencia: “Implantologìa para el Pràctico General”. Prof.: Ricardo Benza Bedoya
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PERIODONTAL ABSCESS
VIDEO YOU TUBEIX Annual meeting of the Peruvian Dental Federation, Conference,periodontal abscess, main features of the
chronic and acute periodontal abscess
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“Royal Tomb of Lord of Sipan” discovered by the peruvian archeologist Walter. Alva. Lambayeque-Perù RBB
“El futuro tiene muchos nombres. Para los débiles es lo inalcanzable. Para los
temerosos, lo desconocido. Para los valientes es la oportunidad.”
Vìctor Hugo (1802-1885)
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ObjetivoAnalizar la evidencia actual sobre las caracterìsticas principales de las periodontitis agresivas
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Temario1. Consideraciones generales2. Determinantes de la
susceptibilidad del huèsped
3. Enfoque terapèutico y casos clìnicos
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PARTE I
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Consideraciones generales.Antecedentes
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Periodontitis juvenil (Page & Schroeder , 1982)
Periodontitis de instalaciòn temprana (AAP, 1989)
Periodontitis de ràpido progreso (Page & Schroeder , 1982)
PERIODONTITISAGRESIVAS(AAP, 1999)
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Periodontosis (Orban y Weinmann,1942)
De Morais Rocha Daniela, Abou Abdallah Elias Yossef, Stork Cesàrio Ericka, Mauad de Abreu Fernando Antônio, De Oliveiro Costa Fernado. Periodontite agressiva: uma visâo histôrica e crìtica sobre os sistemas de classificacâo. Periodontia 2007; 17:11-15 RBB
Atrofia difusa de hueso alveolar (Gottlieb, 1923)
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Ôleo sobre madera: “La estaciòn de Monserrate”Autor: Sèrvulo Gutièrrez
Periodontitis de instalaciòn temprana
Periodontitis del adulto
Periodontitis agresivas
Periodontitis crònica
1999 International Workshop for a Classification of Periodontal
Diseases and Conditions
Ximenez-Fyvie Laurie Ann, Almaguer-Flores Argelia, Lara-Cordoba Mònica, Moreno-Borjas Jazmin-Yunuen, Alcàntara-Maruri Eulalio. Subgingival microbiota of periodontally untreated Mexican subjects with generalizedaggressive periodontitis. J Clin Periodontol 2006; 33: 869-877.
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Ôleo sobre tela: “Paisaje”Autor: Sèrvulo Gutièrrez
Periodontitis de instalaciòn temprana
Periodontitis agresivas
CUESTIONAMIENTO
EDAD
CRITERIO
CLASIFICACION
a la
como
de
Razones delcambio en la clasificaciòn
Armitage G. Development of a classification system for periodontal diseases and conditions. Annals of Periodontology 1999; 4: 1-6
Periodontitis del adulto
Periodontitis crònica
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Ôleo sobre tela: “Paisaje de Buenos Aires”Autor: Sèrvulo Gutièrrez
Periodontitis agresivas
Periodontitis crònica
Periodontitis ulcerativa
necrotizante
Periodontitis comomanifestaciòn de
enfermedadessistèmicas
TIPOS DE
PERIODONTITIS
Ximenez-Fyvie Laurie Ann, Almaguer-Flores Argelia, Lara-Cordoba Mònica, Moreno-Borjas Jazmin-Yunuen, Alcàntara-Maruri Eulalio. Subgingival microbiota of periodontally untreated Mexican subjects with generalizedaggressive periodontitis. J Clin Periodontol 2006; 33: 869-877.
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Batista Jr. EL, Novaes Jr. AB, Calvano LM, do Prado EA, Goudouris ES, Batista FC: Necrotizing ulcerative periodontitis associated with severe congenital immunodeficiency in a prepubescent subject: clinical findings and response to intravenous immunoglobulin treatment. J Clin Periodontol 1999; 26: 499–504.
PeriodontitisUlcerativa Necrotizante
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Ôleo sobre tela: “Retrato de Elvira Miro Quesada”Autor: Sèrvulo Gutièrrez
PERIODONTITISCRÒNICA
Caracterìsticas
Mayor prevalencia en adultos
Destrucciòn òsea lenta o de curso moderado
Puede presentarse en niños y adolescentes
Ximenez-Fyvie Laurie Ann, Almaguer-Flores Argelia, Lara-Cordoba Mònica, Moreno-Borjas Jazmin-Yunuen, Alcàntara-Maruri Eulalio. Subgingival microbiota of periodontally untreated Mexican subjects with generalizedaggressive periodontitis. J Clin Periodontol 2006; 33: 869-877.
Lenta pèrdida de inserciòn o decurso moderado
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Periodontitis Crònica
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Benza Bedoya Ricardo., Arce Calle, Julia IV Curso de Post-Grado de Implantologìa Oral Bàsica. Federaciòn Odontològica del Perù. 2009
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Acuarela : “Calle vieja”Autor: Ignacio Tomaylla
PERIODONTITISAGRESIVAS
PERIODONTITISCOMO
MANIFESTACIÒN DE ENFERMEDADES
SISTÈMICASDISFUNCIÒN
PMNMODERADA SEVERA
ENFERMEDADES SISTÈMICAS
AUSENTES PRESENTES
INSTALACIONDE LA
PERIODONTITIS
TEMPRANA MUYTEMPRANA
ALTERACIONESGENETICAS SEVERASLEVES
Nibali, L, Parkar M, Brett P, Knight J, Tonetti MS, Griffiths GS. NADPH oxidase (CYBA) and Fc ץR polymorphisms as risk factors for aggressive periodontitis. A case-control association study. J Clin Periodontol 2006; 33: 529-539
(CH²)¹NPELGADNa+L
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Meyle J., Gonzàles JR. Influences of systemic diseases on periodontitis in children and adolescents. Periodontology 2000, Vol. 26, 2001, 92–112
Fig. 5. a. Clinical view of a 14-year-old girl with Ehlers-Danlos syndrome type VIII and generalized attachmentloss after 2 years of orthodontic treatment. RBB
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Acuarela: “Pasillo interior del Monasterio de Santa Catalina” Autor: Ignacio Tomaylla
NeutropeniaSindrome de
Chediak Higashi
Periodontitis como manifestaciòn de enfermedades sistèmicas
Instalaciòntemprana
Curso destructivo severo
Malformacionesgenèticas diversas
DISFUNCIÒN DE PMN
Deas DE, Mackey SA, Mc Donnell HT. Systemic disease and periodontitis : manifestations of neutrophil Dysfunction. Periodontology 2000 2003; 32: 82-104
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Periodontitis agresivas
enfermedades periodontales
comprende formas
Pocofrecuentes
severas progresivas
de
pacientes sistèmicamente sanos
en
“Tapada y escribano”. Autor: Pancho Fierro
Noack B, Gôrgens H, Hoffman T, Schackert HK. Variantes genèticas del CARD 15 en la periodontitis agresiva. J Clin Periodontol 2006; 33: 779-783
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“Mujer caminante” Autor: Aquiles Ralli
Periodontitis Agresivas
comprende
distintos tipos de periodontitis
caracterizadas por
Curso ràpido
Sin enfermedad sistèmica
Antecedentesfamiliares periodontales
similares
mayorìa de casos
1. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann. Periodontol 1999; 4: 1-6.2. Oh TJ, Eber R, Wang HL. Periodontal diseases in the child and adolescent. J Clin Periodontol 2002; 29: 400-4103. American Academy of Periodontology. Parameter on aggressive periodontitis. J Periodontol 2000 ; 71 (Suppl.): 867- 869 RBB
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PERIODONTITISAGRESIVAS
Caracterìsticas
Destrucciòn periodontal
Personas en su mayorìa jòvenes
Agente primario extrìnseco
ràpida
severasusceptibilidad Bacterias
patògenas
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Òleo sobre lienzo: “Viaje al interior”Autor: Luis Agusti
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“Escena de carnaval”. Autor: Pancho Fierro
Periodontitis agresivas
Patògenos orales especìficos
Reacciones defensivas del huèsped
es causado por
que inducen
Kinane & Hart 2003, Loos et al. 2005, Shapira et al. 2005
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Aggregatibacter actinomycetemcomitans
Agente etiològico
Periodontitis agresiva
localizada
Enfermedadesperiodontales
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Balashova Nataliya V, Crosby Juan A, Al Ghofaily, Kachlany Scott C. Infection and Inmunity 2006; 74: 2015-2021.
?
Tiza pastel sobre papel: “Buen viaje”Autor: Luis Agusti
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PERIODONTITISAGRESIVAS
Epidemiologìa
Caucàsicos
Hispanos
Afro-americanosChinos
Mayor prevalencia
0,1%-15%
0,12%-0,47%
Albandar JJ, Brown LJ, Lôe H. Clinical features of early onset periodontitis. J Am Dent Assoc 1997; 128: 1393–1399.Neely AL. Prevalence of juvenile periodontitis in a circumpubertal population. J Clin Periodontol 1992; 19: 367–372.Saxen L. Prevalence of juvenile periodontitis in Finland. J Clin Periodontol 1980; 7: 177–186.Sjôdin B, Matsson L, Unell L, Egelberg J. Marginal bone loss in the primary dentition of patients with juvenile periodontitis. J Clin Periodontol 1993; 20: 32–36.Buremeister JJ, Best AA, Palcanis KK, Caine FA, Ranney RR. Localized juvenile periodontitis and generalized severe periodontitis: clinical findings. J Clin Periodontol1984; 11: 181192. Lôe H, Brown LJ. Early onset periodontitis in the United States of America. J Periodontol 1991; 62: 608–616.Melvin WW, Sandifer JB, Gray JL. The prevalence and sex ratio of juvenile periodontitis in a young racially mixed population. J Periodontol 1991; 62: 330–334. RBBRBB
Acrìlico sobre trupàn: “La lucha contra el àngel”Autor: Luis Agusti
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Consideraciones generales.
Aspectos inmunològicos
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Sistema Inmunológico
Antiinfecciosa Antitumoral
defensa
Innata Adaptativa
clasificación
Respuesta inmune
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Respuesta inmuneInnata
Cèlulas fagocìticas
Proteìnas sanguìneas
Citoquinas
Barreras quìmicas
Barreras fìsicas
comprende a las
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Respuesta inmuneAdaptativa
LinfocitosB
LinfocitosT
comprende a los
RBBRBB
CD4 T8
LinfocitosNK
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Glòbulos blancos
Linfocitos Monocitos Granulocitos
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Cèlulas madre pluripotenciales
(steam cells)
Mèdula òsea
Linajes
se diferencian
en
Mieloide Linfoide
Granulocitos
Mastocitos Fagocitos
Megacariocitos Cèlulas dendrìticas
Linfocitos
Plaquetas EosinòfilosBasòfilos
NEUTROFILOS Monocitos
Macròfagos
B T NK
Th Tc RBBRBB
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Neutròfilo
Linaje mieloide
+ abundante en sangre60 -75 %
Vida media corta
(Horas o pocos dìas)
Leucocito
Glòbuloblànco
Micròfago
Granulocito
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Neutròfilo
Nùcleolobulado
Pueden serbastonados (10%) y no
bastonados
No tiene predilecciòn
por colorantesàcidos o bàsicos
Lisosomas
Muchos grànulos con enzimashidrolìticas
Provienendel linajemieloide
Nùcleo multilobulado2 a 5 lòbulos
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Neutròfilo
Funciòn
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Inmunològica
Fagocitosis Participar
Inicio del procesoinflamatorioDestruir bacterias
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Neutròfilo
Propiedades
Adherencia Quimiotaxis
Fagocitosis Generaciónde
superóxido
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Quimiotaxis deneutròfilos
Cèlulasmuertas
Polisacàridosbacterianos
Degradaciòndel
complemento
activada
es
por
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Enzimasneutrofìlicas
Fagocitina
Colagenasainespecìfica
Colagenasa GFosfolipasa A2
Fosfatasaalcalina
CatepsinaG
Enzimas lisosomales
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Acuarela: “Interior monasterio”Autor: Ignacio Tomaylla
Neutròfilos
Respuesta inflamatoria
Rol
Periodontitis de instalaciòn temprana
Investigaciones
Van Dyke TE, Serhan CN. Resolution of inflammation: a new paradigm for the pathogenesis of periodontal diseases,Journal of Dental Research 2003; 82: 82-90
muchas
tratan de explicar el
de
los
durante la
en
las
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Roger David. Crawling Neutrophil Chasing a Bacterium. University of Vanderbilt .Nashville-Tenesse. USA1950
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“Tapada limeña”. Autor: Pancho Fierro
Huèsped
Mecanismosinmunològicos
Protectores Destructivos
desbalance
Destrucciòn tisularKinane & Hart 2003, Loos et al. 2005, Shapira et al. 2005
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RBB“Misti Volcano” seen from the city of Arequipa -Perù
“Vivir no es sólo existir, sino existir y crear, saber gozar y sufrir y no dormir sin soñar. “
Gregorio Marañòn
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Consideraciones generales.
Aspectos genèticos
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Modo hereditariode transmisiòn
Periodontitisagresivas
siguen
Leyesmendelianas
Transmisiònde la
susceptibilidad
- Hart TC, Marazita ML, Schenkein HA, Diehl SR. Re-interpretation of the evidence for X-linked dominant inheritance of Juvenile periodontitis. J Periodontol 1992; 63: 169–173.- Melnick M, Shields ED, Bixler D. Periodontosis: a phenotypic and genetic analysis. Oral Surg Oral Med Oral Pathol 1976; 42: 32–41.Page RC, Vandesteen GE, Ebersole JL, Williams BL, Dixon LI, Altman LC. Clinical and laboratory studies of a family with a high prevalence of juvenile periodontitis. J Periodontol 1985; 56: 602–610.- Spektor MD, Vandesteen GE, Page RC. Clinical studies of one family manifesting rapidly progressive, juvenile and prepubertal periodontitis. J - Periodontol 1985; 56: 3–101. RBBRBB
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Modo hereditariode transmisiòn
raramentePeriodontitis
agresivas
No siguen
Leyesmendelianas
Transmisiònde la
susceptibilidad
Mutaciones de novo
HIROMASA YOSHIE, TETSUO KOBAYASHI, HIDEAKI TAI & JOHNAH C. GALICIA. The role of genetic polymorphisms in periodontitis. Periodontology 2000, Vol. 43, 2007, 102–132 RBBRBB
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CENTROMERO
CROMATIDA
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Leyesmendelianas
UniformidadDistribuciòn
independiente
Principios
Segregaciòn independiente
1ra. Ley 2da. Ley 2da. LeyRBBRBB
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Herenciamendeliana
Autosòmica
Clasificaciòn
Ligada a loscromosomas
sexuales
Dominante Recesiva RBBRBB
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Periodontitisagresiva
Autosòmicarecesiva
Autosòmicadominante
Tipos de herencia mendeliana
Ligada a los cromosomassexuales
Afroamericanos Caucàsicos
màs prevalente
Marazita ML, Burmeister JA, Gunsolley JC, Koertge TE, Lake K, Schenkein HA. Evidence for autosomal dominant inheritance and race-specific heterogeneity in early-onset periodontitis. J Periodontol 1994; 65: 623–630. RBBRBB
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PeriodontitisAgresiva localizada
Cromosoma 1q25
Vinculante
DIS492
?
OR 3,48
LOCUS
Li Y, Xu L, Hasturk H, Kantarci A, DePalma SR, Van Dyke TE. Localized aggressive periodontitis is linked to human chromosome 1q25. Hum Genet 2004: 114: 291–297. RBBRBB
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PeriodontitisAgresiva localizada
Cromosoma 4q
Vinculante No vinculante
Locus delReceptor vit D
?
- Boughman JA, Halloran SL, Roulston D, Schwartz S, Suzuki JB, Weitkamp LR, Wenk RE, Wooten R, Cohen MM. An autosomal-dominant form of juvenile periodontitis: its localization to chromosome 4 and linkage to dentinogenesis imperfecta and Gc. J Craniofac Genet Dev Biol 1986; 6: 341–350.- Hart TC, Marazita ML, McCanna KM, Schenkein HA, Diehl SR. Reevaluation of the chromosome 4q candidate region for early onset periodontitis. Human Genet 1993; 91: 416–422.
OR 3,0
RBBRBB
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Periodontitisprepuberal
Cromosoma 11q14
Vinculante
?
Hart TC, Hart PS, Michalec MD, Zhang Y, Marazita ML, Cooper M, Yassin OM, Nusier M, Walker S. Localisation of a gene for prepubertal periodontitis to chromosome 11q14 and identification of a cathepsin C gene mutation. J Med Genet 2000: 37: 95–101. RBBRBB
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HIROMASA YOSHIE, TETSUO KOBAYASHI, HIDEAKI TAI & JOHNAH C. GALICIA. The role of genetic polymorphisms in periodontitis. Periodontology 2000, Vol. 43, 2007, 102–132
RBBRBB
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Poligènica
Mutaciones en varios loci
Se estima alrededor de 50 genes principales relacionados con la periodontitis
La frecuencia de marcadoreS genèticos muestran gran heterogenicidad entre las razas
La periodontitis agresiva y la periodontitis crònica podrìan presentar polimorfismos genèticos comunes
CONCLUSIONES
RBBRBB
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RBB“Oasis of Huacachina” Ica-Perù
“El hombre de talento es naturalmente inclinado a la crítica, porque ve más cosas que los otros hombres y las ve mejor.”
Montesquieu
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PARTE II
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Determinantesde la
susceptibilidad a la PA
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Factores desusceptibilidad del huèsped en la PA
Family aggregation
Singlenucleotide polymorphisms
Disfunciòn neutrofìlica
Antibody response
Tabaco
StressMorfologìa radicular
Infecciòn viral
RBBRBB
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Anormalidades radicularesen PA
Clasificación
Raìcescònicas
Raìcesdelgadas
Curvaturasradiculares
Relaciòn corono-radiculardesfavorable
Raìces fusionadas
RBB
FACTORES LOCALESCONTRIBUYENTES
De acuerdo a laanchura radicular
RBB
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Huanxin Meng, Li Xu, Qiyan Li, Jie Han & Yibing Zhao. Determinants of host susceptibility in aggressive periodontitis. Periodontology 2000, Vol. 43, 2007, 133–159
RBBRBB
Anormalidades radiculares
en PA
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Factormodificador
PERIODONTITISAGRESIVA
LOCALIZADA
Citomegalovirus
- Slots J. Herpesviruses in periodontal diseases. Periodontol 2000 2005; 38: 33–62.- Cappuyns I, Gugerli P, Mombelli A. Viruses in periodontal disease-a review. Oral Dis 2005; 11: 219–229. Michalowicz
BS, Ronderos M, Camara-Silva R, Contreras- A, Slots J. Human herpesviruses and Porphyromonas gingivalis are associated with early-onset periodontitis. J Periodontol 2000; 71: 981–988.
Pg
Acciòn sinèrgica
RBBRBB
Infecciòn viral
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Citomegalovirus(CMVH)
Virus herpes simple (VHS)
Virus Epstein Barr tipo I (VEB-1)
Actividad Enfermedad Periodontal
- Kanma JJ, Contreras A, Slots M. Herpes viruses and periodontopathic bacteria in early-onset periodontitis. J Clin Periodontol 2001; 28: 879-885. - Ling LJ, Ho CC, Wu CY, Chen YT, Hung SL. Association between human herpesviruses and the severity of periodontitis. J Periodontol 2004; 75: 1479-1485. -Yapar M, Saygun I, Ôzdemir A, Kubar A, Sahìn S, Prevalence of human herpesviruses in patients with aggressive periodontitis. J
Periodontol 2003; 74: 1634-1640
Citomegalovirus (CMVH)
Virus Epstein Barr tipo I (VEB-1)
PREVALENCIA
Periodontitisagresiva
Encìasana
ALTA
ALTA
BAJA
BAJA
RBBRBB
Infecciòn viral
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Citomegalovirus (CMVH)
Núcleo
Envoltura
Càpside
CapsòmeroNùcleo de àcido nucleido DNA
Alta prevalencia de càpsides
Bolsas profundas en
jòvenes
Ting M, Contreras A, Slots J. Herpesviruses in localizedjuvenile periodontitis. J Periodontal Res 2000; 35: 17–25. RBBRBB
Infecciòn viral
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RBB
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Darby IB, Hodge PJ, Riggio MP, Kinane DF. Clinical and microbiological effect of scaling and root planing in smoker and non-smoker chronic and aggressive periodontitis patients. J Clin Periodontol 2005; 32: 200–206.
Reducciòn post-tto PS
Periodontitisagresiva
Fumadores Nofumadores
Menor MayorDetecciòn de Pi
Mayor Menor
RBBRBB
Tabaco
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Periodontitisagresiva Stress
Pèrdida de inserciòn
P. gingivalis
T. dentìcolaCuadros agudos
Pèrdida de piezas dentarias
Yamazaki K, Tabeta K, Nakajima T, Ohsawa Y, Ueki K, Itoh H, Yoshie H. Interleukin-10 gene promoter polymorphism in Japanese patients with adult and early-onset periodontitis.J Clin Periodontol 2001; 28: 828–832. RBBRBB
Stress
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“Ballestas Islands” Ica-Perù
“Vivir para los demás no es solamente una ley de deber, sino también una ley de felicidad.” Augusto Comte
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Determinante de la susceptibilidad del
huèsped a la PAPolimorfismos genèticos
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1. Interleukin-1 gene polymorphisms in AP2. Interleukin-4 gene polymorphisms in AP3. Interleukin-10 gene polymorphisms in AP4. Tumor necrosis factor-a polymorphisms AP5. Fc gamma/alpha receptors gene
polymorphisms in AP6. Human leukocyte antigen polymorphisms in
AP7. Vitamin D receptor gene polymorphisms in
AP8. N-formylpeptide receptor gene
polymorphisms in AP9. Other gene polymorphisms in AP
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AP
Single nucleotide polymorphisms
IL
TNF alfa
Fc receptors HLA Vit D receptors
N-formilpèptide receptor
1,4,10 ganma, alfa
RBBRBB
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Interleukin-1 gene polymorphisms in
AP
RBB
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Interleuquina 1
Monocitos Cèlulas endoteliales
Citoquina
Macròfagos
RBBRBB
Lugar de sìntesis
Cèlulas activadasmononucleares
Fibroblastos Neutròfilos
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Interleuquina 1
Agonistas Antagonistas
CLASIFICACION
IL-1α IL-1β IL1-Ra
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IL1-Ra
Genetic Polymorphisms of the IL-1α and IL-1β Genes in African-American LJP Patients and an African-American Control PopulationStephen J. Walker Conclusion: Given the high frequency of the IL-1β allele "1" in the African-American population, it would appear that knowledge of this +3953 polymorphism would provide little diagnostic or predictive . information for LJP.Journal of Periodontology May 2000, Vol. 71, No. 5, Pages 723-728
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Interlequina 1
Agonista
(1 α + 1β)
Adhesiòn de leucocitos al
endotelio vascular
Antagonista
1 Ra
Activaciòn de células TH
(1 α + 1β)
RBBRBB
Maduraciòn
de cèlulas B
Quimiotaxis
neutròfilos macròfagos
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RBB
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RBB
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q
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Periodonto sano
Gingivitis
Periodontitis crònica
Periodontitisagresiva
Incremento deInterleuquina 1 beta
No se incrementa
3 veces
6 veces
9 veces
Mengel R, Bacher M, Flores-De-Jacoby L. Interactions between stress, interleukin-1beta, interleukin-6 and cortisol in periodontally diseased patients. J Clin Periodontol 2002; 29: 1012–1022 RBBRBB
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Interleukin-4 gene polymorphisms in
AP
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Interleukin-4 gene polymorphisms in Japanese and Caucasian patients with aggressive periodontitis
J. R. Gonzales 1 , T. Kobayashi 2,3 , J. Michel 1 , M. Mann 4 , H. Yoshie 2 and J. Meyle. Journal of Clinical Periodontology
• Volume 31 issues 5, Pages 384 - 389• Published Online: 25 Mar 2004• Conclusion: There was no evidence of an association of IL-4 genotypes
and AgP in either population, although the frequencies of the IL-4 genotypes in the Japanese and the Caucasians were different.
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Interleukin-10 gene
polymorphisms in AP
RBB
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Tumor necrosis factor-α
polymorphisms AP
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RBB
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Human leukocyte antigen
polymorphisms in AP
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“Gochapita Lake” - Pataz. La Libertad-Perù RBB
“Da lo que tienes para que merezcas recibir lo que te falta”. San Agustìn
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PARTE III
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Enfoque terapèutico y
casos clìnicos
RBB
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OBJETIVOS DEL TRATAMIENTO
1.Disminuir o eliminar la carga bacteriana
2.Disminuir o eliminar los factores de riesgo contribuyentes
3.Regeneraciòn o reparaciòn periodontal siempre y cuando estè indicado
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OBJETIVOS DEL TRATAMIENTO
4. Reducción importante de los signos de la inflamación gingival5. Reducción de la profundidad de sondaje6. Ganancia o estabilidad del nivel de inserción
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OBJETIVOS DEL TRATAMIENTO
7. Evidencia radiográfica de la resolución de las lesiones óseas.8. Reducción de la placa clínicamente detectablecompatible con un nivel de salud periodontal.9. Progreso hacia una estabilidad oclusal.
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CONSIDERACIONES
1. Evaluación sistémica del paciente para descartar enfermedades, sobretodo en niños y adolescentes.2. El tratamiento mecánico básico como único tratamiento suele ser inefectivo.3. Los resultados del tratamiento a largo plazo dependerán de la implicación del paciente y de los intervalos de los mantenimientos.
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CONSIDERACIONES
4. Cuando estén afectados los dientes temporales, losdientes permanentes deben ser monitorizados para detectar posibles futuras pérdidas de inserción.5. Debido a la asociación familiar, se recomienda el asesoramiento y evaluación de todos los miembros de la familia del afectado
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RBB
Benza Bedoya, Ricardo, Periodontitis agresiva generalizada. Clìnica de Periodoncia e Implantologìa Docente Asistencia Benzahnarzt
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Benza Bedoya, Ricardo, Periodontitis agresiva generalizada. Clìnica de Periodoncia e Implantologìa Docente Asistencia Benzahnarzt
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Benza Bedoya, Ricardo, Tasayco Gonzàles Frank. Periodontitis agresiva localizada. Pràctica Clìnica de la Asignatura de Periodoncia II. EAPO-UNW
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Benza Bedoya, Ricardo, Tasayco Gonzàles Frank. Periodontitis agresiva localizada. Pràctica Clìnica de la Asignatura de Periodoncia II. EAPO-UNW
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Benza Bedoya, Ricardo, Tasayco Gonzàles Frank. Periodontitis agresiva localizada. Pràctica Clìnica de la Asignatura de Periodoncia II. EAPO-UNW
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Benza Bedoya, Ricardo, Tasayco Gonzàles Frank. Periodontitis agresiva localizada. Pràctica Clìnica de la Asignatura de Periodoncia II. EAPO-UNW
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Huanxin Meng, Li Xu, Qiyan Li, Jie Han & Yibing Zhao. Determinants of host susceptibility in aggressive periodontitis. Periodontology 2000, Vol. 43, 2007, 133–159
RBB
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Huanxin Meng, Li Xu, Qiyan Li, Jie Han & Yibing Zhao. Determinants of host susceptibility in aggressive periodontitis. Periodontology 2000, Vol. 43, 2007, 133–159
RBB
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Huanxin Meng, Li Xu, Qiyan Li, Jie Han & Yibing Zhao. Determinants of host susceptibility in aggressive periodontitis. Periodontology 2000, Vol. 43, 2007, 133–159
RBB
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DATOS PERSONALESNº H.C. : 20055681Edad : 43Sexo : FEMENINOOcupaciòn : su casaEstado Civil : casadaLugar de Nacimiento : LimaLugar de Procedencia : LimaGrado de Instrucción : secundariaFecha de Ingreso : 21 de Marzo 2006
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HISTORIA ODONTOLOGICA
Ultima visita al dentista: hace 9 meses.
Presenta espacios donde las piezas dentarias se cayeron solas, no fue producto de exodoncias.
Obturacion expuesta(caries) en piezas: 3.6 y 3.8
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Benza Bedoya, Ricardo, Osorio Màrquez, Gissella. Periodontitis agresiva generalizada severa. Pràctica Clìnica de la Asignatura de Periodoncia II. FO-USMP
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Benza Bedoya, Ricardo, Osorio Màrquez, Gissella. Periodontitis agresiva generalizada severa. Pràctica Clìnica de la Asignatura de Periodoncia II. FO-USMP
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J Periodontol 2007;78:965-973.
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Int. J. Morphol, 25(4):839-846,2007. Biomaterials Applied to the Bone Healing Process Biomateriales con Aplicación en el Proceso de Reparación Ósea. Cássio do Nascimento; João Paulo Mardegan Issa ; Rafael Ramos de Oliveira; Mamie Mizusaki Iyomasa; Selma Siéssere & Simone Cecilio Hallak Regalo
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Controlled-delivery chlorhexidine chip versus amoxicillin/metronidazole as adjunctive antimicrobial therapy for generalized aggressive periodontitis: a randomized controlled clinical trial. Doğan Journal of Clinical PeriodontologyVolume 34 Issue 10 Kaner, Pages 880 - 891 Published Online: 10 Sep 2007
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RBB
Òleo: “ Lima, proclamación de la independencia”Autor: Francisco González Gamarra
Pacientes susceptibles
Enfermedadperiodontal
Riesgoelevado
periimplantitisPèrdida del
implante
?
a
tienen
de
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“Maparaju Lake”. Caraz. Ancah- Perù RBB
“La dicha de la vida consiste en tener
siempre algo que hacer, alguien a quien amar y
alguna cosa que esperar.”
T. Chalmers
MUCHASGRACIAS