Abstract

Aggressive periodontitis (AgP) is a distinct and rapidly progressing form of periodontal disease characterized by early onset, familial aggregation, and severe destruction of periodontal structures in otherwise systemically healthy individuals. Unlike chronic periodontitis, AgP often presents with disproportionate tissue loss relative to the amount of microbial deposits, suggesting a unique pathogenic mechanism involving complex host-microbial interactions and genetic predispositions. The disease primarily affects the first molars and incisors and often progresses swiftly, resulting in tooth mobility, migration, and eventual tooth loss if left untreated. This review delves into the multifactorial etiology of aggressive periodontitis, with a focus on the underlying pathogenesis involving key microbial agents such as Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, alongside host immune responses, neutrophil dysfunction, and genetic susceptibility. Furthermore, we explore current diagnostic criteria and the utility of clinical, radiographic, and microbiological tools in early and accurate detection. The classification updates from the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions are also discussed, highlighting the shift from the "aggressive" label to a more nuanced grading system under the umbrella of periodontitis. The review also presents a comprehensive overview of the management strategies for AgP, encompassing both non-surgical and surgical approaches, antibiotic adjunctive therapy, regenerative techniques, and the importance of long-term maintenance. Emphasis is placed on the need for early diagnosis, individualized treatment plans, and the integration of emerging biomarker and genetic testing into routine care. Finally, future perspectives in the management of AgP are discussed, including novel therapeutic targets, host-modulation therapy, and the potential of precision periodontal medicine.