A case of localized juvenile periodontitis: treatment and 3 years follow-up with superimposable radiographs

Abstract A 17-year-old male patient with localized juvenile periodontitis was treated by subgingival instrumentation with full thickness flap on the lower molars, combined with a 3-week course of systemic tetracycline, and a programme of supervised oral hygiene. The treatment was rapidly followed by dramatic clinical and microbiological improvement. However, despite good oral hygiene, gingival inflammation recurred at regular intervals. It was necessary to maintain the clinical results by periodic subgingival instrumentation with an ultrasonic sealer. Healing of alveolar bone was monitored in the lower 1st molar regions over 3 years by using superimposable radiographs. Quantitative analysis of bone density performed with a high-resolution digitalisation technique showed a considerable improvement 1 year after therapy. However, continuous remodelling, probably related to variations in inflammation, occurred during the 3 postoperative years.     

Increased adhesion of peripheral blood neutrophils from patients with localized juvenile periodontitis

Adhesion of peripheral blood neutrophils from 5 patients with localized juvenile periodontitis (LJP) and age- and gender-matched healthy controls was measured using a semi-automated 96-well microtiter plate assay method. Both unstimulated and formyl-methionyl-leucyl-phenylalanine (FMLP, 10–1000 nM)-stimulated neutrophils from LJP patients showed in general higher adhesion than did their controls. After 15–60 min incubation with 100 and 1000 nM FMLP the numbers of adherent cells were significantly (p<0.05), 2.1–2.6-fold higher in LJP patients than in controls. Neutrophils from these LJP patients showed also enhanced respiratory burst activity in response to unopsonized zymosan stimulation. To test whether a decrease in intracellular diacylglycerol (DAG) kinase activity could account for the increased neutrophil adhesion of LJP patients normal neutrophils were treated with R59949 (10 μM), a DAG-kinase inhibitor. Both unstimulated and FMLP-stimulated normal neutrophiis showed significantly (p<0.05) enhanced adhesion after R59949-treatment. Taken together, our data indicate that neutrophils from the 5 LJP patients investigated here exhibit 2 parallel hyperactivities, namely increased adhesion and enhanced production of reactive oxygen species. Furthermore, our present and previous (Hurttia et al, J Periodont Res 1997; 32: 401-407) results suggest that the observed neutrophil functional abnormalities in some LJP patients may be associated with decreased cellular DAG-kinase activity. It is proposed that the hyperadherent and -active neutrophils may promote the development of LJP by causing tissue damage in the periodontium.     

Increased adhesion of peripheral blood neutrophils from patients with localized juvenile periodontitis

Adhesion of peripheral blood neutrophils from 5 patients with localized juvenile periodontitis (LJP) and age- and gender-matched healthy controls was measured using a semi-automated 96-well microtiter plate assay method. Both unstimulated and formyl-methionyl-leucyl-phenylalanine (FMLP, 10-1000 nM)-stimulated neutrophils from LJP patients showed in general higher adhesion than did their controls. After 15-60 min incubation with 100 and 1000 nM FMLP the numbers of adherent cells were significantly (p<0.05), 2.1-2.6-fold higher in LJP patients than in controls. Neutrophils from these LJP patients showed also enhanced respiratory burst activity in response to unopsonized zymosan stimulation. To test whether a decrease in intracellular diacylglycerol (DAG) kinase activity could account for the increased neutrophil adhesion of LJP patients normal neutrophils were treated with R59949 (10 μm), a DAG-kinase inhibitor. Both unstimulated and FMLP-stimulated normal neutrophils showed significantly (p<0.05) enhanced adhesion after R59949-treatment. Taken together, our data indicate that neutrophils from the 5 LJP patients investigated here exhibit 2 parallel hyperactivities, namely increased adhesion and enhanced production of reactive oxygen species. Furthermore, our present and previous (Hurttia et al., J Periodont Res 1997; 32 : 401-407) results suggest that the observed neutrophil functional abnormalities in some LJP patients may be associated with decreased cellular DAG-kinase activity. It is proposed that the hyperadherent and -active neutrophils may promote the development of LJP by causing tissue damage in the periodontium.     

Diacylglycerol in peripheral blood neutrophils from patients with localized juvenile periodontitis

Neutrophils from patients with localized juvenile periodontitis (LJP) show several functional abnormalities. Recently, it has become increasingly apparent that the reason for these changes lies in part at the post receptor level of cellular metabolism. In this study we have analyzed intracellular diacylglycerol (DAG), a second messenger and an endogenous activator of protein kinase C, in un-stimulated and agonist-stimulated neutrophils. from five LJP patients showing a chemotaxis defect and matched normal individuals. No difference was observed in the basal cellular DAG between the two groups. In neutrophils from LJP patients the DAG levels increased by 67% and 111% from the basal level following stimulation with N-formyl-methionyl-leucyl-phenylalanine (FMLP) and unopsonized zymosan particles, respectively, while in control cells the mean increases were 36% and 65%, respectively. Incubation with serum-opsonized zymosan particles produced an identical rise in DAG in both groups. These data indicate that the stimulation of receptors for FMLP and unopsonized zymosan may produce an enhanced accumulation of DAG in neutrophils from LJP patients. In addition to DAG mass analysis, we determined the effect of R59022, a DAG-kinase inhibitor, on zymosan-stimulated luminol-amplified chemiluminescence (CL) of neutrophils. In control cells R59022 significantly enhanced unopsonized zymosan induced CL, but it had no effect on cells from LJP patients, suggesting a possible change in the regulation of DAG-kinase in LJP.     

Prevalence of juvenile periodontitis in a circumpubertal population

A cross-sectional radiographic screening was performed on bite-wing pairs (BW) from 1872 10-12 year old schoolchildren in the Greater Worcester, Massachusetts area to assess the prevalence of juvenile periodontitis (JP). The 3-stage screening process entailed: (1) visual identification of possible cases based upon a visual assessment of BW for interproximal crestal bone levels greater than or equal to 2 mm from the cemento-enamel junction (CEJ) on greater than or equal to 1 permanent first molar; (2) identification of probable cases based upon BW from possible cases measured with a transparent ruler calibrated in millimeters; (3) finally, clinical confirmation of JP in consenting probable cases. A total of 1038 subjects were eligible to be included in the study (greater than or equal to 3 mesial sites readable). Of the 1038 eligible subjects, 117 possible and 103 probable cases were identified in stage 1 and stage 2, respectively. A total of 99 probable cases could be contacted and 43 were examined clinically. Two cases of JP were confirmed clinically in stage 3, yielding a prevalence rate of 4.6/1000. Specifically, this report defines a rate of JP in 10-12 year-old schoolchildren for the first time. In addition, these results indicate that BW can be used to identify children with JP from large data sets. However, further studies including complete clinical and radiographic examinations are necessary to determine whether this method is adequate for large epidemiologic studies.     

A retrospective radiographic study of alveolar bone loss in the primary dentition in patients with localized juvenile periodontitis

Lately, it has been questioned whether localized juvenile periodontitis (LJP) is restricted to the permanent dentition, or if it sometimes might have a prepubertal onset, involving the primary dentition. To clarify this question, 17 patients with LJP, together with 17 non-LJP matched controls, were retrospectively examined for radiographic signs of alveolar bone destruction in their primary dentitions. All LJP subjects but one showed localized marginal bone loss, whereas no bone loss was observed among the controls. The results suggest that at least some cases of LJP start in the primary dentition prior to the involvement of the permanent teeth.     

Suppression of the periodontopathic microflora in localized juvenile periodontitis by systemic tetracycline

Abstract. Since recent studies have implicated Actinobacillus actinomycetemcomitans in the etiology of localized juvenile periodontitis, this investigation determined the effectiveness of subgingival debridement, topical Betadine Solution®, and systemic tetiacycline in suppressing subgingival A. actinomycetemcomitans and other microorganisms. A total of 20 deep periodontal pockets and 10 normal periodontal sites of 6 localized juvenile periodontitis patients was included in the study. Each patient was treated in 3 stages over a period of 22 weeks, and the result of treatment was monitored for an additional 38 weeks. The first stage of treatment included plaque control, as well as thorough scaling and root planing, composed of at least 6 h of debridement. No concomitant periodontal surgery was performed. In the second stage, Betadine saturated cotton gauze was inserted into the periodontal pockets for 10 min. Stage 3 involved systemic tetracycline therapy (1 g/day) for J4 days. The subgingival microflora was determined at frequent intervals by selective culturing of A. actinomycetemcomitans and Capnocytophaga and by direct microscopic examination. The clinical effect was assessed by measuring changes in probing periodontal attachment level, probing periodontal pocket depth, radiographic alveolar bone mass, and other relevant clinical parameters. Scaling and root planing reduced the total subgingival bacterial counts and the proportions of certain Gram-negative bacteria, but no periodontal pocket became free of A actinomycetemcomitans. Betadine application had little or no effect on the subgingival microflora. In contrast, tetracycline administered via the systemic route suppressed. A actinomycetemcomitans, Capnocytophaga, and spirochetes to low or undetectable levels in all test periodontal pockets. A, actinomycetemcomitans reappeared in 9 of the deep periodontal pockets after the administration of tetracycline. Most of these 9 pockets became free of detectable A. actinomycetemcomitans during the second week of tetracycline administration, whereas pockets which yielded no A. actinomycetemcomitans after tetracycline therapy became free of the organisms during the first week of tetracycline treatment. This data suggests that systemic tetracycline therapy of localized juvenile periodontitis should, as a practical rate, be continued for 3 weeks. Periodontal destruction continued in 4 deep pockets which all showed high posttetracycline A, actinomycetemcomitans counts. All 6 pockets which demonstrated a marked gain in periodontal attachment yielded no cultivable A. actinomycetemcomitans. No association was found between periodontal disease status and subgingival Capnocytophaga, spirochetes or motile rods. The present study indicates that A. actinomycetemcomitans is an important etiologic agent in localized juvenile periodontitis. Also, this study demonstrates that the effectiveness of therapy can be monitored by subgingival A. actinomycetemcomitans counts, and that periodontal A, actinomycetemcomitans infections cannot be resolved by root surface debridement alone but can be cured by systemic tetracycline therapy.     

Probe-specific DNA fingerprinting applied to the epidemiology of localized juvenile periodontitis

Although Actinobacillus actinomycetemcomitans has been recognized as a primary etiological agent in localized juvenile periodontitis, questions remain concerning the source of infection, mode of transmission, and relative virulence of strains. DNA fingerprinting analysis, using a randomly cloned chromosomal DNA fragment as a probe, revealed that previously characterized strains of A. actinomycetemcomitans displayed significant restriction site heterogeneity which could be applied to the typing of clinical isolates of this bacterium such that individual strains or variants could be traced within subjects from localized juvenile periodontitis families. Hybridization data derived from an analysis of bacterial isolates obtained from families participating in an ongoing longitudinal study of the disease showed that a single individual could be infected with more than one strain or variant of A. actinomycetemcomitans and that various members of the same family could harbor different strains or variants of the bacterium. In several cases the clinical isolates were matched to characterized laboratory strains by comparing hybridization patterns generated by digestion of the DNA with several restriction enzymes in independent reactions. Thus, probe-specific DNA fingerprinting of A. actinomycetemcomitans will permit us to determine if particular strains or variants are frequently associated with sites of periodontal destruction. Attention could then be focused on determining the virulence properties of those strains or variants that have in vivo significance.     

Opsonic IgG antibody against Actinobacillus actinomycetemcomitans in localized juvenile periodontitis

Actinobacillus actinomycetemcomitans is a gram-negative bacterium frequently recovered from periodontal lesions of patients with localized juvenile periodontitis (LJP). Elevated levels of serum IgG and IgM antibodies to A. actinomycetemcomitans antigens are frequently observed in LJP patients, although the functional properties of such antibodies have not been characterized systematically. In this study, we analyzed serum from LJP subjects infected with A. actinomycetemcomitans with respect to the presence of IgG antibodies expressing opsonic, bactericidal and/or leukotoxin-neutralizing activity against this organism. The IgG fractions obtained from serum of 3 LJP patients with elevated antibody titers to A. actinomycetemcomitans contained opsonic activity against a non-leukotoxic Y4 strain, as well as for a highly leukotoxic JP2 strain. Opsonic activity required the presence of complement. The IgG fractions of pooled normal serum and serum from a fourth LJP subject with minimal ELISA-reactive IgG antibody against this organism lacked detectable opsonic activity. Leukotoxin-neutralizing IgG antibodies, although variably present, did not influence neutrophil killing of the leukotoxic JP2 strain. None of the sera tested contained bactericidal IgG antibodies capable of promoting direct complement-mediated killing of A. actinomycetemcomitans. These results indicate that LJP subjects infected with A. actinomycetemcomitans are capable of producing opsonic IgG antibodies which may facilitate neutrophil-mediated host defense against this periodontopathic organism.     

Rapid bony healing in localized juvenile periodontitis: a case report

A 16-yr-old man with localized juvenile periodontitis was treated in one single surgical treatment visit. No adjunctive chemotherapy, implant material, or guided tissue regeneration (GTR) was used. Excellent bone repair was seen after 14 wk at the sites of the vertical periodontal lesions. The rapid healing could have been due to the treatment method, the youth of the patient, or the type and form of the bony defects. Radiographic control seems to be indicated 12–14 wk after surgical treatment.     

Suppression of subgingival Actinobacillus actinomycetemcomitans in localized juvenile periodontitis by systemic tetracycline

Abstract The current study assessed the clinical and microbiological effects of systemic antimicrobial therapy alone in Actinobacillus actinomycetemcomitans-infected adolescents with periodontal disease. The study involved 6 localized juvenile periodontitis patients 13–18 years of age, who harbored high numbers of A. actinomycetemcomitans: in subgingival plaque samples. The periodontal lesions were microbiologically monitored by selective culture, and clinically assessed for probing pocket depth and periodontal attachment level 3 months prior to baseline, and at 3, 6, 12, and 24 months posttreatment. Tetracycline-HCl (250 mg/ QID) was prescribed until 1 week after subgingival A. actinomycetemcomitans was no longer detectable or for a maximum of 8 weeks. During 3 months prior to treatment, pocket depth was unchanged, and was then significantly reduced from an average of 7.1 mm to 5.1 mm 12 months after treatment (p - 0.02). The mean change in clinical attachment level was a gain of 1.4 mm between baseline and 12 months (p= 0.02). 3 of the 6 patients were still infected with A. actinomycetemcomitans after 8 weeks of antibiotic therapy and 4 subjects were infected at 12 months. Numbers of A. actinomycetemcomitans were still suppressed in most lesions. There was a strong association between mean numbers of A. actinomycetemcomitans in periodontal pockets and mean change in probing attachment level at any given time point. For 22 available comparisons, derived from all time points, there was a strong association (r= 0.68) between subgingival A. actinomycetemcomitans and change in probing attachment level. 8 of 9 (89%; sensitivity) individual patient time intervals with “disease” (< 1.5 mm gain in probing attachment level) were tested positive (≥ 100 CFUJ, whereas 9 of 13 (69%; specificity) individual patient time intervals with “no disease” (≥ 1.5 mm gain in probing attachment level) were A. actinomycetemcomitans negative (< 100 CPU) (p= 0.007).     

Evidence of an association between functional abnormalities and defective diacylglycerol kinase activity in peripheral blood neutrophils from patients with localized juvenile periodontitis

Peripheral neutrophils from patients with localized juvenile periodontitis (LJP) show functional abnormalities, such as impaired locomotion and enhanced respiratory burst activity. A defect in intracellular signalling mechanism has been proposed to be responsible for some changes, but direct evidence is lacking. In this study we have determined the activity of diacylglycerol (DAG) kinase, an enzyme controlling the DAG/protein kinase C (PKC)-pathway, in crude cytosolic and membrane fractions of neutrophils from 5 LJP patients and age and gender-matched normal individuals. No difference was observed in the DAG kinase activity in subcellular fractions from unstimulated cells between the 2 groups. When normal neutrophils were stimulated with N–formyl–methionyl-leucyl-phenylalanine (FMLP), the enzyme activity was markedly increased in both subcellular fractions. In contrast, neutrophils from 3 of the 5 LJP patients tested completely failed to rise the DAG kinase activity upon chemoattractant stimulation. These data indicate that in some LJP patients the neutrophil DAG kinase may be defective. To examine whether a decrease in DAG kinase activity could account for some neutrophil abnormalities seen in LJP, normal neutrophils were treated with R59O22, a DAG kinase inhibitor, that has been shown to reduce DAG kinase activity in human neutrophils. Upon stimulation with FMLP, R59O22-treated normal neutrophils showed significantly reduced chemotactic response and enhanced respiratory burst activity, two typical functional abnormalities featured by LJP cells. It is concluded that a defect in DAG kinase may cause, through an abnormal accumulation of the endogenous PKC activator DAG, some of the functional changes observed in neutrophils from LJP patients.     

A skin window study of neutrophil migration in subjects with localized juvenile periodontitis

Abstract This study investigated the effect of a chemoattractant, N-formylmethionyi-leucyl-phenylalanine (FMLP), upon skin window migration of neutrophils into filters in 5 patients with a history of localized juvenile periodontitis (LJP) and 8 controls. On 2 occasions, each subject had 2 superficial skin abrasions made on the inner aspect of the forearm. Initial periodontal treatment was carried out on the disease group between the visits. On one skin window filters were placed that were soaked in physiological saline, and on the other filters soaked with FMLP. Leading fronts and cell densities were measured in each filter. At visit 1, LJP subjects had significantly lower leading fronts and cell densities. At visit 2, the differences were insignificant. The leading fronts for the LJP group were significantly improved on the second visit. No difference was observed between saline and FMLP. The findings of this study indicate that neutrophil migration is reduced in LJP patients where treatment is not involved, and that FMLP has no effect on neutrophil migration from the skin windows under the conditions of this study.     

Metronidazole in the treatment of localized juvenile periodontitis

Abstract Systemic metronidazole and tetracycline were compared as adjunctive agents in the treatment of localized juvenile periodontitis (LJP). 27 patients with Actinobacillus actinomycetemcomitans-positive (Aa) LJP were treated with scaling and rootplaning, control of oral hygiene and periodontal surgery if indicated. The patients were randomly divided into 3 equal groups: the 1st group had metronidazole 200 mg × 3 × 10 days, the 2nd tetracycline 250 mg × 4 × 12 days, the 3rd group received no medication and served as a control. 6 patients had periodontal surgery. 4 sites with the most advanced bone loss as determined on radiographs were selected in each subject for test sites. Gingival index, gingival bleeding after probing (GB), probing depth (PD), suppuration, and radiographic bone loss were registered, and subgingival Aa was selectively cultured. GB and PD>4 mm were registered in the whole dentition as well. All parameters were monitored at baseline and at 6 and 18 months after treatment. By the end of the study, Aa was suppressed to below detection level at all test sites only in the metronidazole group, at 17/26 sites (4 patients) in the tetracycline group and at 19/26 sites (6 patients) in the control group. Clinically, all groups showed improvement. In conclusion, metronidazole was more effective than tetracycline in the suppression of Aa and the suppression of Aa appeared to produce better clinical results.     

Microbiological and clinical effects of surgical treatment of localized juvenile periodontitis

Since Actinobacillus actinomycetemcomitans appears to be a key etiologic agent in localized juvenile periodontitis, this study determined the effectiveness of different treatment modalities in suppressing A. actinomycetemcomitans in localized juvenile periodontitis lesions. A total of 25 deep periodontal lesions from 7 patients with localized juvenile periodontitis were included in the study. The test periodontal lesions either received scaling and root planing alone, scaling and root planing together with soft tissue curettage, or modified Widman flap surgery. Subgingival A. actinomycetemcomitans were enumerated using selective culturing. Clinical measurements included changes in probing periodontal attachment level, probing periodontal pocket depth, gingival index, plaque index, and digital subtraction of standardized serial radiographs. The microbiological and clinical effects of treatment were monitored over a period of 16 weeks. All periodontal lesions studied demonstrated high numbers of A. actinomycetemcomitans prior to treatment. Scaling and root planing alone did not markedly change the subgingival A. actinomycetemcomitans counts, nor any of the clinical parameters studied. In contrast, soft tissue curettage as well as modified Widman flap surgery suppressed A. actinomycetemcomitans to undetectable levels immediately after therapy in more than 80% of the lesions studied. A total of 5 periodontal lesions exhibited gain of probing periodontal attachment after subgingival curettage or Widman flap treatment; 3 of these sites revealed no detectable A. actinomycetemcomitans, and the remaining 2 sites harbored only low levels of A. actinomycetemcomitans. 5 periodontal lesions which lost probing attachment after treatment all demonstrated high numbers of subgingival A. actinomycetemcomitans. Changes in alveolar bone, assessed by digital subtraction of serial radiographs, correlated with changes in probing periodontal attachment level, confirming the clinical results. The present study revealed a close relationship between post-treatment A. actinomycetemcomitans levels and the clinical response to treatment, which supports the concept that A. actinomycetemcomitans is an important organism in the etiology of localized juvenile periodontitis. This study also showed that a substantial suppression of subgingival A. actinomycetemcomitans cannot be achieved by periodontal scaling and root planing alone, but can be accomplished by surgical removal of periodontal tissues.(ABSTRACT TRUNCATED AT 400 WORDS)     

Long‐term follow‐up of successful orthodontic‐periodontal treatment of localized aggressive periodontitis: a case report

This report describes a case of localized aggressive periodontitis (localized juvenile periodontitis) that was jointly treated with conventional periodontal therapy, selective extractions to eliminate localized areas of vertical bone loss, and orthodontic therapy. A 20‐year follow‐up is described in this report. The success of periodontal treatment in a case such as this depends on making an accurate diagnosis, providing periodontal treatment to control the disease, and providing regular periodontal maintenance during and after orthodontic treatment.     

Prevalence of juvenile periodontitis in Chile

The aim of this survey was to study the prevalence of juvenile periodontitis in schoolchildren aged 15-19 years in Santiago, Chile. A random sample of 2500 schoolchildren (1318 male, 1182 female) that represented the full range of different socio-economic strata and ethnic groups seen in the population of Santiago, was used. Initially, the children were screened clinically at school by assessment of probing depths around the incisors and first molars with a WHO 621 pattern probe. Children with 2 or more teeth with 5.5 mm or deeper pockets were invited for a radiographic examination comprising bitewing radiographs of molars, and periapical radiographs of incisors. Any subject with 2 mm or more alveolar bone loss was invited for a full clinical and radiographic examination. After screening, 27 subjects had a tentative diagnosis of juvenile periodontitis. 4 of these refused radiographic examination and only accepted a thorough clinical examination. 23 subjects presented themselves for the radiographic and complete clinical examination. Of the 27 subjects selected for detailed examination, 8 subjects (7 female, and 1 male) were diagnosed as having juvenile periodontitis. There was an overall prevalence of juvenile periodontitis of 0.32% with 95% confidence, which gives a range of +/- 0.10%. When prevalence was assessed by socio-economic status, juvenile periodontitis was found more commonly in low socio-economic group. The results of the current study suggest that in Chile, there might be a relationship between socio-economic status and prevalence of juvenile periodontitis, and that this disease is more frequent in women.     

Increased respiratory burst activity is associated with normal expression of IgG-Fc-receptors and complement receptors in peripheral neutrophils from patients with juvenile periodontitis

The respiratory burst activity in peripheral neutrophils from nine patients with localized juvenile periodontitis (LJP) and age- and sex-matched healthy controls was studied by measuring the intensity of luminol-enhanced chemiluminescence (CL) induced by unopsonized and three differently opsonized zymosan particles, formyl-methionyl-leucyl-phenylalanine (FMLP) or phorbol myristate acetate (PMA). The neutrophils from LJP patients showed in general more intense CL with all activators than did their controls. Particulary, the CL response induced by unopsonized zymosan particles and FMLP were significantly higher (p < 0.05 and 0.001). When comparisons were made between female LJP patients (n = 6) and matched controls, also serum-opsonized and IgG-opsonized zymosan particles produced CL was significantly increased (p < 0.05). In order to determine whether the elevated CL responses to zymosan particles were due to altered levels of the interacting receptors on neutrophil surface, an immunofluorescence analysis of the expression of IgG-Fc-receptors (FcR) and complement receptors (CR) was performed with flow cytometry. No significant difference in the expression of FcRII, FcRIII, CRl and CR3 was detected in LJP group compared to controls. Since the elevated CL responses can not be explained by changes in receptor numbers it is hypothesized that the increased respiratory burst activity in LJP may be caused by altered post receptor signalling pathway.     

Relationship between palatoradicular grooves and localized periodontitis

Abstract A total of 404 maxillary lateral and central incisors were examined in a group of 101 individuals comprising 64 males and 37 females for the presence of palatoradicular groove (PRG). The methods used to document the presence of PRO situated at or apical to the cemento-enamel junction (CEJ) included clinical probing, flap operation and inspection with the aid of an enlarging oral mirror. PRGs were classified by location in the mesial, distal and midpalatal areas of affected teeth. The plaque index (PII), gingival index (GI) and probing pocket depth (PPD) were recorded on the lingual aspect of the teeth examined. Those PRG with initial PPDs of mm and located at or apical to the CEJ were counted as PRG with PPD. The difference in the PRG location for teeth with and without PPDs was analyzed via the φ² test. The relationship between the presence of a PRG and the patients periodontal health and plaque accumulation were analyzed using the t-test. Results are summarized as follows: (1) the proportional test showed statistical non-significance amongst the sexes; (2) PRGs were greatest in the maxillary lateral incisors when compared to the central incisors; few patients had PRGs in both the maxillary and central incisors; (3) PRGs were most often located in the midpalatal part of affected teeth as opposed to the mesial or distal area; however, more distal and mesial PRGs were associated with PPDs when compared to centrally situated PRGs; (4) a direct statistical relationship was established between the depth, location of PRGs and the GI, P1I and development of PPDs in affected teeth.