Periodontol 2000. 2010 Jun;53:12-27. doi: 10.1111/j.1600-0757.2010.00353.x.
Overall, while most clinicians would agree that aggressive forms of periodontitis exist as clinical entities, the clinical distinction between chronic and aggressive periodontitis (especially generalized) is not clear cut. This may not be all that significant from a treatment perspective, in so far as individualized anti-infective therapies are effective for both forms of the disease. However, from a research perspective, it is essential that these diseases be clearly distinguished in order to gain a complete understanding of their etiology and pathogenesis. The relative lack of clinical inflammation often associated with the localized molar-and-incisor form of aggressive periodontitis has been commented on for almost 100 years, and it is generally accepted that this form of the disease is associated with a thin biofilm, at least in its early stages. In contrast, the presence of clinical inflammation in generalized aggressive periodontitis appears to be similar to that observed in chronic periodontitis, and in this situation age of onset and family history are important additional criteria for either diagnosis or classification. It is also generally recognized that chronic periodontitis may subsequently be superimposed on both localized and generalized forms of aggressive periodontitis. While this may have little bearing on the treatment of such cases, it could have an enormous impact on both the design and interpretation of research studies, whether basic science or clinical. This highlights the essential difference between a diagnosis and a classification, whereby a diagnosis is the clinician's best guess, leading on to a treatment plan, whereas a classification does not allow such flexibility, requiring non-overlapping case definitions for research purposes if the underlying etiology of these diseases is ever to be fully elucidated.
总的来说，虽然大多数临床医生都认为侵袭性牙周炎是一种临床实体疾病，但慢性和侵袭性牙周炎（尤其是广泛性）之间的临床区别并不明显。从治疗的角度来看，这可能并不重要，因为个体化的抗感染治疗对这两种疾病都有效。然而，从研究的角度来看，为了全面了解这些疾病的病因和发病机制，明确区分这些疾病是至关重要的。近 100 年来，人们一直在评论侵袭性牙周炎局限性磨牙和切牙形式常与临床炎症程度低相关，人们普遍认为这种疾病与薄生物膜有关，至少在早期阶段是这样。相比之下，广泛性侵袭性牙周炎的临床炎症的存在似乎与慢性牙周炎观察到的情况相似，在这种情况下，发病年龄和家族史是诊断或分类的重要附加标准。人们还普遍认为，慢性牙周炎随后可能会叠加在局限性和广泛性侵袭性牙周炎上。虽然这可能对这些病例的治疗影响不大，但它可能对基础科学或临床研究的设计和解释产生巨大影响。这突出了诊断和分类之间的本质区别，诊断是临床医生的最佳猜测，从而制定治疗计划，而分类不允许这种灵活性，如果要充分阐明这些疾病的潜在病因，则需要为研究目的制定不重叠的病例定义。
