Accepted: 15 February 2018

DOI: 10.1111/jre.12548

ORIGINAL ARTICLE

Radiographic morphology of intrabony defects in the first

molars of patients with localized aggressive periodontitis:
Comparison with health and chronic periodontitis

L. Nibali1  | P. Tomlins2 | A. Akcalı1

1
Centre for Immunobiology & Regenerative
Medicine, Centre for Oral Clinical
Research, Institute of Dentistry, Bart’s
and the London School of Medicine and
Dentistry, Queen Mary University of London
(QMUL), London, UK
2
Bart’s and the London School of Medicine
and Dentistry, Queen Mary University of
London (QMUL), London, UK
Correspondence
Luigi Nibali, Centre for Immunobiology &
Regenerative Medicine, Centre for Oral
Clinical Research, Institute of Dentistry,
Barts and the London School of Medicine
and Dentistry, Queen Mary University of
London (QMUL), London, UK.
Email: l.nibali@qmul.ac.uk
Background and Objective: The aim of this study was to describe the radiographic
features of the first molars of patients with localized aggressive periodontitis (LAgP)
and of their associated intrabony defects and to compare them with a control sample
of chronic periodontitis cases and healthy subjects.
Methods: Data from a total of 93 patients were included in this analysis. First, dental
panoramic tomograms of 34 patients with LAgP (131 first molars) and 30 periodon-
tally healthy patients (110 first molars) were compared. Then, periapical radiographs
of the first molars of the same patients with LAgP and of 29 patients with chronic
periodontitis affected by intrabony defects were analysed.
Results: Shorter root trunks were associated with the presence of intrabony defects
in patients with LAgP (P = .002 at multilevel logistic regression), also when LAgP mo-
lars were compared with healthy subjects (P = .036). Although no difference in defect
depth and angle was noted between LAgP and chronic periodontitis intrabony de-
fects, LAgP intrabony defects appeared to be more frequently symmetrical and arch-­
shaped than in chronic periodontitis (P = .008), with positive predictive value and
negative predictive value of for ‘wide arch’ defect of 87.3% (95% CI = 77.2%-­93.3%)
and 32.3% (95% CI = 27.7%-­37.2%) respectively.
Conclusions: First molars of patients with LAgP affected by intrabony defects may
have some distinct radiographic anatomical characteristics to those of healthy sub-
jects. The shape of intrabony defects seems to differ between LAgP and chronic
periodontitis cases. Further studies need to confirm these features and investigate if
they are related to the initiation and progression of periodontitis.

KEYWORDS
bone loss, localized aggressive, molar, periodontitis, radiography

1 |  I NTRO D U C TI O N
Localized aggressive periodontitis (LAgP) (previously known as
localized juvenile periodontitis) is a rare form of periodontitis
affecting children and young adults. Familial aggregation, rapid
progression and systemic health are typical of forms of aggres-
sive periodontitis.1 LAgP has a characteristic circumpubertal
onset1 but cases of primary dentition involvement have also been
described. 2,3 LAgP cases classically consist of vertical bone loss
affecting first molars and incisors symmetrically in both sides,
although asymmetrical cases have been described.4 The lesions
usually present radiographically as a ‘vertical’, ‘U-­shaped’ or ‘arch-­
shaped’ image of radiolucency surrounding maxillary or man-
dibular first molars and incisors. 5,6 However, it is not clear if the

J Periodont Res. 2018;1–7. wileyonlinelibrary.com/journal/jre   © 2018 John Wiley & Sons A/S. |  1
Published by John Wiley & Sons Ltd
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2       NIBALI et al.
aetiology and hence the morphology of these intrabony defects
differ in any way from intrabony defects observed in chronic peri-
odontitis cases.7 The reason for increased susceptibility of first
molars and incisors to LAgP is probably due to an aetiological fac-
tor occurring during their eruption, as they are the first permanent
teeth to erupt. 8 LAgP cases seem to present a distinct microbiota
compared with generalized AgP or chronic periodontitis cases.9
In some populations, subgingival detection of Aggregatibacter
actinomycetemcomitans and particularly its JP2 clone has been
10
strongly associated with onset and progression of LAgP. It has
been postulated that specific bacterial consortia subgingivally
coupled with salivary activity can predict onset of LAgP in spe-
cific populations.11,12 Specific microbial colonization during tooth
eruption or cytomegalovirus infection during root formation has
been considered possible aetiological factors.13 Furthermore, de-
fects in neutrophil chemotaxis, phagocytosis and microbial killing
have been implicated as potential predisposing factors.14,15 Other
authors have suggested structural defects affecting these teeth
as predisposing to LAgP, such as cementopathia/cemental hypo-
plasia16 or alterations in cementum formation and maturation.17 A
recent study showed possible initiation on first primary molars of
LAgP and abnormal root resorption patterns.18
However, are the disease processes and the bone loss pattern
actually different between LAgP and the more common chronic
periodontitis? In addition, are there any specific characteristics of
molars of patients with LAgP predisposing them to this early-­onset
periodontal breakdown? To our knowledge, no published studies
have investigated specific features of intrabony defects affecting
first molars in LAgP. Therefore, the aim of this study was to perform
a radiographic analysis of anatomic features of first molars of LAgP
cases and of their respective intrabony defects. Unaffected first mo-
lars of healthy individuals and first molars of chronic periodontitis
with intrabony defects were used as controls.
2 |  M ATE R I A L A N D M E TH O DS
This exploratory study reports a post-­hoc radiographic analysis of
cases included in 2 previous studies.
2.1 | Localized aggressive periodontitis
Dental panoramic tomograms (DPT) and periapical radiographs of
34 consecutive patients with LAgP with at least 1 upper and 1 lower
molar and taking part in a study investigating risk factors for perio-
dontitis were screened to detect the presence of intrabony defects.
The study had been reviewed and approved by the Eastman/UCLH
joint ethics committee and all patients signed informed consents to
take part.19 Inclusion criteria for LAgP were as follows:
• Systemic health (self-reported)
• Age <35 years
• Presenting with interproximal probing pocket depths (PPD) and
clinical attachment loss ≥5 mm and radiographic bone loss of
≥30% of root length on at least 2 permanent teeth, of which at
least 1 was a first molar or incisor, and no more than 3 teeth other
than first molars or incisors.1
2.2 | Healthy subjects
DPTs of 30 consecutive periodontally healthy subjects included as
controls in the LAgP study above19 and having at least 1 upper and 1
lower molar were screened. All healthy patients had been recruited
from subjects attending the Eastman Dental Hospital for non-­
periodontal reasons. All subjects had signed consent forms to take
part in the study as healthy controls. Inclusion criteria were:
• Age ≥25 years
• Absence of sites with PPD and clinical attachment loss ≥4 mm
2.3 | Chronic periodontitis
Periapical radiographs of 29 consecutive patients with chronic periodon-
titis included in a retrospective study20 were analysed. Ethics approval
for the retrospective analysis had been sought from the London and City
Ethics Committee, which gave permission for the study to be carried out
as service evaluation (reference 14 LO 0629). Inclusion criteria were:
• Diagnosis of chronic periodontitis21
• Interproximal clinical attachment loss ≥3 mm in at least 2 non-ad-
jacent teeth22
• At least 2 sites with PPD >4 mm
• At least 2 sites with radiographic evidence of bone loss ≥20% of
root length
• Presence of intrabony defects (≥2 mm depth radiographically) in
at least 1 first molar
2.4 | Analysed parameters
The first molars of all patients were analysed radiographically with
respect to the following (see Figure 1):
• Tooth anatomy: crown and root length (mm), crown-to-root ratio,
length of root trunk and root cones (mm), root divergence (mm),
coefficient of separation, degree of separation (angle). A single
measurement per tooth was taken for root trunk length, while
root cone length was averaged between roots
• Open contact (yes/no), measured as visible contact between the
affected molar and the tooth neighbouring the intrabony defect
• Presence of restorations, secondary caries and overhanging margins
(yes/no)
• Endodontic status, measured as previous endodontic therapy (yes/
no) and periapical radiolucency (yes/no)23
NIBALI et al.
F I G U R E   1   Schematic representation of radiographic landmarks
and measurements of examined molars
• Presence of visible calculus (yes/no) on the affected root surface
• Presence of furcation involvement (yes/no), measured as an area of
radiolucency visible in the root separation area
• Bone loss [cemento-enamel junction (CEJ)-apical point of the de-
fect, mm]
• Presentation of the intrabony defects: defect depth (mm) and angle
(degrees)
• Over-eruption (mm), measured as distance from the most coronal
portion of the crown (cusp tip) and the line connecting the most
coronal portion of the crowns (cusp tips) of the 2 neighbouring
teeth
• Distance to the line of adjacent CEJ (mm), measured as the distance
from the line drawn between the 2 neighbouring CEJs to the alve-
24
olar crest
• Interproximal distance (mm), measured as the distance between
the affected molar and the neighbouring root at the most coronal
level of the interproximal alveolar crest 25
Furthermore, only in intrabony defects, we calculated:
• Intrabony defect shape (see Figure 2): distance (mm) from the
deepest point of the defect (roof of the arch, point A) to the line
connecting apical and coronal extreme parts of the defect (line
B-C). This is a measure of the shape of the defect, being higher in
‘arch-shaped’ defects and lower in straighter oblique-line defects.
The radiographic data detailed above were analysed within
LAgP cases first (first molars affected by intrabony defects vs not
affected). Then DPTs of LAgP first molars were compared with
DPTs of first molars of healthy subjects. Lastly, measurements
from periapical radiographs of LAgP and chronic periodonti-
tis cases (all affected by intrabony defects) were compared (see
Appendix S1).
|
      3
F I G U R E   2   Schematic representation of radiographic measure
of ‘intrabony defect shape’. First, a straight line (B-­C) was drawn,
joining the most coronal (B) and apical (C) points of the bony defect;
then a straight line against B-­C was drawn from point A (furthest
away part of the defect from the B-­C line). Distance A to line B-­C
was measured in mm to indicate ‘defect shape’
2.5 | Calibration of radiographic parameters
One single investigator (author A.A.) performed all radiographic analy-
ses. To assess reproducibility of the radiographic assessments, an intra-­
examiner calibration exercise was performed before starting the study
by obtaining 2 separate measurements of all the above-­mentioned radio-
graphic parameters on a combination of 50 radiographic sites obtained
from long cone parallel periapical radiographs and DPTs 1 week apart. The
intraclass coefficient for calibration was >.90 for all studied parameters.
2.6 | Statistical analysis/power calculation
This is an exploratory study, aimed at detecting possible differences in
tooth and intrabony defect morphology between LAgP, chronic perio-
dontitis and healthy patients. Therefore, no formal power calculation was
performed. ‘Intrabony defect’ was the main outcome for the within LAgP
and LAgP vs healthy analyses, while ‘diagnosis’ was the main outcome
for the LAgP vs chronic periodontitis analysis (all affected by intrabony
defects). Statistical analyses were carried out using ibm spss Statistics 23
(IBM Corp., Armonk, NY, USA). Differences between categorical and con-
tinuous variables were initially analysed by chi-­squared test and ANOVA
respectively. A multilevel model with logistic regression target distribu-
tion was then used to account for dependency of outcomes on the com-
mon oral environment of multiple teeth in individual patients.26 Predictor
variables were included in the model as fixed effects. Sub-­analyses were
carried out in the largest ethnic subgroup (Caucasians) and separately
for maxillary and mandibular molars. A separate analysis was performed
to explore associations between intrabony defect shape and diagnosis
(LAgP vs chronic periodontitis). Statistical significance was set at P < .05.
3 | R E S U LT S
The LAgP group included 34 patients (20 females, 12 males), with
a mix of Caucasian (53%), African-­
C aribbean (38%) and Asian
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4       NIBALI et al.

TA B L E   1   Radiographic characteristics of first molars from LAgP TA B L E   2   Radiographic characteristics of first molars from
and healthy patients patients with LAgP and CP affected by intrabony defects

First molars LAgP (n = 131) Healthy (n = 110) First molars LAgP (n = 62) CP (n = 35)

Jaw Jaw
Maxilla (%) 66 (50.4) 57 (51.8) Maxilla (%) 30 (48.4) 9 (25.7)
Mandible (%) 65 (49.6) 53 (48.2) Mandible (%) 32 (51.6) 26 (74.3)
Previously restored (%) 59 (45.0) 76 (69.1)** Previously restored (%) 27 (43.5) 33 (94.3)**
Previous endodontic 2 (1.5) 8 (7.3)* Previous endodontic 0 (1.5) 3 (8.6)*
treatment (%) treatment (%)
Presence of furcation 13 (9.9) 0 ** Presence of furcation 5 (8.1) 9 (25.7)*
involvement (%) involvement (%)
Open contact (%) 8 (6.1) 8 (7.3) Open contact (%) 10 (16.1) 7 (20)
Presence of intrabony 80 (61.1) 0 ** Root length (mm) 12.99 ± 1.82 13.84 ± 1.97*
defect (%) Root trunk length (mm) 3.84 ± 1.17 4.24 ± 1.10
Root length (mm) 18.88 ± 2.82 19.61 ± 3.75 Root divergence (mm) 3.91 ± 1.71 3.48 ± 1.35
Root trunk length (mm) 6.55 ± 1.50 7.12 ± 2.02* Degree of separation (°) 56.22 ± 14.89 50.97 ± 16.85
Root divergence (mm) 4.95 ± 2.26 4.28 ± 2.08* Over-­eruption (mm) 0.19 ± 0.84 −0.49 ± 1.17*
Degree of separation 52.17 ± 14.64 38.99 ± 14.85** Intrabony defect depth 4.56 ± 2.29 3.77 ± 2.08
(°) (mm)
Over-­eruption (mm) 0.50 ± 1.05 0.12 ± 1.00* Total distance CEJ-­bone 7.11 ± 2.72 7.09 ± 3.52
Intrabony defect 3.42 ± 3.65 0.05 ± 0.22** crest (mm)
depth (mm) Defect angle (°) 37.19 ± 13.58 37.05 ± 11.51
Total distance 7.87 ± 4.94 2.20 ± 1.44** Defect shape (mm) 0.83 ± 0.88 0.45 ± 0.70*
CEJ-­bone crest (mm)
CEJ, cemento-­enamel junction; CP, chronic periodontitis; LAgP, localized
Defect angle (°) 26.75 ± 21.30 2.96 ± 11.57*
aggressive periodontitis.
CEJ, cemento-­enamel junction; LAgP, localized aggressive periodontitis. Means and standard deviations are reported. Comparisons between
Means and standard deviations are reported. Comparisons between groups were performed by chi-­squared test and ANOVA respectively for
groups were performed by chi-­squared test and ANOVA respectively for categorical and continuous variables. Number of LAgP defects in Table 1
categorical and continuous variables. Please note that small intrabony is different from those in Table 2, owing to the different radiographs
defects depths (distance between the most coronal and the most apical used (dental panoramic tomograms for Table 1 and periapicals for
portion of the alveolar bone adjacent to the tooth) might have been Table 2).
measured in healthy cases, none of which reached the 2 mm threshold to *P < .05, **P < .001.
qualify them as ‘intrabony defects’.
*P < .05, **P < .001.
3.1 | Within localized aggressive
ethnicities (9%). The healthy group included 30 patients (19 females,
periodontitis analysis
11 males) with a majority of Caucasians (83%), 10% of African-­
Caribbeans and 7% of Asians. The chronic periodontitis group in- A total of 131 first molars from 34 patients with LAgP were included
cluded 29 patients (21 females, 8 males) prevalently Caucasians in the analysis. A total of 80 of these teeth had at least 1 intrabony
(93%), with 1 Black Caribbean and 1 Asian subject. The character- defect (defined as ≥2 mm distance between the most coronal and
istics of first molars of LAgP and healthy patients, as assessed by the most apical portion of the alveolar bone adjacent to the tooth),
DPTs, are reported in Table 1. Periodontally healthy subjects had while 51 had no intrabony defects. Lower first molars were af-
more restored and endodontically treated teeth, while LAgP cases fected by intrabony defects more commonly than upper first mo-
had more teeth with furcation involvement and, by definition, more lars (72% vs 50%). In the analysis within patients with LAgP only,
bone loss and intrabony defects. The characteristics of first molars shorter root trunks (adjusted P = .002) and African-­C aribbean eth-
of patients with LAgP and chronic periodontitis (only those with in- nicity (P = .029) were associated with the presence of intrabony
trabony defects), as assessed by periapical radiographs, are reported defects in the model (see Table 3 and Appendix S2). Including only
in Table 2. A higher degree of restored and endodontically treated first molars of Caucasians (n = 69), root trunk length was still as-
teeth was evident in the chronic periodontitis group, along with sociated with intrabony defects (P = .028). When data were split
higher furcation involvement. Table 3 reports P values of associa- by upper and lower jaw, both overall root length (P = .032) and
tions with presence of intrabony defects (within LAgP and LAgP vs root trunk length (P = .044) were associated with maxillary intra-
healthy analyses) and with diagnosis (LAgP vs chronic periodontitis bony defects, while both root trunk length (P = .015) and African-­
intrabony defects). Appendices S2-S4 graphically depict the strength Caribbean ethnicity (P = .046) were associated with mandibular
of associations of the analyses above. intrabony defects (data not reported in tables).
NIBALI et al. |
      5

TA B L E   3   Statistical significance (P values) for associations with Table 3). No associations were detected in Caucasians. Including
presence of intrabony defects (for within LAgP and LAgP vs only mandibular molars, ethnicity (P = .007) was associated with in-
healthy) and diagnosis (for LAgP vs CP) as observed by multilevel trabony defects (data not reported in Tables).
logistic regression

LAgP vs
Statistical significance Within LAgP healthy LAgP vs 3.3 | Localized aggressive periodontitis vs chronic
in multilevel model (n = 131) (n = 241) CP (n = 97) periodontitis analysis
Gender 0.511 0.447 0.839 Intrabony defects as detected in periapical radiographs from 62 first
Ethnicity 0.029 0.039 0.486 molars of 33 LAgP patients and 35 first molars of 29 patients with
Restored 0.398 0.031 0.078 chronic periodontitis were compared (see examples in Figure 4). Mesial
Open contact 0.191 0.720 0.656 defects were more common than distal defects for both LAgP (41 of
Root length 0.206 0.769 0.645 62 = 66%) and chronic periodontitis (29 of 38 = 76%, including 3 teeth
Root trunk length 0.002 0.036 0.709 with both mesial and distal defects). LAgP defects appeared more

Root divergence 0.762 0.105 0.286

symmetrical than chronic periodontitis defects: in the 33 patients with
LAgP examined, 13 of 49 (26.5%) of these defects had contralateral
Over-­eruption 0.137 0.876 0.506
intrabony defects (on the symmetrical first molar), in contrast to only
Upper or lower jaw 0.537 0.651 0.792
4 of 31 (13%) in patients with chronic periodontitis. None of the inves-
CP, chronic periodontitis; LAgP, localized aggressive periodontitis. tigated factors was associated with diagnosis (see Table 3).
Significant associations are shown in bold.
Different types of intrabony defects were noted (more arch-­
shaped vs more linear intrabony defects) (see Appendix S5). The
defect ‘shape’ measure was higher in LAgP than in chronic peri-
3.2 | Localized aggressive periodontitis vs
odontitis. Statistical analysis adjusted for gender and ethnicity re-
healthy analysis
vealed that diagnosis was associated with defect ‘shape’ (P = .008)
The 131 first molars of 34 patients affected by LAgP described above (see Appendix S6). In other words, LAgP defects showed higher dis-
were compared with 110 first molars belonging to 30 patients with tance from the deepest point of the defect (roof of the ‘arch’) to the
no periodontitis (none of them with intrabony defects) (see exam- line connecting apical and coronal extreme parts of the defect (ie,
ples in Figure 3). Previous restorative treatment (P = .031), shorter wider arch) (distance A to B-­C line in Figure 2). No adjustment for
root trunk (P = .036) and African-­C aribbean ethnicity (P = .039) were age was carried out, as the diagnosis of LAgP is also a function of
associated with presence of intrabony defects (see Figure 3 and age. However, correlation analysis revealed an association between

(A) (B)

F I G U R E   3   Dental panoramic
tomograms of a 17-­year-­old male patient
diagnosed with localized aggressive
periodontitis (A) and of a 25-­year-­old
female patient diagnosed with periodontal
health (B)

F I G U R E   4   Periapical radiographs of first molars of a 26-­year-­old male patient diagnosed with localized aggressive periodontitis (A) and of
a 40-­year-­old female patient diagnosed with chronic periodontitis (B)
 |
6       NIBALI et al.
age and defect shape for LAgP (P < .001) but not chronic periodon-
titis (P = .818). With a definition of ‘wide arch’ for ≥1 mm distance
A to B-­C line for, 18% and 45% of chronic periodontitis and LAgP
respectively had a wide arch defect shape. This results in a sensi-
tivity of 42.5% (95% CI = 33.2%-­52.1%), a specificity of 81.6% (95%
CI = 65.7%-­92.3%), a positive likelihood ratio of 2.3 (95% CI = 1.1-­
4.7), a positive predictive value of 87.3% (95% CI = 77.2%-­93.3%)
and a negative predictive value of 32.3% (95% CI = 27.7%-­37.2%).
4 |  D I S CU S S I O N
This study provides the best evidence so far for the existence of a
characteristic arch-­shaped pattern of bone loss in intrabony defects
of LAgP (when compared with chronic periodontitis). Furthermore,
it suggests that specific anatomic characteristics may exist in first
molars of LAgP cases.
LAgP is a rare form of periodontal disease affecting young indi-
viduals, with a fast rate of progression but often undergoing a ‘burn-­
out’ self-­arresting period. 27 Neutrophil defects and specific patterns
of subgingival microbial colonization, including the JP2 clone of A.
actinomycetemcomitans in some populations, have been associated
with onset and progression of LAgP.10 Familial aggregation of cases
is also typical of LAgP. 28 Interestingly, although LAgP cases are
thought to have a genetic predisposing background, striking site-­
based characteristics are noticed, with the pattern of attachment
and bone loss usually affecting first molars and incisors with no con-
comitant signs of disease in the remaining teeth. The vertical bone
loss affecting these cases has been reported to be usually symmet-
4
rical on the right and left side. The radiographic bony lesions have
been described as ‘vertical’, ‘U-­shaped’ or ‘arch-­shaped’ images of
radiolucency surrounding maxillary or mandibular first molars and
incisors.5,6 The finding of an increased tendency to ‘arch-­shaped’ de-
fects in LAgP cases in the current study is in agreement with these
previous reports. The increase in the width of the intrabony defects
(to define the so-­called ‘arch’) was found after adjustment for gen-
der and ethnicity. The presence of a ‘wide’ defect arch (≥1 mm) gave
a sensitivity of 42.5% and a specificity of 81.6% for differential di-
agnosis between LAgP and chronic periodontitis. Remarkably, dif-
ferences in defect shape did not reflect differences in defect depth
or angle between LAgP and chronic periodontitis cases. It should
be mentioned that the difference in defect shape may also vary ac-
cording to the age of diagnosis, as the defect, if left untreated, may
evolve to a more angular shape. In fact, age was associated with ‘de-
fect shape’ in patients with LAgP. LAgP also had increased symme-
try compared with chronic periodontitis, with a higher frequency of
bilateral intrabony defects. Furthermore, both in LAgP and chronic
periodontitis the mesial surfaces of first molars were more likely to
be affected by intrabony defects than the distal surfaces.
Interestingly, teeth affected by intrabony defects (within LAgP
and comparing LAgP with healthy) appeared to have shorter root
trunks (as measured radiographically) compared with teeth with
no intrabony defects. This association persisted even when the
potential residual confounding effects of ethnicity was eliminated
by subgroup analyses among LAgP subjects.
Although residual confounding due to the molars being maxillary or
mandibular may be present, the pattern of shorter root trunk seemed
to be consistent in the different sub-­analyses performed. The root
trunk is defined as the area of the tooth from the CEJ to the furca-
tion fornix and it usually inversely associated with root cone length.29
Short root trunks are associated with risk of developing furcation in-
volvement29,30 but also with successful treatment of furcation involve-
ment.31 However, to our knowledge, root trunk length has not been
previously associated with presence of intrabony defects or specifi-
cally with LAgP. The rationale for this association, if not a chance find-
ing, is unclear at present, but may reflect different overall anatomical
characteristics, which may be difficult to capture by a simple clinical or
radiographic examination. However, it is important to stress that radio-
graphic measures of root trunk length are subject to errors, particularly
in the maxilla, where the buccal furcation entrance in most cases over-
laps with the palatal root. A degree of over-­eruption, unclear if a con-
sequence or a contributing factor to disease, was also found in LAgP
compared with healthy and chronic periodontitis molars, although dif-
ferences were not statistically significant at adjusted analysis.
Limitations of this study include its exploratory nature, with the in-
vestigation of a large number of parameters in a relatively small tooth
sample with the potential of an increased probability of a type I error,
and the restriction of the analysis to just radiographic characteristics.
Although different radiographs (DPTs and periapical radiographs)
were used in this study, only comparisons within the same type of
radiographs were carried out. Furthermore, the different selection
criteria for LAgP and chronic periodontitis in the 2 studies compared
here may have established a priori differences in radiographic defect
morphology between the groups. The novelty lies in the detailed anal-
yses comparing first molars of LAgP cases and their intrabony defects
with healthy teeth of subjects without periodontitis and with teeth
with intrabony defects of patients with chronic periodontitis.
This study suggests that radiographic evaluation of the present
selected anatomical landmarks may complement the clinical exam-
ination in this group of patients. Further radiographic, clinical and
histological studies should be conducted in larger populations and
different settings to understand if different anatomical features
(eg, shorter root trunk length) could predispose first molars of pa-
tients with LAgP to periodontal breakdown and if they might have
any bearing on treatment response. It would be interesting to study
whether specific pathogenic processes may lead to an enlargement
of the defect in LAgP cases, to create the characteristic ‘arch-­shape’.
ORCID
L. Nibali  http://orcid.org/0000-0002-7750-5010
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S U P P O R T I N G I N FO R M AT I O N
Additional Supporting Information may be found online in the
­supporting information tab for this article.      
How to cite this article: Nibali L, Tomlins P, Akcalı A.
Radiographic morphology of intrabony defects in the first
molars of patients with localized aggressive periodontitis:
Comparison with health and chronic periodontitis. J Periodont
Res. 2018;00:1–7. https://doi.org/10.1111/jre.12548