Aggressive periodontitis with streptococcal gingivitis first, to show how streptococcal infections can be effective to cause severe periodontal damage in AP and second, to test a supportive treatment modality which may be very effective to this devastating condition. CASE REPORT The patient, a 26-year-old female, was referred to our clinic by her general dentist for severe bleeding gums, gingival hyperplasia, and halitosis. At the time, the patient was experiencing pain, severe bleeding with brushing related to her periodontal disease. She had a non-contributory medical history. However, prior to her visit to our clinic, she had never had a periodontal examination. On examination, generalized edematous, hyperplastic gingiva, bleeding on probing and calculus formation was seen (Figure 1). To determine the clinical situation of the subject, gingival index,6 plaque index,7 periodontal probing depths (PPD) and clinical attachment levels (CAL) of the teeth were recorded before and after the treatment by using a manual probe (Hu- Friedy Manufacturing Inc., Chicago, IL, USA) (Table 1). Periodontal examination revealed gingival swelling, 78.2% bleeding at probing sites, 52.7% plaque control record, and 72.9% of the sites had a periodontal pocket depth of 4 mm or more. Upon initial examination, radiographs demonstrated extensive generalized vertical intra-bony defects in the maxillary and mandibular arches (Figure 2). Based on the clinical and radiographic findings, a diagnosis of generalize AP was assigned to the patient. According to these findings, treatment was started with an initial phase of mechanical therapy; including systematic scaling and planing of all accessible root surfaces and the introduction of meticulous oral hygiene. During oral hygiene instruction and subsequent initial preparation as a chemotherapeutic support tetracycline (only first day 2 x 100mg and 1 x 100mg/day – Tetradox, Fako, Turkey) had been given to the patient with a mouth rinse including Chlorhexidine Digluconate (0.12%) and Benzidamin HCL (0.15%) (Kloroben, Drogsan, Turkey). And also to improve the patient’s oral and dental hygiene, a new soft toothbrush was referred for use as part of the oral care protocol. After optimal oral hygiene was provided, based on persistence of periodontal lesions, a second phase of therapy was planned and the advanced periodontal therapy, flap and gingivectomy operations were done and remaining roots were Figure 1. Pre-treatment clinical view of anterior region of the oral cavity showing severe gingival inflammation diffused periodontal and gingival abscess formation. Figure 2. Panoramic radiograph showing generalize bone loss; especially at the molar areas. Table 1. Clinical parameters of patient assessed at baseline (T0), after initial treatment (T1), after periodontal surgery (T2) and after the all periodontal treatments (T3). T0 2.34 2.81 6.41 4.96 T1 0.67 0.95 5.13 4.85 T2 0.51 0.35 4.09 4.05 T3 0.18 0.05 4.01 3.91 PI GI PPD CAL 252 European Journal of Dentistry PI, Plaque Index; GI, Gingival Index; PPD, Periodontal Probing Depths; CAL, Clinical Attachment Levels.