In this study, fine structural features of the pocket walls in rapidly progressive periodontitis (RPP) and adult periodontitis (AP) in 20 cases were compared using light and transmission electron microscopy. Gingiva was also obtained from a control group of periodontally healthy teeth. Clinical parameters were assessed in both RPP and AP patients and in controls. Bone destruction and attachment loss were more marked in RPP than in AP. Light microscopical observations of inflamed RPP tissue as compared to AP showed gross histological distortions in the pocket walls. Micro-ridges within the epithelium and large intercellular spaces between the epithelial cells were observed in most RPP biopsies. Epithelial cells surrounding the microclefts and adjacent keratinocytes were found to produce interleukin-1beta (IL-1beta). Prevotella intermedia and Porphyromonas gingivalis were identified in the RPP biopsies using immunohistological methods. These microorganisms were localized outside the epithelium and inside intercellular spaces. Furthermore, the effect of inflammation on the distribution of collagen types I, III, IV, V, and VI in the human gingiva was studied after staining them with antibodies to these proteins. In RPP and AP tissues, the staining was sparse in areas of inflammation and leukocytic infiltration. Collagen type I and III were almost entirely lost at sites of inflammation. Type V and VI collagen antibodies were retained in inflamed areas. Type IV collagen was restricted to basement membrane structures. These observations demonstrated numerous structural features indicative of more pronounced degenerative changes in RPP than in AP.