The diagnosis of localized aggressive periodontitis includes first molar attachment loss as an obligatory criterion. This tooth-specific based diagnosis has never been questioned or tested previously. We present a rare case of aggressive periodontitis that developed during orthodontic treatment, which included extraction of right lower first molar and bodily movement of the second molar to the original first molar site. At the end of the orthodontic therapy, localized periodontal disease was diagnosed at the site of the lower left first molar and the second lower right molar that was now occupying the site of the former first lower molar. The patient's periodontal condition was stabilized, and the bony defects were filled following periodontal treatment. This report shows that bacterial induced aggressive periodontitis developed during orthodontic treatment in a site-specific manner and suggest the hypothesis that localized aggressive periodontitis was targeted to a specific alveolar site rather than a tooth-specific site.