Current Classification of Periodontal and Peri-Implant Diseases

classification of periodontal and peri-implant diseases and conditions

1999 classification

-recognized 2 major forms of periodontitis:

-chronic periodontitis (the common phenotype)

-aggressive periodontitis (the infrequent phenotype- tended to be younger pts)

why was a new classification necessary?

what constitutes a periodontitis case?

-definition based on clinical attachment loss (CAL)

-interdental CAL is present at 2 or more non-adjacent teeth

-observed CAL canNOT be ascribed to other causes (trauma-induced gingival recession, dental caries extending beyond the cervical area, endodontic lesion draining through the crevice, root fracture, surgical trauma)

-buccal or lingual CAL >/=3mm is present concurrent with a pocket of >/=3mm at 2 or more teeth

why not based on alveolar bone loss?

-because bone loss needs to engage a substantial extent of the buccal-lingual/palatal dimension to be visible on a radiograph

-incipient stages of periodontitis would be missed

in the absence of discernible attachment loss that qualifies a case as a periodontitis case

two-vector framework of periodontitis case

-assigns a stage and grade

-takes into account the multi-factorial etiology of the disease & incorporates the disease severity and extent, the complexity of the required treatment, and the history of/risk for disease progression

stage

-reflects the severity and extent of the disease, expressed through attachment loss, bone loss, and tooth loss that has occurred as a result of periodontitis

-incorporates an assessment of the complexity of treatment required

grade

-incorporates additional biological dimensions of the disease

-observed or inferred rate of progression

-risk for further deterioration due to exposures or comorbidities (smoking, diabetes, compliance) that may affect treatment outcomes

stage I/II/III/IV

grade A/B/C

practical approach- step 1

practical approach- step 2

practical approach- step 3

practical approach- step 4