2017 Periodontal Classification System

Periodontal Classification System

• Four categories of periodontal conditions:
  • Periodontal health, gingivitis, and other gingival diseases
  • Periodontitis
  • Other conditions affecting the periodontium
  • Peri-implant diseases and conditions

Periodontal Health and Gingival Diseases

• Periodontal health indicates absence of disease.
• Gingivitis is often biofilm-induced.
• Other gingival diseases arise from non-biofilm factors.

Periodontitis

• Includes:
  • Periodontitis
  • Necrotizing gingivitis
  • Periodontitis associated with systemic diseases

Other Conditions Affecting Periodontium

• Factors include:
  • Systemic diseases
  • Endo-perio lesions
  • Mucogingival deformities
  • Traumatic occlusal forces
  • Factors related to prostheses or teeth

Peri-implant Diseases and Conditions

• Comprises:
  • Peri-implant health
  • Peri-implant mucositis
  • Peri-implantitis
  • Deficiencies in soft and hard tissues around implants

Localized and Generalized Periodontitis

• Localized periodontitis characterized by:
  • BOP (Bleeding on probing) at 10-30% of sites
  • No significant radiographic bone loss
  • No pockets greater than 3mm
• Generalized periodontitis shows:
  • BOP at over 30% of sites
  • No radiographic bone loss
  • No pockets exceeding 3mm

Gingivitis with Reduced Periodontium

• Classified as gingivitis if there’s radiographic bone loss but no probing depths greater than 3mm.

Factors Defining Periodontitis

• Interdental CAL (Clinical Attachment Loss) greater than 2mm in two or more non-adjacent teeth.
• Buccal or lingual CAL exceeding 3mm with pocket depth greater than 3mm in two non-adjacent teeth.
• CAL must not be due to non-periodontal causes.

Non-Periodontal Causes of CAL

• Include:
  • Traumatic occlusion
  • Draining sinus
  • Vertical root fractures
  • Cervical dental caries
  • CAL associated with third molar extraction or malposition

Assessment of Periodontal Conditions

• Severity assessed by:
  • Amount of attachment loss and degree of periodontal breakdown
  • Number of teeth lost due to periodontitis
• Complexity determined by:
  • Probing depths
  • Root fractures
  • Furcation involvement
  • Missing teeth and mobility
  • Residual ridge defect sizes
• Extent evaluated by:
  • Percentage of teeth affected and patterns (e.g., molar-incisor vs. generalized)

Main Risk Factors

• Smoking
• Diabetes

Staging of Periodontal Conditions

• Represents the disease state at various times and helps in assessing prognosis.
• Factors for staging include:
  • Severity (CAL, radiographic bone loss, tooth loss)
  • Extent and complexity
  • Risk factors like smoking and diabetes

Grading of Periodontal Conditions

• Indicates the rate of progression and potential health impact on the patient.
• Factors for assigning a grade include:
  • Direct evidence of progression
  • Indirect evidence (% radiographic bone loss vs. age)
  • Modifiers, such as smoking and HbA1c levels

Stages of Periodontitis

• Stage I - Initial Periodontitis:
  • Interdental CAL: 1-2mm
  • RBL: Coronal third, < 15%
  • No teeth lost, Pocket depth < 4mm
  • Bone loss mostly horizontal
• Stage II - Moderate Periodontitis:
  • Interdental CAL: 3-4mm
  • RBL: Coronal third, up to 33%
  • No teeth lost, Pocket depth < 5mm
  • Bone loss primarily horizontal
• Stage III - Severe Periodontitis:
  • Interdental CAL: ≥ 5mm
  • RBL: Middle third and beyond
  • Tooth loss ≤ 4, Pocket depth > 6mm
  • Vertical bone loss > 3mm
  • Furcation involvement class II and III
  • Moderate residual ridge defects
• Stage IV - Advanced Periodontitis:
  • Interdental CAL: ≥ 5mm
  • RBL: Middle third and beyond
  • Tooth loss > 5
  • Pocket depth > 6mm
  • Possible complex rehabilitation needs

Grade A - Slow Rate

• Direct evidence shows no loss over the past 5 years.