The American Academy of Periodontology (AAP) has released a comprehensive update to the classification of periodontal and peri-implant diseases and conditions. The complete suite of review papers and consensus reports from a joint workshop held by the European Federation of Periodontology (EFP), and the AAP in Chicago in 2017, is available in the June 2018 print and online issues of the Journal of Clinical Periodontology and the Journal of Periodontology. The workshop included more than 100 experts from Europe, Asia, Australia, and the Americas who conducted literature reviews, established case definitions, and deliberated diagnostic considerations for the classification’s primary topic areas.
The multi-dimensional staging and grading framework for periodontitis classification is among the 2017 workshop’s major features. Staging levels indicate the severity of the disease and the complexity of disease management, while the grading structure considers supplemental biologic characteristics of the patient in estimating the rate and likelihood of periodontitis progression. This framework builds upon a notable change: Forms of periodontal disease are now defined as one of three distinct forms which include periodontitis (formerly aggressive and chronic), necrotizing periodontitis, and periodontitis as a manifestation of systemic conditions.
The four categories of periodontitis staging are determined by a number of variables and range from the least severe Stage I to most severe Stage IV. The three levels of periodontitis grading—which consider a patient’s overall health status and risk factors such as smoking and metabolic control of diabetes—indicate low risk of progression (Grade A), moderate risk of progression (Grade B), and high risk of progression (Grade C).
“The new staging and grading system provides a structure for treatment planning and for monitoring a patient’s response to therapy,” says Kenneth Kornman, DDS, PhD, editor-in-chief of the Journal of Periodontology and member of the workshop’s organizing committee. “A personalized approach to patient care is essential for effective periodontal case management. The staging and grading system guides a clinician’s assessment of several dimensions beyond severity of past destruction, including specific elements that contribute to complexity of managing their patient’s case and the risk for future disease progression. The new classification system provides a paradigm similar to what is used in some fields of medicine, from which clinicians can develop a well-rounded treatment strategy based on a patient’s specific needs.”
The workshop proceedings also include, for the first time, a new classification for peri-implant diseases and conditions. Peri-implant mucositis is characterized by bleeding on probing and visual signs of inflammation and peri-implantitis, a plaque-associated condition occurring in the tissue around dental implants, is indicated by inflammation of mucosal tissue and subsequent progressive loss of supporting bone. Peri-implant health is identified by the absence of visible inflammation and bleeding on probing.
Hard and soft tissue implant site deficiencies (associated with healing after tooth loss, extraction trauma, endodontic infections, injury, and other causes) are also included within the implant condition classification.
The AAP plans to develop resources that guide the integration of the updated classification within various facets of dentistry, including dental education, dental hygiene, third-party reimbursement, and general clinical practice.