CLASSIFICATION Flashcards
4 workgroups of the classification
- Gingival Health and Gingivitis
- Periodontitis
- Systemic Diseases and Development and Acquired Conditions
- Peri Implant Diseases and Conditions
Categories under Gingival Health, Gingivitis, Periodontitis
- Gingival Health
- intact periodontium, reduced periodontium - Gingivitis
- intact periodontium, reduced periodontium - Treated Periodontitis
-gingival health, gingival inflammation - Periodontitis
- Necrotizing Periodontitis (Gingivitis)
- Periodontitis as a Manifestation of Systemic Disease
Extent
Localized <30%
Generalized > than or = to 30%
**must be percent of teeth at the stage defining severity (specific stage used for diagnosis from worst affected tooth in dentition)
Periodontitis Staging
Interproximal CAL > than or equal to 2 non adjacent teeth
Buccal or oral CAL> than or = 3mm
Pocketing >3mm, > than or equal to 2 teeth
Unknown reason for tooth loss cannot be included
** interdental CAL detectable at > or equal to 2 non adjacent teeth OR buccal or oral CAL > than or = to 3mm with pocketing >3mm is detectable at > than or = to 2 teeth .
HOWEVER, cannot be ascribed to:
1. Gingival recession or traumatic origin
2. Dental caries extending to cervical area of teeth
3. CAL on 2nd molar distal associated with malpositioned or extraction of a 3rd molar
4. Endodontic lesion draining through marginal periodontium.
5. Vertical root fracture.
Relation to stage and prognosis
Stage 1or 2-Good prognosis; no tooth loss expected
Stage 3- Risk of loss of a tooth or teeth up to 4
Stage 4- Risk of loss of arch of dentition (5 or more)
Name the 3 parameters for Grading
- Direct (longitudinal RBL and CAL)
- A none
-B <2mm
-C>2mm - Indirect (% BL/Age)
- A <0.25
-B 0.25-1.0
-C >1.0 - Plaque-BL
Name 2 risk factors in grading
- Smoking
-A- non smoker
-B<10cigg/day
-C- = or >10cigg/day - HbA1c
A- normoglycemic
B- <7
C- >than or = to 7
Systemic Impact
CRP (mg/L)
A<1
B 1-3
C>3
Systemic conditions affecting periodontium
- Down Syndrome
- Leukocyte adhesion deficiency
- Papillon Lefevre syndrom
- Chediak Higashi Syndrome
- Hypophosphatasia
What conditions fall under Necrotizing Periodontal disease
- Necrotizing gingivitis
- Necrotizing periodontitis
- Necrotizing stomatitis
- NOMA
NPD in severely compromised patients
ADULTS
1.HIV/AIDS
2. Immunosupression
CHILDREN
1. Severe malnourishment
2. Extreme living conditions
3. Severe viral infections
NPDin temporarily or moderatley compromised patients
Gingivitis patients
- uncontrolled factors, stress, nutrition, smoking, habits
- previous NPD: residual craters
- local factors: root proximity, tooth malposition
- Gen or Loc NG, may progress to NP
Periodontitis patients
-common predisposing factors
- poor OH, stress, tobacco, alcohol, young age, ethnicity
- NP with infrequent progression
Peri Implant Health
Absence of:
- visual inflammation (pink, no swelling, firm tissue)
- BoP (line or drop within 30sec and or suppuration on gentle probing)
-Increase in PD from baseline (prosthesis delivery)
-absence of further BL beyond initial healing, which should not be > than or = to 2mm
- Can exist around an implant with reduced support
- PD usually greater at implants
- IP papilla may be shorter for an implant
How to examine an implant?
Visual
Probing
Palpation
Radiograph
Peri Implant Mucositis
Bleeding on gentle probing
PD increase likely
Can resolve, but may take up to 3 weeks
Main etiology: plaque
Peri Implantitis
Inflammation +BoP/suppuration
RBL following initial healing
Increase in PD from suprastructure placement
Progressive RBL compared to 1 year post prosthesis delivery
In the absence of initial radiographs and PD, radiographic evidence of BL> or =3mm AND/OR PD> than or= 6mm with profuse BOP
Peri implantitis facts
- no unique bacteria or cytokines identified
- PIM assumed to precede PI but factors leading to change from PIM to PI not identified.
- Progression of PI may be faster than periodontitis
- Risk indicators (RI): History of periodontitis, poor plaque control, inadequate maintenance
- crestal RBL usually associated with inflammation
**data identifying smoking and diabetes as risk indicators is not conclusive.
- poor placement/position may increase prevalence of PI
- post restorative submucosal cement may lead to increased PI
- progression of PI may be faster than periodontitis
NOT ENOUGH EVIDENCE FOR RISK INDICATORS
- KT, occlusal overload, titanium particules, bone compression necrosis, overheating, micromotion and biocorrosion
Peri Implant Disease Treatment
No standard therapy
Hard tissue deficiencies
- Horizontal ridge deficiency
- Vertical ridge deficiency
- Pneumatization of maxillary sinus
- Thin/absent buccal and lingual bone plates
Factors leading to bone deficiency
Post extraction healing
Loss of perio support
Endo infection
VRF
Thin buccal bone
Buccal or lingual relative to arch position
Traumatic exo
Injury
Sinus pneumatization
Meds and systemic diseases reducing bone formation
Tooth agenesis
Pressure from soft tissue supported removable prosthesis
Soft tissue deficiencies
Thin peri implant mucosa
Lack of KT at peri implant site
Reduced papilla height
Peri implant frenum attachments
Factors leading to recession
Poor implant position
Lack of buccal bone
Thin soft tissue
Lack of KT
Status of attachment on adjacent teeth
Surgical trauma
*evidence if equivocal on role of KT
Relation of peri implant bone and peri implant soft tissue
Implant tooth papilla height determined by soft tissue attachment to the tooth
Implant to implant papilla height determined by bone crest between implants
Equivocal evidence on necessity of buccal bone plate for long term support of buccal soft tissue
Prosthesis and tooth related factors
Localized tooth related factors
- tooth anatomic factors
- root fractures
-cervical root resorption, cemental tears
- root proximity
- APE
Localized prosthesis related factors
1.Restoration margin within supracrestal attachment
2. Loss of periodontal supporting tissues caused by fabrication of indirect restoration
3. Hypersensativity/toxicity reactions to dental materials (nickle is most common)
Mucogingival deformaties around TEETH
- Gingival phenotype
- Gingival recession
- facial/lingual
-interproximal RT1, RT2, RT3 - Lack of gingiva
- Decreased vestibular depth
- Aberrant frenum/muscle position
- Gingival excess
- pseudopocket, inconsistent gingival margin
-excessive gingival display - Abnormal colour
- Root surface condition
Periodontal Phenotype
Gingival phenotype (thickness and width of KT)
Bone morphotype (thick and thin)
Recession and other factors
Tooth position
Toothbrushing
Cervical restoration margin
Orthodontic (buccal positioning)
Cairo
RT1= no IP attachment loss- complete root coverage expected
RT2= IP loss < or = to buccal AL - partial root coverage expected
RT3= IP attachment loss >buccal AL - no coverage expected.
Millers Recession Classification
Class 1- recession not to MGJ; no IP bone or papilla loss- 100% root coverage possible
Class 2- recession PAST MGJ, no IP bone loss or papilla loss- 100% root coverage possible
Class 3- recession PAST MGJ, IP bone and papilla loss, malpostion, partial root coverage possible
Class 4- recession PAST MGJ, SEVERE IP bone and papilla loss, malposition, no coverage
CEJ (A/B)
Step (+/-)
CEJ A- detectable CEJ
CEJ B- undetectable CEJ
+ = root concavity, cervical step >0.5
- = root concavity, no cervical step >0.5
PERIO ENDO LESIONS CLASSIFICATION
Endo perio lesion WITH ROOT DAMAGE
- root fracture
root canal or pump perforation
-external root resorption
Endo perio lesion WITHOUT ROOT DAMAGE in periodontitis patients
Grade 1- narrow, deep periodontal pocket in 1 tooth surface
Grade 2- wide, deep periodontal pocket in 1 tooth surface
Grade 3- deep periodontal pockets in more than 1 tooth surface
Periodontal Abscess
PERIODONTITIS PATIENT
Acute:
- maintenance SPT
-non responsive to treatment
- untreated
Post treatment:
-post SRP, surgery, medication
NON PERIODONTITIS PATIENT
-Impaction: ortho elastics, popcorn hull
-Habits: nail biting, clenching
-Ortho: orthoforces , cross bite
- Gingival overgrowth/ enlargement
- Root surface alterations: cemental tear, peforation, fracture
McGuire and Nunn
Good: one or more of the following- control of etiologic factors and adequate periodontal support as measured clinically and radiographically to assure the tooth would be relatively easy to maintain by the patient and clinician assuming proper maintenance
Fair: one or more of the following: approx 25% AL as measured clinically and radiographically and or class 1 furcation involvement. The location and depth of the furcation would allow proper maintenance with good patient compliance
Poor: one or more of the following, 50% AL with class II furcations. The locations and depths of the furcation would allow for proper maintenance but with difficulty
Questionable: greater than 50% AL resulting in poor CR ratio. Poor root form. Class 2 furcations not easily accessible for maintenance care or Class 3 furcations. Grade 2 mobility or greater. Significant root proximity
Hopeless: inadequate attachment to maintain the tooth. Extraction performed or suggested
McGuire and Nunn (individual and overall prognosis )
Individual- % of BL, deepest PD, horizontal or vertical BL, deepest furcation involvement, mobility, CR ratio, root form, caries or pulp involvement, tooth malpostion, fixed or removable abutment
Overall prognosis: age, significant medical history, family history of periodontal disease, hygiene, compliant, maintenance interval, parafunctional habit with bitegaurd, parafunctional habit without bitegaurd.
Kowk and Caton
Favourable - periodontal status can be stabilized with periodontal treatment and maintenance. Future loss of periodontal supporting tissues is unlikely if these conditions are met
Questionable- periodontal status of a tooth is influenced by local or systemic factors that may or may not to controlled. Periodontium can be stabilized with periodontal treatment and maintenance if these factors are controlled, otherwise future periodontal breakdown may occur.
Unfavourable- periodontal status of the tooth is influenced by local and or systemic factors that cannot be controlled. Periodontal breakdown likely to occur even with periodontal tx and maintenance
Hopeless - needs exo
Becker and Becker Prognosis
When to assign prognosis?
- initial exam
- re-evaluation
- post therapy
- annually during maintenance unless some event indicates a need to re-evaluate the prognosis
*prognosis is not static and may change
