Classification of periodontal and peri-implant diseases and conditions 2017

Question 1

4 General classifications

Answer 1

1. Periodontal health, gingival diseases and conditions
2. Periodontitis
3. Other conditions affecting the periodontium
4. Per-implant diseases and conditions

Question 2

3 Periodontal health and gingival disease and conditions

Answer 2

1. Periodontal and gingival health

(a) Clinical gingival health on an intact periodontium
(b) Clinical gingival health on a reduced periodontium *
- Stable periodontitis patient
- Non periodontitis patient (recession/crown lengthening)

2. Gingivitis Biofilm induced
3. Gingivitis non biofilm induced

Question 3

3 Periodontitis

Answer 3

1. Necrotizing periodontal disease
   - Necrotizing gingivitis
   - Periodontitis
   - Necrotizing stomatitis
2. Periodontitis
3. Periodontitis as a manifestation of systemic diseases

Question 4

5 other conditions affecting the periodontium

PTTSM

Answer 4

1. Systemic diseases
2. Periodontal abscess
3. Mucogingival deformities and conditions
4. Traumatic occlusal forces
5. Tooth and prosthesis related factors

Question 5

4 peri-implant diseases and conditions

Answer 5

1. Peri-implant health
2. Peri-implant mucositis
3. Peri-implantitis
4. Peri-implant soft and hard tissue deficiencies

Question 6

Defining health

Answer 6

Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”.
Based upon this definition from the World Health Organization (WHO), it follows that periodontal health should be defined as a state free from inflammatory periodontal disease that allows an individual to function normally and avoid consequences (mental or physical) due to current or past disease.

Question 7

5 Clinical Features of gingival health on an intact periodontium

Answer 7

Absence of bleeding on probing (BOP)
Absence of erythema and oedema
Absence of patient symptoms
Absence of attachment and bone loss
Physiological bone levels range from 1.0 to 3.0mm apical to the cemento-enamel junction

Question 8

Clinical features of gingival health following treatment of gingivitis on an intact periodontium

Answer 8

Absence of bleeding on probing (BOP)
Absence of erythema and oedema
Absence of patient symptoms
Absence of attachment and bone loss

Question 9

Periodontal stability

Answer 9

= successful treatment through control of local and systemic risk factors
= resulting in minimal (< 10% of sites) BOP
= no probing depths of 4mm or greater that bleed on probing
= optimal improvement in other clinical parameters
= lack of progressive periodontal destruction

Question 10

Staging and grading

Answer 10

Staging

1. Severity
   - CAL (1-2mm, 3-4mm, more than 5mm)
   - Tooth loss (1&2 no teeth loss, 3&5, more than 5)
   - RBL (15%, 15-33%, middle 3rd of root ad beyond)

2. Complexity
Stage 1 & 2, mostly horizontal bone loss, max probing depth less than 4 mm and 5 mm respectively

Stage 3, Probing depths ≥ 6 mm, vertical bone loss ≥ 3mm, furcation involvement grade II or III, moderate ridge defects

Stage 4, masticatory dysfunction, tooth mobility degree ≥ 2, bite collapse, less than 20 remaining teeth

*Grading *
Primary criteria

- Direct evidence of progression
(a) Radiographic bone loss

*- Indirect evidence of progression *
(b) % bone loss/age <0.25, 0.25-1.0, > 1.0
(c) Case phentype

Grade modifiers
Risk factors- Smoking/Diabetes