Periodontal New classification

1. NEW
CLASSIFICATION
Dr.Nashwa Helaly

2. OUTLINE
⮚Overview
⮚Points of difference between new &previous
classification
⮚Advantages
⮚Limitations
⮚Recommendations for future research

3. So why do we
need to
classify
periodontal
diseases?
Communicate finding to other
professionals.
Help the patient to understand
there disease.
Formulate diagnosis and
treatment plan.
Predict diagnosis.

5. CLASSIFICATION OF PERIODONTAL AND PERI-IMPLANT
DISEASES AND CONDITIONS (WORLD WORKSHOP 2018)

8. Definition of periodontal health:
A state free from inflammatory periodontal disease, absence
of inflammation associated with gingivitis or periodontitis,
as assessed clinically.
Clinical
health Pristine
clinical health

9. Periodontal health and gingival health
• Clinically:- gingival health on an intact or reduced periodontium is characterized by the
absence of bleeding on probing, erythema and edema, patient symptoms, and active
attachment and bone loss.
• On biological level:- immune inflammatory response, manifested as a neutrophilic
infiltrate that is consistent with clinical gingival health.
• Radiographic features:- intact lamina dura , no evidence of bone loss ,
2 mm average distance from the alveolar bone crest (AC) to the cementoenamel
junction (CEJ).

10. Case definition of periodontal health
Periodontal health in intact periodontium and reduced stable periodontium :
❑ < 10% bleeding sites with probing depths ≤3 mm.
❑ Intact lamina dura
❑Optimal improvement in other clinical parameters
❑ Lack of progressive periodontal destruction.
The treated and stable periodontitis patient with gingival health remains at increased risk
of recurrent periodontitis and must be closely monitored.

11. The transition from periodontal health to gingivitis is reversible following treatment
The transition to periodontitis results in attachment loss which is irreversible.

12. intact periodontium

14. Gingivitis :Dental biofilm induced
Associated with
biofilm alone
Mediated by systemic
or local risk factors
Drug influenced
gingival enlargement

16. Symptoms
bleeding
halitosis
Reduced
quality
of life
Pain
Signs
swelling
Discomfort
on
pressure
redness
Bleeding
on probing
Gingivitis is a clinical diagnosis.

17. Bleeding on Probing(BOP%)is the primary parameter for
gingivitis assessment:
•A BOP score is assessed as the proportion of bleeding
sites ( yes/no evaluation).
• mild = < 10%,
• moderate = 10%‐30%,
• severe = > 30% sites

18. The recommendations for an ISO periodontal probe :-
• 1- diameter 0.5 mm
• 2. Cylindrical tine structure
• 3. Constant force ≤ 0.25 N
• 4. 15‐mm scale with precise millimeter markings
• 5. A taper of 1.75°.
•The pocket is measured at six sites (mesio‐ buccal, buccal,
disto‐buccal, mesio‐lingual, lingual, disto‐lingual) on all
present teeth.

19. Advantages :
Assessment gingival inflammation using a bleeding on probing score (BOP%):-
• simple, objective and cost effective.
• accurate case definition .
• clinical sign often perceived by the patient, affect the quality of life.
• used to inform and motivate the patient .
• monitor the efficacy of preventive therapy.

20. Limitations:
1-lack of standardized periodontal probes (e.g.
probe dimensions, taper), examiner variability
(probe pressure, angle).
2- Several patient‐related factors can affect gingival
bleeding response on probing as smoking or
Patients on anticoagulant medications (e.g., aspirin)
or periodontal phenotype.

21. Non–dental plaque‐induced gingival conditions
Neoplasm
Gingival
pigmentations
Endocrine.
metabolic
diseases
Traumatic
lesions
Developmental
disorders Infections
Inflammatory
Reactive
processes

24. Gingival
health
on intact
PDL
Gingival
health on
reduced
PDL
Gingivitis
biofilm induced
Gingival disease
non biofilm
induced

25. Periodontitis
Necrotizing
periodontal diseases Periodontitis
Periodontitis as
manifestation of
systemic diseases

26. ➢ PERIODONTITIS
● The necrotizing periodontal diseases have been classified into following three
categories:
Necrotizing gingivitis, necrotizing periodontitis and necrotizing stomatitis. The older
terms like ANUG and ANUP are replaced with the above newer terms.
● The term Chronic and aggressive periodontitis is removed. They replaced by stages and
grades.
● Staging I to IV of periodontitis is defined based on severity & complexity
● Grading of periodontitis estimated as: slow, moderate and rapid progression as Grade
A, B & C respectively. Risk factor analysis is used as grade modifier.

28. Case definition of periodontitis
1. Interdental CAL is detectable at ≥2 non‐adjacent teeth,
or
2. Buccal CAL ≥3 mm with pocketing >3 mm is detectable
at ≥2 teeth
• CAL that is not due to gingival recession of traumatic
origin, dental caries ,an endodontic lesion or a vertical
root fracture
• The cases of “periodontitis” are further characterized
using a staging and grading system.

37. Other conditions affecting the periodontium
Mucogingival
conditions
Systemic diseases
affecting the
periodontium
Tooth prosthesis
factors
Traumatic
occlusion
Periodontal
abscess& endo-
perio lesions

38. 1-The periodontal abscess is classified according to etiologic factors
PA in periodontitis
patient(pre-existing)
periodontal pocket
PA in non-
periodontitis patient
Periodontal
abscess

40. Endo-periodontal lesions
Endo-perio lesions
with root damage
Endo-perio lesions
without root damage
Endo-perio
lesions
Periodontitis
patient
Non-
periodontitis
patient

41. Endo-perio lesion

42. 2- PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASE AND
DEVELOPMENTAL AND ACQUIRED CONDITIONS
● A variety of systemic diseases and conditions can affect the course of periodontitis or have a
negative impact on the periodontal attachment apparatus.
1-Systemic disorders that affect the supporting tissue :
Ex: obesity, diabetes melitids, smoking, stress.
2-Systemic disorders that affect periodontal inflammation:
Ex: genetic disorder as Down’s syndrome
3-Systemic disorders that can result in loss of periodontal tissues independent of periodontitis:
Ex:neoplasm

43. 3-MUCOGINGIVAL CONDITIONS AROUND THE NATURAL DENTITION
“phenotype” VS “biotype”
Biotype: anatomic characteristic (genetics).
Phenotype :A multifactorial combination of genetic and environmental factors ,
gingival biotype= (gingival thickness)
gingival phenotype =(gingival thickness and keratinized tissue width)
Periodontal phenotype = (gingival phenotype and bone morphotype)
Thin phenotype increases risk and progression of gingival recession.

45. 4- Occlusal trauma is renamed as traumatic occlusal forces.
Traumatic occlusal force is defined as any occlusal force resulting in injury
of the teeth and/or the periodontal attachment apparatus ex :orthodontic
force.

46. 5-Causes of inflammatory changes related to tooth &dental
prosthesis:
fixed
&removable
prosthesis
Dental
materials
Tooth
position&
anatomy

47. ➢ PERI IMPLANT DISEASE AND CONDITIONS:
◦ The term peri implant disease is newly added
to this classification. Peri‐implant tissues are
those that occur around osseointegrated
dental implants .
◦ The new classification, addresses about its
health and disease such as
◦ Mucositis = (soft tissues only around
implant),
◦ Periimplantitis = (soft &hard tissues) and
deficiencies of hard and soft tissues.