The document discusses the classification of periodontal diseases, detailing various classification systems and their evolution over time. It emphasizes the importance of having an organized classification for understanding the etiology, diagnosis, and treatment of periodontal conditions while highlighting the advantages and drawbacks of different classifications. The latest classifications aim to reflect advances in clinical understanding and address limitations of previous frameworks.

1. Classification of Periodontal
Diseases
Guided by-
Dr. Monica Mahajani
Dr. Anup Shelke
Dr. Subodh Gaikwad
Dr. Kuldeep Patil
Dr. Chitrika Subhadarshanee
Presented by-
Dr. Pranjal Baheti

2. Content-
• Introduction
• Need of classification
• Ideal Requisite
• Classification
• Advantages & disadvantages
• Conclusion
• Reference

3. Introduction:
• Periodontal disease are the infectious disease resulting in
inflammation within the supporting tissues of the teeth,
progressive attachment loss and bone loss.
• Depending on updation of knowledge during different times in
the past regarding the etiopathogenesis and clinical
manifestations, various schemes for classifying periodontal
diseases were proposed.

4. Need of classification
• Foundation to study the etiology, susceptibility traits,
pathogenesis, and treatment of diseases in an organized manner.
• To give clinicians a way to organize the health care needs of
their patients.
• Diagnosis, prognosis, treatment planning; communication.

5. Ideal Requisite
• Suitable organizing principle matching the nature of the disease
being classified.
• Simple
• Every disease should fall into at least one of the classes.
• No disease should fall into more than one of the classes.

6. Dominant paradigms in the evolution of
classification systems
(~1870–1920) Clinical characteristics paradigm
There was dispute about the nature of periodontal diseases;
whether they were caused by local or systemic factors.
Many of the advocates for the etiological role of local factors also
acknowledged that in some cases both local and systemic factors
are responsible.

7. (~1920–1970) Classical pathology paradigm
At that time a new concept developed that periodontal diseases can be of
2 types-inflammatory and non-inflammatory (‘degenerative’ or
‘dystrophic’)
This was based on the observation that certain forms of periodontal
diseases were due to degenerative changes in the periodontium.

8. (~1970–present) Infection/ host response paradigm
Infection/ host response paradigm.
W.D. Miller stated three factors which were to be taken into
consideration in every case-
(1)predisposing circumstances,
(2)local irritation,
(3)bacteria.

9. GOTTLIEB (1921)
Pyorrhea alveolaris
Schmutz
pyorrhea /Filth
pyorrhea
Alveolar
Atrophy
Trauma
from
occlusion
Paradontal
Pyorrhea

10. Fish described pyorrhea simplex and pyorrhea profunda.
Box divided chronic periodontitis into complex and
simplex, and ascribed a prominent role for occlusal trauma
in the aetiology of complex.

11. ORBAN’S Classification(1942)
Degeneration Atropy Hypertropy Traumatism
Inflammation
Periodontal
atropy
Periodontal
traumatism
Gingival
hypertropy
Periodontosis
Gingivitis
Periodontitis

12. IRVING GLICKMAN
I. INFLAMMATORY
A . Chronic Inflammatory Gingival Enlargement
1. Generalized or localized
2. Discrete (Tumor-like)
B. Acute Inflammatory Gingival Enlargement (Gingival abscess)
II. NON-INFLAMMATORY HYPERPLASTIC GINGIVAL
ENLARGEMENT (Gingival hyperplasia)
A . Marginal
B. Diffuse

13. III. COMBINED GINGIVAL ENLARGEMENT
IV. CONDITIONED GINGIVAL ENLARGEMENT
A . Hormonal
1. Gingival Enlargement of Pregnancy
2. Gingival Enlargement of Puberty
B. Leukemic Gingival Enlargement
C. Gingival Enlargement Associated with Vitamin C Deficiency
V . NEOPLASMS
VI . DEVELOPMENTAL GINGIVAL ENLARGEMENT

14. 1957 AAP Classification
IN F L A M M A T IO N D Y ST R O PH Y
Gingivitis
Periodontitis
PRIMARY
(Simplex)
SECONDARY
(Complex)
 Chronic
 Acute
 Chronic papillary
 Necrotizing
 Fibrotic
 Desquamative
 Ulcerative
 Bullous
Occlusal
traumatism
Periodontal
disuse atropy
 Gingivosis
 Periodontosis

15. Page and Schroeder (1976)
Juvenile
Rapidly
progressive
Pre-
pubertal
Adult
periodontiti
s
Acute
necrotizing
ulcerative
gingivo-
periodontitis

16. AAP 1977 Classification
I. Juvenile Periodontitis
II. Chronic Marginal Periodontitis

17. AAP 1986 Classification
• Juvenile Periodontitis
-Prepubertal
-Localized juvenile periodontitis
-Generalized juvenile periodontitis
• Adult Periodontitis
• Necrotizing Ulcerative Gingivo-Periodontitis
• Refractory Periodontitis

18. AAP World Workshop in Clinical Periodontics
(1989) Classification
I. Early- onset Periodontitis
A.
B.
Prepubertal
Periodontitis
Localized
Generalized
Juvenile
Periodontitis
Localized
Generalized

19. II. Adult Periodontitis
III. Necrotising Ulcerative Periodontitis
IV. Refractory Periodontitis
V. Periodontitis associated with Systemic diseases

20. Drawbacks of the 1989 Classification
• Gingival disease category was absent.
• Non-validated age-dependent criteria in other periodontitis
categories.
• Extensive crossover in rates of progression of the different
categories of periodontal disease.

21. • ‘Rapidly Progressive Periodontitis’, ‘Refractory Periodontitis’
and ‘Prepubertal Periodontitis ‘were heterogeneous category.
• Extensive overlap in the clinical characteristics of the different
categories of periodontitis.

22. European Workshop in Periodontology (1993)
Classification
• Adult Periodontitis - Begins at the 4th decade of life, slow rate
of progression of disease.
• Early onset Periodontitis - Begins before the 4 th decade of life,
rapid rate of progression of disease, altered host response is seen.
• Necrotizing Periodontitis - Tissue necrosis with clinical
attachment and bone loss is seen.

23. Drawbacks
• Elaboration of the broad spectrum of periodontal diseases
encountered in clinical practice was absent.

24. American Academy of Periodontology (1999)
Classification
I. Gingival diseases
II. Chronic periodontitis (CP)
III. Aggressive periodontitis
IV. Periodontitis as a manifestation of
systemic diseases (NP)
V. Necrotizing periodontal diseases
VI. Periodontal abscesses
VII. Periodontitis with endodontic lesions
VIII. Developmental and acquired
deformation and conditions

25. I. Gingival diseases (G)
A. Gingival diseases caused by plaque
1. Gingivitis exclusively caused by plaque
a. With no local modifying factors
b. With local modifying factors

26. 2. Gingival diseases modified with systemic factors
A. Associated with endocrine system
1.Gingivitis connected with puberty
2. Gingivitis connected with the menstrual cycle
3.Connected with pregnancy
a) Gingivitis in pregnancy
b) Pyogenic granuloma
4.Gingivitis connected with diabetes mellitus

27. b. Connected with blood disease
1) Gingivitis connected with leukaemia
2) Other diseases

28. 3. Gingival diseases modified by application of
medications
a. Gingival diseases caused by medications
1) Gingival growths caused by medications
2) Gingivitis caused by medications
a) Gingivitis connected with oral contraceptives
b) Other medications

29. 4. Gingival diseases caused by malnutrition
a. Gingivitis due to lack of vitamin C
b. Others

30. B. Gingival lesions not induced by plaque
1. Gingival diseases of specific bacterial etiology
a. Lesions connected with Neisseria gonorrhoeae
b. Lesions connected with Treponema pallidum
c. Lesions connected with streptococci
d. Others

31. 2. Gingival diseases of viral etiology
A. Infection with the Herpes virus
1) Primary herpetic gingivostomatitis
2) Recurring oral herpes
3) Varicella zoster infection
B. Others

32. 3. Gingival diseases of fungal etiology
A. Infection with candida
1) Generalised gingival candidiasis
B. Linear gingival erythema
C. Histoplasmosis
D. Others

33. 4. Gingival diseases of genetic etiology
a. Inherited fibromatosis of the gingiva
b. Others

34. 5. Systemic diseases which manifest on the gingiva
A. Changed mucous membrane
1) Lichen planus
2) Pemphigoid
3) Pemphigus vulgaris
4) Erythema multiformis
5) Lupus erythematosus
6)Others

35. B. Allergic reactions
1) Material in restorative dentistry
a) Mercury
b) Nickel
c) Acrylic
d) Others

36. 2) Reaction to:
a) Toothpaste
b) Mouthwashes
c) Additives in chewing gum
d) Nutritive substitutes
3) Others

37. 6. Traumatic lesions (iatrogenic, accidents)
a. Chemical
b. Physical
c. Thermal
7. Reaction to foreign bodies
8. Not otherwise defined

38. II. Chronic periodontitis (CP)
• A. Localised
• B. Generalised

39. III. Aggressive periodontitis (AP)
• A. Localised
• B. Generalised

40. IV. Periodontitis as a manifestation of
systemic diseases (NP)
• A. Connected with blood diseases
• 1. Acquired neutropenia
• 2. Leukaemia
• 3. Others

41. B. Connected with genetic disorders
1. Family or cyclic neutropenia
2. Down’s syndrome
3. Leucocyte adhesive deficiency syndrome
4. Papillon-Lefevre syndrome
5. Chediak-Higashi syndrome
6. Histiocytosis or Eosinophilic granuloma syndrome

42. 7. Glycogen storage syndrome
8. Infantile genetic agranulocytosis
9. Cohen’s syndrome
10. Ehlers-Danlos syndrome, type IV and VIII AD
11. Hypophosphatasia
12. Others
C. Not otherwise defined

43. V. Necrotizing periodontal diseases
• A. Necrotizing ulcerous gingivitis (NUG)
• B. Necrotizing ulcerous periodontitis (NUP)

44. VI. Periodontal abscesses
• A. Gingival abscess
• B. Periodontal abscess
• C. Pericoronal abscess

45. VII. Periodontitis with endodontal lesions
• A. Combined perio-endo lesion

46. VIII. Developmental and acquired
deformation and conditions
• A. Localised dental factors which encourage plaque, caused by
gingivitis / periodontitis
• 1. Anatomy of the teeth
• 2. Reconstruction of teeth/effect of the device
• 3. Fractured root
• 4. Resorption of roots and (cement pearls)

47. B. Mucogingival deformities and relations in the tooth vicinity
1. Recession
a. Facially and orally
b. Approximally
2. Lack of gingival keratinization
3. Shortened gingival attachment
4. Localisation of the tongue or lip frenum

48. 5. Gingival enlargement
a. Pseudo-pockets
b. Irregular development of the gingival edge
c. Excessive gingival presentation
d. Gingival enlargement
6. Abnormal staining

49. C. Changed mucous membrane on an edentulous ridge
1.Loss of vertical or horizontal bone dimension
2.Loss of gingiva, i.e. keratinized tissue
3.Gingival growths, i.e. of soft tissue
4.Abnormal localisation of the tongue or lip frenum
5.Reduced vestibule depth
6.Abnormal staining

50. D. Occlusal trauma
1. Primary occlusal trauma
2. Secondary occlusal trauma

51. Changes in the 1999 Classification for
Periodontal diseases
• Addition of a Section on “Gingival diseases
• Replacement of “Adult Periodontitis” with “Chronic Periodontitis”
• Replacement of “Early-Onset Periodontitis” With “Aggressive Periodontitis”
• Elimination of a Separate Disease Category for “Refractory Periodontitis”
• Clarification of the Designation “Periodontitis as a Manifestation of Systemic
Diseases”

52. • Replacement of “Necrotizing Ulcerative Periodontitis” With
“Necrotizing Periodontal diseases”
• Addition of a Category for “Periodontal Abscess” and
“Periodontic-Endodontic Lesions”
• Addition of a Category on “Developmental or Acquired
Deformities and Conditions”
• Essentialistic or Nominalistic disease classification

53. DISADVANTAGE
• It did not serve as therapeutic guide
• Categorizing aggressive & chronic periodontitis –confusing
• Current evidence does not support the distinction between chronic and
aggressive periodontitis as separate clinical entities

54. • Confusion in diagnosing a case of plaque-induced gingival
inflammation on a reduced but healthy periodontium –
periodontitis or gingivitis?
• Categories of gingival disease modified by medication & diabetes
mellitus exist but no such periodontitis class exists.
• No mention of peri-implant diseases

55. Classification of Periodontal &Peri-implant diseases and conditions
2017(AAP & EFP)
A) Periodontal Diseases and Conditions

56. B) Peri- Implant diseases and conditions
 Peri-implant Health
 Peri implant Mucositis
 Peri-implantitis
 Peri-implant soft and Hard tissue deficiency

59. 0.25%
0.25-1%
>1%

62. Advantages
• Evidence-based and clinically relevant
• Helps in accurate case selection
• Disease risk and complexity factors
• Reflect on tooth loss
• Periodontal & gingival health have been defined.
• Endo-Perio lesion- classification based on clinical findings

63. Disadvantages
• very extensive and more complicated
• Some degree of overlap
• Necrotizing gingivitis is included in the periodontitis
• Periodontal abscess is a clinical manifestation and not a disease yet
is considered as a diagnosis
• There is no distinction between periodontal and gingival abscesses.

64. 2018 New Periodontal Classification (By EFP & AAP)
AAP)

67. Mucogingival deformities & conditions around teeth
1.Periodontal Biotype
• Thin scalloped
• Thick scalloped
• Thick flat
2.Gingival soft tissue recession
• Facial & lingual surface
• Interproximal (papillary)
• Severity of recession(cairo RT1,2,3)
• Gingival thickness
• Gingival width
• Presence of NCCL /Cervical caries
• Presence of hypersensitivity

68. 3.Lack of keratinised gingiva
4.Decrease vestibular depth
5.Aberrunt frenum /muscle position
6.Gingival excess
• Psuedo pocket
• Inconsistent gingival margin
• Excessive gingival display
• Gingival enlargement
7.Abnormal colour

69. Conclusion
• It is just a guideline that certainly may possess some limitations
in some cases. Therefore, judgement of clinicians is essential to
make a definitive diagnosis. Clinical efficiency of the
classification’s should be evaluated in a future studys.

70. References
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concepts]. 5th
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• Newman, M. G., Takei, H., Klokkevold, P. R., & Carranza, F. A. (2011, February 14).
Carranza’s Clinical Periodontology. 10th
Ed
• Sutthiboonyapan, P., Wang, H., & Charatkulangkun, O. (2020, April 8). Flowcharts for
Easy Periodontal Diagnosis Based on the 2018 New Periodontal Classification. Clinical
Advances in Periodontics, 10(3), 155–160. https://doi.org/10.1002/cap.10095

71. • Caton, J. et al. (2018, June). A new classification scheme for periodontal and
peri implant diseases and conditions – Introduction and key changes from the
‐
1999 classification. Journal of Periodontology, 89(S1).
• Salme E. Lavigne. The 2018 AAP/EFP Classification of Periodontal & Peri-
implant Diseases. Crest® + Oral-B® at dentalcare.com
• Mahajan A.,Kolte R. , Kolte A., Development and Evolution of Classification
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72. • Papapanou PN, Sanz M, et al. Periodontitis: Consensus report of Workgroup 2 of
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