2017 CLASSIFICATION OF PERIODONTAL AND PERI-IMPLANT DISEASES AND CONDITIONS

American Academy of Periodontology & European Federation of Periodontotology November 2017

Periodontal diseases (gum diseases) are now classified according to the condition present, its stage affecting the patient, the extent of involvement of the dentition and the rate of progression. This leaflet is to clarify for patients and members of the dental team what the classification is and how it relates to the level of periodontal disease that affects a patient.

There are 3 MAJOR categories of periodontal disease and conditions:

1. Periodontal health and degree of gingival health or disease.

1. Periodontal health (no bone loss) & gingival health (no soft gum tissue inflammation) 
2. Gingivitis (gum inflammation) caused by the presence of plaque/biofilm
3. Gingivitis (gum inflammation) not caused by the presence of plaque/biofilm)

2. Periodontitis

1. Necrotising (ulcerative forms)
2. Periodontitis (bone loss) as a manifestation of systemic/general illness
3. Periodontitis (see below)

3. Other conditions affecting the periodontium (tooth supporting tissues)

1. Systemic disease affecting the health of the periodontium (tissues supporting teeth)
2. Periodontal abscess or combination of periodontal and endodontic infection (combined infection relating to both the tissues supporting the teeth and the pulp and tissues within the tooth)
3. Mucogingival conditions – abnormality of the soft tissue arrangement around the tooth
4. Traumatic occlusion – a loose tooth being subjected to heaving biting forces or forces that are not along the long axis of the tooth
5. Tooth-related or prosthesis-related factors

4. Periodontal – Peri-implant Diseases

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

The next part of the classification process is to address:

• STAGE OF DISEASE (initial, moderate, severe 1 and severe 2)
• EXTENT OF DISEASE (localised, generalised, incisal-molar)
• PROGRESSION OF DISEASE (slow, moderate, rapid)

STAGING:

1. Stage 1 (initial disease)

• 1-2mm of lost clinical soft tissue attachment
• <15% loss of bone supporting the teeth
• No tooth loss due to periodontal disease
• <4mm pocket depths
• Mostly horizontal pattern of bone loss or loss of clinical attachment

 2. Stage 2 (moderate disease)

• 3-4mm of lost clinical soft tissue attachment
• 15-33% loss of bone supporting the teeth
• Tooth loss 
• <5mm pocket depths
• Mostly horizontal pattern of bone loss or loss of clinical attachment

3. Other Stage 3 (severe disease with the potential for additional tooth loss)

• >5mm of lost clinical soft and hard tissue attachment
• >33% bone loss 
• Loss of 4 or less teeth due to periodontal disease
• >6mm pocket depths
• >3mm of vertical bone loss
• Class 3 “through-and-through” furcation involvements

4. Stage 4 (severe disease with potential for loss of the dentition)

• All those factors outlined in Stage 3 plus additional factors
• Need for complex dental rehabilitation
• Secondary occlusal trauma
• Ridge defects
• Collapse of the bite and Tooth migration
• <20 teeth or 10 pairs of opposing teeth

EXTENT:

1. Localised <30% of the teeth
2. Generalised >30% of the teeth
3. Incisal and molar distribution

RATE OF PROGRESSION:

GRADE A – (slow progression):

• No apparent loss of bone or clinical attachment over 5 years
• No smoking
• No diabetes
• Minimal biofilm

GRADE B (moderate progression)

• >2mm of apparent bone and clinical attachment loss over 5 years
• Smoking up to half a pack a day
• HbA1c <7% (glycolated haemagobin measures recent sugar intake)
• Destruction commensurate with biofilm present

GRADE C (rapid progression)

• >2mm of apparent bone and clinical attachment loss over 5 years
• Smoking > half a pack a day
• HbA1c >7%
• Destruction appears excessive for the Biofilm present