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new classification framework along with case definitions. To this end, five position papers were commissioned, authored, peer‐ reviewed, and accepted. The first reviewed the classification and diagnosis of aggressive periodontitis (Fine et al. 2 2018); the second focused on the age‐dependent distribution of clinical at - tachment loss in two population‐representative, cross‐sectional studies (Billings et al. 3 2018); the third reviewed progression data of clinical attachment loss from existing prospective, longi - tudinal studies (Needleman at al. 4 2018); the fourth reviewed the diagnosis, pathobiology, and clinical presentation of acute peri - odontal lesions (periodontal abscesses, necrotizing periodontal diseases and endo‐periodontal lesions; Herrera et al. 5 2018); lastly, the fifth focused on periodontitis case definitions (Tonetti et al. 6 2018), Table 1.
The workgroup reviewed, debated and agreed by consensus on the overall conclusions of the five position papers, that can be largely summarized as follows: 1. The conflicting literature findings on aggressive periodontitis are primarily due to the fact that (i) the currently adopted classification is too broad, (ii) the disease has not been studied from its inception, and (iii) there is paucity of lon - gitudinal studies including multiple time points and different populations. The position paper argued that a more restrictive definition might be better suited to take advantage of modern methodologies to enhance knowledge on the diagnosis, pathogenesis, and management of this form of periodontitis.
TABLE 1A Classification of periodontitis based on stages defined by severity (according to the level of interdental clinical attachment loss, radiographic bone loss and tooth loss), complexity and extent and distribution
The initial stage should be determined using clinical attachment loss (CAL); if not available then radiographic bone loss (RBL) should be used. Information on tooth loss that can be attributed primarily to periodontitis – if available – may modify stage definition. This is the case even in the absence of com - plexity factors. Complexity factors may shift the stage to a higher level, for example furcation II or III would shift to either stage III or IV irrespective of CAL. The distinction between stage III and stage IV is primarily based on complexity factors. For example, a high level of tooth mobility and/or posterior bite collapse would indicate a stage IV diagnosis. For any given case only some, not all, complexity factors may be present, however, in general it only takes one complexity factor to shift the diagnosis to a higher stage. It should be emphasized that these case definitions are guidelines that should be applied using sound clinical judgment to arrive at the most appropriate clinical diagnosis. For post‐treatment patients, CAL and RBL are still the primary stage determinants. If a stage‐shifting complexity factor(s) is eliminated by treatment, the stage should not retrogress to a lower stage since the original stage complexity factor should always be considered in maintenance phase management.
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