S4 |
CATON et al .
Since the 1999 workshop, substantial new information has emerged from population studies, basic science investigations, and the evidence from prospective studies evaluating environmental and systemic risk factors. The analysis of this evidence has prompted the 2017 workshop to develop a new classification framework for periodontitis. 14 In the last 30 years, the classification of periodontitis has been re‐ peatedly modified in an attempt to align it with emerging scientific ev‐ idence. The workshop agreed that, consistent with current knowledge on pathophysiology, three forms of periodontitis can be identified: necrotizing periodontitis , 15 periodontitis as a manifestation of systemic disease , 16 and the forms of the disease previously recognized as “chronic” or “aggressive”, now grouped under a single category, “peri‐ odontitis”. 14,17‒20 In revising the classification, the workshop agreed on a classification framework for periodontitis further characterized based on a multidimensional staging and grading system that could be adapted over time as new evidence emerges. 20 Staging is largely dependent upon the severity of disease at pre‐ sentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease, including a history based analysis of the rate of disease progression, assessment of the risk for further progression, anticipated poor outcomes of treatment, and assessment of the risk that the dis‐ ease or its treatment may negatively affect the general health of the patient. 14,20 Staging involves four categories (stages 1 through 4) and is determined after considering several variables including clinical attach‐ ment loss, amount and percentage of bone loss, probing depth, pres‐ ence and extent of angular bony defects and furcation involvement, tooth mobility, and tooth loss due to periodontitis. Grading includes three levels (grade A – low risk, grade B – moderate risk, grade C – high risk for progression) and encompasses, in addition to aspects related to periodontitis progression, general health status, and other exposures such as smoking or level of metabolic control in diabetes. Thus, grad‐ ing allows the clinician to incorporate individual patient factors into the diagnosis, which are crucial to comprehensive case management (Table 3). For a complete description of the new classification scheme for periodontitis, the reader is directed to the consensus report on periodontitis 14 and the case definition paper on periodontitis. 20 SYSTEMIC DISEASES ASSOCIATED WITH LOSS OF PERIODONTAL SUPPORTING TISSUES 16,21 The new classification of periodontal diseases and conditions also includes systemic diseases and conditions that affect the periodon‐ tal supporting tissues. 16 It is recognized that there are rare systemic disorders, such as Papillon Lefèvre Syndrome, that generally result in the early presentation of severe periodontitis. Such conditions are grouped as “Periodontitis as a Manifestation of Systemic Disease”, and classification should be based on the primary systemic disease. 16 Other systemic conditions, such as neoplastic diseases, may affect the periodontal apparatus independent of dental plaque biofilm‐induced periodontitis, 21 and such clinical findings should also be classified
based on the primary systemic disease and be grouped as “Systemic Diseases or Conditions Affecting the Periodontal Supporting Tissues”. There are, however, common systemic diseases, such as uncontrolled diabetes mellitus, with variable effects that modify the course of periodontitis. These appear to be part of the multifactorial nature of complex diseases such as periodontitis and are included in the new clinical classification of periodontitis as a descriptor in the staging and grading process. 20 Although common modifiers of periodontitis may substantially alter disease occurrence, severity, and response to treat‐ ment, current evidence does not support a unique pathophysiology in patients with diabetes and periodontitis. 22 CHANGES IN THE CLASSIFICATION OF PERIODONTAL DEVELOPMENTAL AND ACQUIRED DEFORMITIES AND CONDITIONS 21,23‒25 Mucogingival conditions The new case definitions related to treatment of gingival recession are based on interproximal loss of clinical attachment and also in‐ corporate the assessment of the exposed root and cemento‐enamel junction. 23 The consensus report presents a new classification of gingival recession that combines clinical parameters including the gingival phenotype as well as characteristics of the exposed root sur‐ face. 21 In the consensus report the term periodontal biotype was re‐ placed by periodontal phenotype (Table 4). 21 Occlusal trauma and traumatic occlusal forces Traumatic occlusal force , replacing the term excessive occlusal force , is the force that exceeds the adaptive capacity of the periodontium and/ or the teeth. Traumatic occlusal forces can result in occlusal trauma (the lesion) and excessive wear or fracture of the teeth. 21 There is lack of evidence from human studies implicating occlusal trauma in the progression of attachment loss in periodontitis (Table 4). 24 Prosthesis‐ and tooth‐related factors The section on prostheses‐related factors was expanded in the new classification. The term biologic width was replaced by supracrestal attached tissues . 21 Clinical procedures involved in the fabrication of indirect restorations was added because of new data indicating that these procedures may cause recession and loss of clinical attachment (Table 4). 25
A NEW CLASSIFICATION FOR PERI‐ IMPLANT DISEASES AND CONDITIONS 26
A new classification for peri‐implant health, 27 peri‐implant mu‐ cositis 28 and peri‐implantitis 29 was developed by the workshop
Made with FlippingBook Annual report