Introduction: classifying periodontitis Previous attempts to classify periodontitis have revolved around the question of whether phenotypically different case presentations represent different diseases or variations of a single disease. The internationally accepted classification of periodontitis, published in 1999, provided a workable framework that has been used extensively in both clinical practice and scientific investigation. But this system suffers from significant shortcomings, including substantial overlap, the lack of a clear pathobiology- based distinctions between categories, diagnostic imprecision, and difficulties in implementation. The New Classification from the 2017 World Workshop on Periodontal and Peri- implant Disease and Conditions (“the World Workshop”) reviewed the scientific evidence and reached four main conclusions: 1. There is no evidence of a specific pathophysiology that enables the differentiation of cases as “aggressive” or “chronic” periodontitis or provides guidance for different kinds of intervention. 2. There is little consistent evidence that aggressive and chronic periodontitis are different diseases. But there is evidence that multiple factors, and the interactions between them, influence clinically observable disease outcomes (phenotypes) at the individual level. 3. On a population basis, the average (mean) rates of periodontitis progression are consistent across all observed populations in the world. However, there is evidence that specific segments of the population exhibit different levels of disease progression. 4. A classification system based only on disease severity fails to capture important dimensions of an individual’s disease, including complexity (which influences approaches to therapy) and risk factors (which influence disease outcomes). Based on these findings, a new periodontitis classification scheme has been adopted. The forms of the disease previously described as “chronic” and “aggressive” are now described under the single category of “periodontitis”. Three forms of periodontitis have been identified:
1. Periodontitis; 2. Necrotising periodontitis; 3. Periodontitis as a direct manifestation of systemic diseases.
A multidimensional system of stages and grades has been devised to further describe the different manifestations of periodontitis in individual cases. Stages describe the severity and the extent of the disease, grades describe the likely rate of progression.
Periodontitis
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Guidance for clinicians
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