STEP 3b Stages III and IV versus I and II
If CAL is greater than 5mm or if the BL affects the middle third of the root or beyond in more than two adjacent teeth, the diagnosis is either Stage III or IV. If CAL is 5mm or less in fewer than two teeth, we should look for furcation lesions (degrees II and III). If these are present, the diagnosis is either Stage III or IV. If absent, we should check PPD and if these are greater than 5mm in more than two adjacent teeth, the diagnosis is either Stage III or IV. If PPD are between 3-5 mm, we should assess PTL. If there is PTL, the diagnosis is either Stage III or IV. If not, the diagnosis is Stage I or II. Regarding pocket depth, clinical judgement should be applied to use this criterion to upgrade from Stages I & II to Stage III. For example, in the presence of pseudo pockets, the periodontitis case should stay as Stage II.
Periodontitis case
Localised
< 30%
Periodontal & bone appraisal
Extent (% teeth)
Generalised
˃ 30%
Severity & complexity
Level of bone/CAL loss
Coronal third < 5 mm
Class II or III furcation
No
Yes
Pocket depth *
˃ 5 mm
Stage III or IV periodontitis
3-5 mm
Periodontal tooth loss
Yes
No
Stage I or II periodontitis
Proceed to grading
* Clinical judgement should be applied to use this criterion to upgrade from Stages I & II to Stage III. For example, in the presence of pseudo pockets, the periodontitis case should stay as Stage II.
Periodontitis: clinical decision tree for staging and grading
5
Guidance for clinicians
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