STEP 3c Stages I, II, III, and IV
Stages I and II are based on the level of CAL and BL. The diagnosis is Stage I if: (a) BL is less than 15% and (b) CAL is between 1-2mm. The diagnosis is Stage II if: (a) BL is between 15% and 33% and (b) CAL is between 3-4mm. The diagnosis is Stage III if: (a) BL affects the middle third of the root or beyond, (b) CAL is 5mm or more, (c) PTL is four teeth or fewer, (d) 10 or more occluding pairs are present, and (e) in the absence of bite collapse, drifting, flaring, or a severe ridge defect. The diagnosis is Stage IV if: (a) BL affects the middle third of the root or beyond, (b) CAL is 5mm or more, (c) PTL is more than four teeth, (d) there are fewer than 10 occluding pairs, or (e) when there is bite collapse, drifting, flaring, or a severe ridge defect.
Periodontitis case
Localised
< 30%
Periodontal & bone appraisal
Extent (% teeth)
Generalised
˃ 30%
Severity & complexity
Level of bone/CAL loss
BL coronal third CAL < 5mm
Class II or III furcation
Perio tooth loss
˃4
No
1-4
BL middle third CAL CAL 5mm or more
Yes
10 or more occluding pairs
Pocket depth
˃5 mm
No
3-5 mm
Stage IV periodontitis
Yes
Bite collapse, drifting, flaring
Periodontal tooth loss
Stage III or IV periodontitis
Yes
Yes
No
No
Level of bone/CAL loss
Stage I or II periodontitis
Severe ridge effect
Yes
No
BL <15% CAL 1-2 mm
BL 15-33% CAL 3-4 mm
Stage III periodontitis
Stage I periodontitis
Stage II periodontitis
Proceed to grading
Periodontitis: clinical decision tree for staging and grading
6
Guidance for clinicians
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