The 2018 AAP/EFP Classification of Periodontal & Peri-implant Diseases
Course Number: 610
Course Contents
Requirements of a Periodontitis Case
In order for an individual to be diagnosed as a periodontitis case, there are three essential requirements:5
Detectable clinical attachment loss (CAL) at two (2) non-adjacent teeth.
Identification of the form of periodontitis i.e., necrotizing periodontitis, periodontitis as a manifestation of systemic disease, or periodontitis.
Description of the case characteristics and aggressiveness of the disease by Stage and Grade.
Table 9. Periodontitis Stages.
| Periodontal Stage | Stage I | Stage II | Stage III | Stage IV | |
|---|---|---|---|---|---|
| Severity | Interdental CAL at site of greatest loss | 1-2mm | 3-4mm | ≥5mm | ≥5mm |
| Radiographic Bone Loss | Coronal third (<15%) | Coronal third (15%-33%) | Extending to mid-third of root and beyond | Extending to mid-third of root and beyond | |
| Tooth Loss | No tooth loss due to Periodontitis | No tooth loss due to Periodontitis | Tooth loss due to Periodontitis of ≤4 teeth | Tooth loss due to Periodontitis of ≥5 teeth | |
| Complexity | Local | Maximum Probing Depth ≤4mm Mostly horizontal bone loss | Maximum Probing Depth ≤5mm Mostly horizontal bone loss | In addition to Stage II complexity: Probing depth ≥6mm Vertical bone loss ≥3mm Furcation involvement Class II or III Moderate ridge defect | In addition to Stage III complexity: Need for complex rehabilitation due to: Masticatory dysfunction Secondary occlusal trauma (tooth mobility degree ≥2) Severe ridge defect Bite collapse, drifting, flaring Less than 20 remaining teeth (10 opposing pairs) |
| Extent and distribution | Add to Stage as Descriptor | For each stage, describe extent as localized (<30% teeth involved), generalized, or molar/incisor pattern | |||
Adapted from Tonetti et al.5
Table 10. Periodontitis Grade.
| Periodontitis Grade | Grade A Slow rate of progression | Grade B Moderate rate of progression | Grade C Rapid rate of progression | ||
|---|---|---|---|---|---|
| Primary Criteria | Direct Evidence of Progression | Longitudinal data (Radiographic bone loss or CAL) | Evidence of no loss over 5 years | <2mm over 5 years | ≥2mm over 5 years |
| Indirect Evidence of Progression | % Bone Loss | <0.25 | 0.25 - 1.0 | >1.0 | |
| Case Phenotype | Heavy biofilm deposits with low levels of destruction | Destruction commensurate with biofilm deposits | Destruction exceeds expectation given biofilm deposits; specific clinical patterns suggestive of periods of rapid progression and/or early-onset disease (e.g., molar/incisor pattern; lack of expected response to standard bacterial control therapies) | ||
| Grade Modifiers | Risk Factors | Smoking | Non-smoker | Smoker <10 cigarettes/day | Smoker ≥10 cigarettes/day |
| Diabetes | Normoglycemic/no diagnosis of diabetes | HbA1c <7.0% | HbA1c ≥7.0% in patients with diabetes | ||
Adapted from Tonetti et al.5
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