FACULTYPERSPECTIVE VIEWS ON DENTAL TOPICS & TRENDS

Classification of Periodontal and Peri-Implant Diseases and Conditions Since the 1999 American Academy of Peri- • The terms “staging” and “grading,” similarly odontology Classification Workshop, periodon- used in oncology, have been incorporated tal diseases had been classified using the into the new system: “Armitage Classification,” which included Staging: Identifies the severity, extent chronic, aggressive (localized/generalized), (localized/generalized/molar-incisor necrotizing, or a manifestation of systemic con- distribution) and complexity of the treatment ditions. However, recent advances in the under- (Stage I – Stage IV). standing of risk factors, etiology, pathogenesis, Grading: Indicates the rate of disease pro- and treatment modalities necessitated a new gression (Grade A – C), and estimates the evidence-based classification. The new ap- future risk and impact on the systemic proach was developed and officially launched condition of the patient (smoking and at the 2017 World Workshop, jointly presented ). by the American Academy of • Both chronic and are Contributed by Dr. Yu Cheng Chang and and the European Federation of Periodontology. now grouped under the single classification Dr. Joseph Fiorellini, Dept. of Periodontics Here we review the new classification scheme. of periodontitis because the current evidence fails to support the difference between the two. PERIODONTAL HEALTH, GINGIVAL • Necrotizing periodontal diseases, which are PERI-IMPLANT DISEASE AND DISEASE AND CONDITIONS associated with host immune response CONDITIONS The concept of gingival health includes ab- impairment are classified as a distinct For the very first time, this new classification sence of histologic and clinical inflammation. It subgroup of periodontitis. clarifies and addresses peri-implant disease: is important to note that the concept of health • The diagnosis of endodontic-periodontal • Peri-implant health: Absence of the sign of also applies to three categories of patients: lesions is based on the presence of root inflammation and further additional bone loss • Patients with less than 10% of probed sites damage and/or periodontitis. after the initial healing. exhibiting . • Periodontal is classified as present in • Peri-implant mucositis: Presence of • Patients with absence of inflammation, but the presence or absence of periodontitis. inflammation without further additional bone with reduced periodontal support due to loss after the initial healing. previous lengthening surgery and/or PERIODONTAL MANIFESTATION OF • Peri-implantitis: Presence of inflammation, recession. SYSTEMIC DISEASE/DEVELOPMENT evidence of bone loss and increasing probing • Patients with a history of AND ACQUIRED CONDITION depth after the implant restoration in placed. who were successfully treated and are This new group includes systemic diseases • Soft and hard tissue deficiencies currently stable. which adversely affect the periodontal appa- ratus. Such conditions may include diabetes, It is noted that defining the health status of a PERIODONTITIS cancers, and external factors such as smoking. by the range of probing depth The new classification recognizes that peri- Other new key findings include: alone is not appropriate. It is recommended odontal disease is similar to many other pro- • The term “biologic width” has been replaced that the clinician should always obtain the gressive medical conditions which are strongly by “supracrestal tissue attachment” and the radiographic and probing measurements. influenced by the host’s systemic health as “biotype” has been replaced by “phenotype.” We hope this introduction can be bene- well as by various risk factors. The import- • Excessive occlusal force now is concluded as ficial to your daily practice. For more detailed ant aspects of this classification include: no evidence, but the splitting is recommended information about the new periodontal classifi- when traumatic occlusion causes progressive cation, please refer to the American Academy mobility. of Periodontology, www.perio.org.

PENN DENTAL MEDICINE JOURNAL | FALL 2019 11