Magda_Classification of periodontal disease Flashcards
What are the 3 types of periodontal health? Describe
Chapple ‘18:
Healthy intact periodontium: All PD ≤3mm, zero CAL, <10% BOP.
Healthy reduced periodontium: All PD ≤3mm, yes there is CAL, <10% BOP. There may possibly be some bone loss.
Successfully treated periodontitis patient All PD ≤4 mm (with no PD ≥4mm with BOP), yes there is CAL, <10% BOP. There is presence of bone loss
What are the 3 types of gingivitis? Describe
Chapple ‘18
Gingivitis is localized if BOP ≥10% but ≤30%.
It is generalized if BOP >30%
Gingivitis in an intact periodontium: All PD ≤3mm, >10% BOP, zero CAL
Gingivitis in a reduced periodontium (non-periodontitis patient): All PD ≤3mm, >10% BOP, yes there is CAL loss, possibly some bone loss
Gingivitis in a patient with a history of periodontitis: All PD ≤3 mm, >10% BOP, yes there is CAL loss, yes bone loss.
What are the 3 types of necrotizing periodontal diseases?
Herrera ‘18
1. Necrotizing gingivitis
2. Necrotizing periodontitis
3. Necrotizing stomatitis
All are associated with host immune impairments. Symptoms include: Papilla necrosis, bleeding, and pain
What is the official AAP classification for Endo-Perio lesions?
Herrera ‘18:
Endo-Perio lesions with root damage
* Root fracture
* Root perforation
* External root resorption
Endo-Perio lesions without root damage. Two subcategories:
In Periodontitis patients:
* Grade 1: Narrow deep pocket on 1 surface
* Grade 2: Wide deep pocket on 1 surface
* Grade 3: Deep pockets on more than 1 surface
In non-periodontitis patients:
* Grade 1: Narrow deep pocket on 1 surface
* Grade 2: Wide deep pocket on 1 surface
* Grade 3: Deep pockets on more than 1 surface
What is the official definition of a periodontitis patient?
Tonetti ‘18:
* Interdental CAL is detectable at ≥2 non-adjacent teeth, or
* Buccal (or oral) CAL is ≥3mm with pocketing >3 mm at ≥2 non-adjacent teeth
and the CAL cannot be due to non-periodontal causes, such as:
1. Recession of traumatic origin;
2. Caries in the cervical area of the tooth;
3. CAL on the distal of a 2nd molar due to a 3rd molar (either present or extracted);
4. Endodontic lesion draining through the marginal periodontium;
5. vertical root fracture
Describe how periodontal staging is determined.
2018 AAP World Workshop:
Looks at the:
* Severity: Interdental CAL, RBL, tooth loss due to periodontitis
* Complexity: Local factors such as PD, bone loss patterns, mobility
* Extent & Distribution - Localized, generalized, or molar/incisor pattern
Describe how you use CAL to determine staging.
Stage 1: 1-2 mm
Stage 2: 3-4 mm
Stage 3: 5+ mm
Stage 4: 5+ mm
Describe how radiographic bone level (RBL) is used to determine Staging
Stage 1: RBL in coronal third (<15%)
Stage 2: Coronal third (15- 33%)
Stage 3: Mid third and beyond
Stage 4: Mid third and beyond
Describe how local factors are used to determine Staging
Stage 1: PD ≤4mm, horizontal bone loss
Stage 2: PD ≤ 5mm, horizontal bone loss
Stage 3: PD ≥6mm, vertical bone loss ≥3mm, Furcations (2 or 3), moderate ridge defects
Stage 4: In addition to Stage 3: Need for complex rehabilitation due to masticatory dysfunction, secondary occlusal trauma (tooth mobility ≥2mm), severe ridge defects, bite collapse (drifting, flaring), <20 remaining teeth (10 opposing pairs)
Describe how Grading is determined
(Preferred): Direct evidence of progression via CAL or bone loss. Grade A: No loss over 5 years. Grade B: <2mm over 5 years. Grade C: ≥2 mm over 5 years
(Alternatively): Indirect evidence of progression via CAL or bone loss.
Looks at % bone loss/age and case phenotype (biofilm levels):
Grade A: <0.25 and heavy biofilm with low destruction.
Grade B: 0.25 - 1.0 and biofilm seems reasonable for the amount of destruction.
Grade C: >1.0 and destruction seems way more than expected with the amount of biofilm; signs of rapid progression and/or early onset of disease
Then, use the Grade Modifiers
Describe the Grade Modifiers
Smoking:
Grade A: Nonsmokers
Grade B: Light smokers (<10 cigs/day)
Grade C: Heavy smokers (≥10 cigs/day)
Diabetes:
Grade A: Nondiabetic
Grade B: HbA1c <7.0%
Grade C: HbA1c > 7.0%
What parameters are used to define a periodontal biotype? What are the three official periodontal biotypes?
Cortellini & Bissada ‘18
Periodontal Biotype: Determined from
1) the Gingival biotype (KTW, GT),
2) the Bone morphotype
3) Tooth morphology
The three types of periodontal biotype are:
**1) Thin scalloped: **Triangular teeth with contacts close to the incisal edge, thin GT, thin KTW, thin bone. Teeth also have minimal cervical convexity
**2) Thick flat: **Square teeth with large contacts located more apically, broad KTW, thick GT, thick bone. Teeth have large cervical convexity.
**3) Thick scalloped: ** Slender teeth, thick GT, thin KTW, pronounced scalloping
What are the official AAP mucogingival conditions?
Cortellini & Bissada ‘18
1) Gingival recessions
* interproximal
* buccal / lingual
2) Lack of keratinized tissue
3) decreased vestibular depth
4) aberrant frenum / muscle positions
5) Gingival excess
* Pseudo-pockets
* Inconsistent gingival margins
* excessive gingival display
* gingival enlargements
6) Abnormal color
What are the official AAP definitions for RT1, RT2, RT3 recessions?
Cortellini & Bissada ‘18
RT1: Recession with no loss of interproximal attachment. Also, the interproximal CEJ is not detectable at the mesial or distal of the tooth.
RT2: Recession with loss of interproximal attachment. The interproximal recession does not exceed the buccal or lingual recession (measured from CEJ to apical end of pocket)
RT3: Recession with loss of interproximal attachment. The interproximal recession exceeds the buccal or lingual recession (measured from CEJ to apical end of pocket)
What is the classification for abfractions?
Pini Prato ‘10
Class A: CEJ detectable
Class B: CEJ is not detectable
(+) : step is present
(-) : no step
New Classification framework
