Why is Classification
Important?
Classical Pathology
Paradigm (1920 to 1970)
• A case of clinical gingival health was therefore established on an intact and a reduced
periodontium in a non-periodontitis patient as <10% sites of bleeding on probing and probing
depths of ≤3 mm (12)
• A successfully treated periodontitis patient in whom sites of gingival bleeding appear remains
at high risk of disease recurrence at those sites and of progressive attachment loss (12)
• *Therefore gingivitis is defined as bleeding at a shallow site of ≤3 mm rather than ≤ 4 mm as in
the case of gingival health (12)
Workshop 2: Periodontitis
Workshop 2: Defining Periodontitis
• In summary a periodontitis diagnosis for an individual patient should encompass three
dimensions:
• 1) Interdental CAL is detectable at 2 non-adjacent teeth OR buccal or oral CAL 3 mm with
pocketing 3 mm is detectable at 2 teeth (13)
• cannot be ascribed to non-periodontal causes such as 1) gingival recession of traumatic
origin
• 2) Identification of the form of periodontitis (13)
• Necrotizing Characterized by a hx of pain, presence of ulceration of the gingival margin,
and/or fibrin deposits at sites with decapitated gingival papillae, exposure of the marginal
alveolar bone
• Periodontitis as a manifestation of systemic disease
• Periodontitis
• 3) Description of the presentation and aggressiveness of the disease by stage and grade (13)
Workshop 2: Defining Periodontitis continued
Stage
Stage 4
Stage 3
Stage 2
I
Workshop 2: Stage 1 periodontitis
• Is borderline between gingivitis and periodontitis and represents the early
stages of attachment loss (11)
• If patients show CAL at a relatively early stage, these patients may have
heightened susceptibility to disease onset (11)
• Early diagnosis may be a challenge in general dental practice because
periodontal probing depths may be inaccurate (11)
Workshop 2: Stage 2 periodontitis
• Represents established periodontitis in which a carefully performed clinical
periodontal exam identifies the characteristic damages that periodontitis has caused
to tooth support (11)
• Careful evaluation of the stage 2 patient’s response to standard treatment principles
is essential, and the case grade plus treatment response may guide more intensive
management for specific patients (11)
Workshop 2: Stage 3 periodontitis
• At stage 3, periodontitis has produced significant damage to the attachment
apparatus, and in the absence of advanced treatment, tooth loss may occur (11)
• Masticatory function is preserved, and treatment of periodontitis doesn’t require
complex rehabilitation of function (11)
Workshop 2: Stage 4 periodontitis
• At the more advanced stage 4, periodontitis causes considerable damage to
the periodontal support and may cause significant tooth loss, and this
translates to loss of masticatory function (11)
• In the absence of proper control of the periodontitis and adequate rehab, the
dentition is at risk of being lost (11)
Workshop 2: Staging chart
Workshop 2: Grading