AAP Updates Periodontal Disease Classifications

Dentistry Today


The American Academy of Periodontology (AAP) has published the official proceedings of its 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. These works provide a comprehensive update to the previous disease classification established at the 1999 International Workshop for a Classification of Periodontal Diseases and Conditions. 

Highlights include a recategorization of various forms of periodontitis, the development of a novel staging and grading system for periodontitis, and the inaugural classification for peri-implant diseases and conditions. The complete suite of review papers and consensus reports from the workshop, which was co-presented by the European Federation of Periodontology (EFP), is available in the June 2018 print and online issues of the Journal of Periodontology.

The multi-dimensional staging and grading framework for periodontitis classification was among the 2017 workshop’s major features. Staging levels indicate the severity of the disease and the complexity of disease management, while the grading structure considers supplemental biologic characteristics of the patient in estimating the rate and likelihood of periodontitis progression.

This framework builds upon a notable change, the AAP reports. Forms of periodontal disease are now defined as one of three distinct forms, which include periodontitis (formerly aggressive and chronic), necrotizing periodontitis, and periodontitis as a manifestation of systemic conditions.

The four categories of periodontitis staging are determined by a number of variables and range from the least severe at Stage I to the most severe at Stage IV. The three levels of periodontitis grading, which consider a patient’s overall health status and risk factors such as smoking and metabolic control of diabetes, indicate low risk of progression (Grade A), moderate risk of progression (Grade B), and high risk of progression (Grade C). 

“The new staging and grading system provides a structure for treatment planning and for monitoring a patient’s response to therapy. A personalized approach to patient care is essential for effective periodontal case management,” said Kenneth Kornman, DDS, PhD, editor in chief of the Journal of Periodontology and member of the workshop’s organizing committee.

“The staging and grading system guides a clinician’s assessment of several dimensions beyond severity of past destruction, including specific elements that contribute to complexity of managing their patient’s case and the risk for future disease progression,” Kornman said. “The new classification system provides a paradigm similar to what is used in some fields of medicine, from which clinicians can develop a well-rounded treatment strategy based on a patient’s specific needs.”

The workshop’s proceedings also include, for the first time, a new classification for peri-implant diseases and conditions. Peri-implant mucositis is characterized by bleeding on probing and visual signs of inflammation, and peri-implantitis is indicated by inflammation of mucosal tissue and subsequent progressive loss of supporting bone. Peri-implant health is identified by the absence of visible inflammation and bleeding on probing.

“Implant dentistry has become a major component of patient treatment planning and care since the last workshop in 1999. And just like tissues that support natural teeth, the bone and soft tissues surrounding dental implants are susceptible to inflammation-driven complications without proper care and management,” Kornman said.

“The 2017 workshop proceedings outline definitions of health and disease in this particular context, acknowledging that with a growing number of implant cases comes an increased need to identify and treat implant-related conditions,” Kornman said.

Hard- and soft-tissue implant site deficiencies (associated with healing after tooth loss, extraction trauma, endodontic infections, injury, and other causes) are also included within the implant condition classification.

“The updated proceedings align with what scientific literature has revealed about disease progression in the last 20 years. As greater understanding emerges, the Academy is committed to revisiting and modifying the classification as evidence dictates,” said AAP president Steven R. Daniel, DDS. “The new classification will also lay the foundation for future research.”

Held last November at Chicago’s Gleacher Center, the workshop welcomed more than 100 experts from Europe, Asia, Australia, and the Americas who conducted literature reviews, established case definitions, and deliberated diagnostic considerations for the classification’s primary topic areas.

“We assembled periodontal scholars whose commitment to evidence-based practice would inform their contributions. Because of its inclusion of international researchers, educators, and clinicians, the workshop created a global consensus by which care can be standardized and modernized for patients and practitioners everywhere,” said Daniel.  

“The experts involved in this effort recognize the classification’s clinical salience and its likely influence on the improvement of patient outcomes around the world,” said Daniel. “Although its widespread adoption will take time, we hope that the updated classification model will be the primary paradigm for patient care around the globe.”

The AAP plans to develop resources that guide the integration of the updated classification within various facets of dentistry, including dental education, dental hygiene, third-party reimbursement, and general clinical practice.

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