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A New Classification Scheme for Periodontal and Peri-Implant Diseases and Conditions

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Early this year, a new classification for periodontal and peri-implant diseases and conditions was published in the Journal of Periodontology. The paper summarized the proceedings of the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. The workshop was co-sponsored by the American Academy of Periodontology and the European Federation of Periodontology and included expert participants from all over the world. 

We have invited Dr. Thomas Nguyen, Periodontist and Instructor in oral medicine, infection and immunity at the Harvard School of Dental Medicine, to highlight the key changes that were adopted in this new classification. 

We would like to hear from you and know your thoughts and questions about this scenario. If you wish to reach us, it’s quite easy: email us at oasisdiscussions@cda-adc.ca or call our toll-free number 1-855-716-2747.

Until next time!

Chiraz Guessaier, CDA Oasis Manager

Highlights

  • Consistent with current knowledge on pathophysiology, three forms of periodontitis can be identified: necrotizing periodontitis, periodontitis as a manifestation of systemic disease, and the forms of the disease previously recognized as “chronic” or “aggressive”, now grouped under a single category, “periodontitis.
  • The classification framework for periodontitis is based on a multidimensional staging and grading system that could be adapted over time as new evidence emerges. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease.
  • The consensus report presents a new classification of gingival recession that combines clinical parameters including the gingival phenotype as well as characteristics of the exposed root surface. In the consensus report the term periodontal biotype was replaced by periodontal phenotype.
  • Traumatic occlusal force, replacing the term excessive occlusal force, is the force that exceeds the adaptive capacity of the periodontium and/ or the teeth.
  • The term biologic width was replaced by supracrestal attached tissues. Clinical procedures involved in the fabrication of indirect restorations was added because of new data indicating that these procedures may cause recession and loss of clinical attachment.
  • Clinically, peri‐implant health is characterized by an absence of visual signs of inflammation and bleeding on probing. Peri‐implant health Clinically, peri‐implant health is characterized by an absence of visual signs of inflammation and bleeding on probing. Peri‐implant health can exist around implants with normal or reduced bone support. It is not possible to define a range of probing depths compatible with peri‐implant health.
  • Peri‐implant mucositis is characterized by bleeding on probing and visual signs of inflammation. While there is strong evidence that peri‐implant mucositis is caused by plaque, there is very limited evidence for non‐plaque induced peri‐implant mucositis. Peri‐implant mucositis can be reversed with measures aimed at eliminating the plaque. 
  • Peri‐implantitis was defined as a plaque‐associated pathologic condition occurring in the tissue around dental implants, characterized by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone. Peri‐implant mucositis is assumed to precede peri‐implantitis. Peri‐implantitis, in the absence of treatment, seems to progress in a non‐linear and accelerating pattern.
  • Larger ridge deficiencies can occur at sites associated with severe loss of periodontal support, extraction trauma, endodontic infections, root fractures, thin buccal bone plates, poor tooth position, injury and pneumatization of the maxillary sinuses. Other factors affecting the ridge can be associated with medications and systemic diseases reducing the amount of naturally formed bone, tooth agenesis, and pressure from prostheses.

Resources

Oasis Moment (2.06″)

Full Conversation (10.33″)

Highlighted Tables (9.41″)

 

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