Periodontal diseases classification.pptx

Periodontal diseases classification refers to the categorization of various conditions that affect the supporting structures of the teeth, including the gums, periodontal ligament, and alveolar bone. These diseases are typically divided into two broad categories: gingivitis and periodontitis. Classification systems are based on factors such as the extent and severity of disease, the presence of systemic conditions, and genetic or environmental risk factors. The 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions established a more comprehensive system, categorizing periodontitis into stages (based on severity and progression) and grades (reflecting risk factors like smoking or diabetes).This classification helps clinicians assess the prognosis and determine appropriate treatment plans for managing periodontal health. This presentation includes most of the classification systems of periodontal diseases since 1921 to till 2018 classification.

1. Classification of Periodontal Diseases Guided by- Dr. Monica Mahajani Dr. Anup Shelke Dr. Subodh Gaikwad Dr. Kuldeep Patil Dr. Chitrika Subhadarshanee Presented by- Dr. Pranjal Baheti

2. Content- Introduction Need of classification Ideal Requisite C lassification Advantages & disadvantages Conclusion Reference

3. Introduction: Periodontal disease are the infectious disease resulting in inflammation within the supporting tissues of the teeth , progressive attachment loss and bone loss . Depending on updation of knowledge during different times in the past regarding the etiopathogenesis and clinical manifestations, various schemes for classifying periodontal diseases were proposed.

4. Need of classification Foundation to study the etiology , susceptibility traits, pathogenesis, and treatment of diseases in an organized manner . To give clinicians a way to organize the health care needs of their patients . Diagnosis , prognosis, treatment planning; communication.

5. Ideal Requisite Suitable organizing principle matching the nature of the disease being classified. Simple Every disease should fall into at least one of the classes. No disease should fall into more than one of the classes.

6. Dominant paradigms in the evolution of classification systems (~1870–1920 ) Clinical characteristics paradigm There was dispute about the nature of periodontal diseases; whether they were caused by local or systemic factors. Many of the advocates for the etiological role of local factors also acknowledged that in some cases both local and systemic factors are responsible.

7. (~1920–1970 ) Classical pathology paradigm At that time a new concept developed that periodontal diseases can be of 2 types-inflammatory and non-inflammatory (‘degenerative’ or ‘dystrophic ’) This was based on the observation that certain forms of periodontal diseases were due to degenerative changes in the periodontium.

8. (~1970–present ) Infection/ host response paradigm Infection/ host response paradigm. W.D. Miller stated three factors which were to be taken into consideration in every case- predisposing circumstances , local irritation , bacteria .

9. GOTTLIEB (1921) Pyorrhea alveolaris Schmutz pyorrhea /Filth pyorrhea   Alveolar A trophy T rauma from occlusion Paradontal Pyorrhea

10. Fish described pyorrhea simplex and pyorrhea profunda . Box divided chronic periodontitis into complex and simplex, and ascribed a prominent role for occlusal trauma in the aetiology of complex.

11. ORBAN’S Classification(1942) Degeneration Atropy Hypertropy Traumatism Inflammation Periodontal atropy Periodontal traumatism Gingival hypertropy Periodontosis Gingivitis Periodontitis

12. IRVING GLICKMAN INFLAMMATORY A . Chronic Inflammatory Gingival Enlargement 1 . Generalized or localized 2 . Discrete ( Tumor -like) B . Acute Inflammatory Gingival Enlargement (Gingival abscess ) II. NON-INFLAMMATORY HYPERPLASTIC GINGIVAL ENLARGEMENT (Gingival hyperplasia ) A . Marginal B. Diffuse

13. III. COMBINED GINGIVAL ENLARGEMENT IV . CONDITIONED GINGIVAL ENLARGEMENT A . Hormonal 1 . Gingival Enlargement of Pregnancy 2 . Gingival Enlargement of Puberty B . Leukemic Gingival Enlargement C . Gingival Enlargement Associated with Vitamin C Deficiency V . NEOPLASMS VI . DEVELOPMENTAL GINGIVAL ENLARGEMENT

14. 1957 AAP Classification IN F L A M M A T IO N D Y ST R O PH Y Gingivitis Periodontitis PRIMARY (Simplex) SECONDARY (Complex) Chronic Acute Chronic papillary Necrotizing Fibrotic Desquamative Ulcerative Bullous Occlusal traumatism Periodontal disuse atropy Gingivosis Periodontosis

15. Page and Schroeder  (1976) Juvenile Rapidly progressive Pre-pubertal Adult periodontitis Acute necrotizing ulcerative gingivo -periodontitis

16. AAP 1977 Classification I . Juvenile Periodontitis II. Chronic Marginal Periodontitis

17. AAP 1986 Classification Juvenile Periodontitis - Prepubertal -Localized juvenile periodontitis -Generalized juvenile periodontitis Adult Periodontitis Necrotizing Ulcerative Gingivo -Periodontitis Refractory Periodontitis

18. AAP World Workshop in Clinical Periodontics (1989) Classification Early- onset Periodontitis A. B .

19. II. Adult Periodontitis III. Necrotising Ulcerative Periodontitis IV. Refractory Periodontitis V. Periodontitis associated with Systemic diseases

20. Drawbacks of the 1989 Classification Gingival disease category was absent. Non-validated age-dependent criteria in other periodontitis categories. Extensive crossover in rates of progression of the different categories of periodontal disease.

21. ‘Rapidly Progressive Periodontitis’, ‘Refractory Periodontitis’ and ‘ Prepubertal Periodontitis ‘were heterogeneous category. Extensive overlap in the clinical characteristics of the different categories of periodontitis.

22. European Workshop in Periodontology (1993) Classification Adult Periodontitis - Begins at the 4th decade of life, slow rate of progression of disease . Early onset Periodontitis - Begins before the 4 th decade of life, rapid rate of progression of disease, altered host response is seen . Necrotizing Periodontitis - Tissue necrosis with clinical attachment and bone loss is seen.

23. Drawbacks Elaboration of the broad spectrum of periodontal diseases encountered in clinical practice was absent.

24. American Academy of Periodontology (1999) Classification I. Gingival diseases II . Chronic periodontitis (CP ) III. Aggressive periodontitis IV. Periodontitis as a manifestation of systemic diseases (NP) V. Necrotizing periodontal diseases VI. Periodontal abscesses VII . Periodontitis with endodontic lesions VIII. Developmental and acquired deformation and conditions

25. I. Gingival diseases (G) Gingival diseases caused by plaque Gingivitis exclusively caused by plaque a. With no local modifying factors b . With local modifying factors

26. 2. Gingival diseases modified with systemic factors A. Associated with endocrine system 1.Gingivitis connected with puberty 2. Gingivitis connected with the menstrual cycle 3.Connected with pregnancy a ) Gingivitis in pregnancy b ) Pyogenic granuloma 4.Gingivitis connected with diabetes mellitus

27. b. Connected with blood disease 1 ) Gingivitis connected with leukaemia 2) Other diseases

28. 3 . Gingival diseases modified by application of medications a . Gingival diseases caused by medications 1 ) Gingival growths caused by medications 2 ) Gingivitis caused by medications a ) Gingivitis connected with oral contraceptives b ) Other medications

29. 4 . Gingival diseases caused by malnutrition a . Gingivitis due to lack of vitamin C b. Others

30. B. Gingival lesions not induced by plaque 1 . Gingival diseases of specific bacterial etiology a . Lesions connected with Neisseria gonorrhoeae b . Lesions connected with Treponema pallidum c . Lesions connected with streptococci d. Others

31. 2. Gingival diseases of viral etiology A. Infection with the Herpes virus 1 ) Primary herpetic gingivostomatitis 2 ) Recurring oral herpes 3 ) Varicella zoster infection B . Others

32. 3. Gingival diseases of fungal etiology A. Infection with candida 1 ) Generalised gingival candidiasis B. Linear gingival erythema C. Histoplasmosis D. Others

33. 4. Gingival diseases of genetic etiology a. Inherited fibromatosis of the gingiva b . Others

34. 5. Systemic diseases which manifest on the gingiva A. Changed mucous membrane 1) Lichen planus 2) Pemphigoid 3) Pemphigus vulgaris 4) Erythema multiformis 5 ) Lupus erythematosus 6)Others

35. B. Allergic reactions 1 ) Material in restorative dentistry a ) Mercury b) Nickel c) Acrylic d) Others

36. 2 ) Reaction to: a ) Toothpaste b) Mouthwashes c) Additives in chewing gum d) Nutritive substitutes 3 ) Others

37. 6. Traumatic lesions (iatrogenic, accidents) a . Chemical b . Physical c . Thermal 7. Reaction to foreign bodies 8. Not otherwise defined

38. II. Chronic periodontitis (CP) A. Localised B . Generalised

39. III. Aggressive periodontitis (AP ) A. Localised B. Generalised

40. IV. Periodontitis as a manifestation of systemic diseases (NP) A . Connected with blood diseases 1. Acquired neutropenia 2. Leukaemia 3. Others

41. B. Connected with genetic disorders 1. Family or cyclic neutropenia 2 . Down’s syndrome 3. Leucocyte adhesive deficiency syndrome 4. Papillon-Lefevre syndrome 5 . Chediak -Higashi syndrome 6 . Histiocytosis or Eosinophilic granuloma syndrome

42. 7. Glycogen storage syndrome 8. Infantile genetic agranulocytosis 9. Cohen’s syndrome 10. Ehlers- Danlos syndrome, type IV and VIII AD 11. Hypophosphatasia 12. Others C. Not otherwise defined

43. V. Necrotizing periodontal diseases A. Necrotizing ulcerous gingivitis (NUG ) B . Necrotizing ulcerous periodontitis (NUP)

44. VI. Periodontal abscesses A. Gingival abscess B . Periodontal abscess C . Pericoronal abscess

45. VII. Periodontitis with endodontal lesions A . Combined perio -endo lesion

46. VIII. Developmental and acquired deformation and conditions A. Localised dental factors which encourage plaque, caused by gingivitis / periodontitis 1 . Anatomy of the teeth 2. Reconstruction of teeth/effect of the device 3. Fractured root 4 . Resorption of roots and (cement pearls)

47. B. Mucogingival deformities and relations in the tooth vicinity 1 . Recession a . Facially and orally b . Approximally 2. Lack of gingival keratinization 3. Shortened gingival attachment 4. Localisation of the tongue or lip frenum

48. 5. Gingival enlargement a. Pseudo-pockets b. Irregular development of the gingival edge c. Excessive gingival presentation d. Gingival enlargement 6 . Abnormal staining

49. C. Changed mucous membrane on an edentulous ridge 1.Loss of vertical or horizontal bone dimension 2.Loss of gingiva, i.e. keratinized tissue 3.Gingival growths, i.e. of soft tissue 4.Abnormal localisation of the tongue or lip frenum 5.Reduced vestibule depth 6.Abnormal staining

50. D. Occlusal trauma 1 . Primary occlusal trauma 2 . Secondary occlusal trauma

51. Changes in the 1999 Classification for Periodontal diseases Addition of a Section on “Gingival diseases Replacement of “Adult Periodontitis” with “Chronic Periodontitis ” Replacement of “Early-Onset Periodontitis” With “Aggressive Periodontitis ” Elimination of a Separate Disease Category for “Refractory Periodontitis ” Clarification of the Designation “Periodontitis as a Manifestation of Systemic Diseases ”

52. Replacement of “Necrotizing Ulcerative Periodontitis” With “Necrotizing Periodontal diseases” Addition of a Category for “Periodontal Abscess” and “ Periodontic -Endodontic Lesions” Addition of a Category on “Developmental or Acquired Deformities and Conditions” Essentialistic or Nominalistic disease classification

53. DISADVANTAGE It did not serve as therapeutic guide Categorizing aggressive & chronic periodontitis –confusing Current evidence does not support the distinction between chronic and aggressive periodontitis as separate clinical entities

54. Confusion in diagnosing a case of plaque-induced gingival inflammation on a reduced but healthy periodontium – periodontitis or gingivitis ? Categories of gingival disease modified by medication & diabetes mellitus exist but no such periodontitis class exists. No mention of peri -implant diseases

55. Classification of Periodontal & Peri -implant diseases and conditions 2017(AAP & EFP) A) Periodontal Diseases and Conditions

56. B) Peri - Implant diseases and conditions Peri -implant Health Peri implant Mucositis Peri-implantitis Peri -implant soft and Hard tissue deficiency

57. 0.25% 0.25-1% >1%

58. Advantages Evidence-based and clinically relevant Helps in accurate case selection D isease risk and complexity factors R eflect on tooth loss Periodontal & gingival health have been defined . Endo- Perio lesion- classification based on clinical findings

59. Disadvantages very extensive and more complicated Some degree of overlap Necrotizing gingivitis is included in the periodontitis Periodontal abscess is a clinical manifestation and not a disease yet is considered as a diagnosis There is no distinction between periodontal and gingival abscesses.

60. 2018 New Periodontal Classification (By EFP & AAP) AAP)

61. Mucogingival deformities & conditions around teeth 1.Periodontal Biotype Thin scalloped Thick scalloped Thick flat 2.Gingival soft tissue recession Facial & lingual surface Interproximal (papillary) Severity of recession( cairo RT1,2,3) Gingival thickness Gingival width Presence of NCCL /Cervical caries Presence of hypersensitivity

62. 3.Lack of keratinised gingiva 4.Decrease vestibular depth 5.Aberrunt frenum /muscle position 6.Gingival excess Psuedo pocket Inconsistent gingival margin Excessive gingival display Gingival enlargement 7.Abnormal colour

63. Conclusion It is just a guideline that certainly may possess some limitations in some cases. Therefore, judgement of clinicians is essential to make a definitive diagnosis. Clinical efficiency of the classification’s should be evaluated in a future studys .

64. References Lindhe , J. (2008, January 1). Clinical periodontology and implant dentistry. 1. [Basic concepts] . 5 th Ed Newman, M. G., Takei, H., Klokkevold , P. R., & Carranza, F. A. (2011, February 14). Carranza’s Clinical Periodontology . 10 th Ed Sutthiboonyapan , P., Wang, H., & Charatkulangkun , O. (2020, April 8). Flowcharts for Easy Periodontal Diagnosis Based on the 2018 New Periodontal Classification. Clinical Advances in Periodontics , 10 (3), 155–160. https:// doi.org/10.1002/cap.10095

65. Caton , J. et al. ( 2018, June). A new classification scheme for periodontal and peri ‐implant diseases and conditions – Introduction and key changes from the 1999 classification. Journal of Periodontology , 89 (S1 ). Salme E. Lavigne . The 2018 AAP/EFP Classification of Periodontal & Peri -implant Diseases. Crest® + Oral-B® at dentalcare.com Mahajan A., Kolte R. , Kolte A., Development and Evolution of Classification of Periodontal Diseases: An Insight. International Dental Journal of Student’s Research, January – March 2015;3(1):3-11

66. Papapanou PN, Sanz M, et al. Periodontitis: Consensus report of Workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri -Implant Diseases and Con ditions . J Periodontol . 2018;89( Suppl 1):S173–S182 . Mittal V, Bhullar RP, Bansal R, Singh K, Bhalodi A, Khinda PK. A practicable approach for periodontal classification. Dent Res J (Isfahan). 2013 Nov;10(6):697-703. PMID: 24379855; PMCID: PMC3872618 . GLICKMAN I. A basic classification of "gingival enlargement". J Periodontol (1930). 1950 Jul;21(3):131-9. doi : 10.1902/jop.1950.21.3.131. PMID: 15428964.