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Steps for Determining a Diagnosis of Periodontitis

A simple 4-step process has been suggested by Kornman and Papapanou17 to assist clinicians in developing a diagnosis for each individual case using the new classification.

Step 1 - Case Overview

  • Examine full mouth radiographs
  • Examine full mouth probing depths
  • Document number of missing teeth

This will help to first determine whether the case is: Mild/Moderate or Severe/Very Severe

Step 2 - Determine Stage

  • Determine maximum Clinical Attachment Loss (CAL) or Radiographic Bone Loss (RBL)
  • Confirm pattern of bone loss (horizontal or vertical)
  • Determine number of missing teeth due to periodontitis
  • Determine complexity of case (i.e., probing depths, furcations, occlusion/function, need for extensive rehabilitation, etc.)
  • Decision made using Table 9

Step 3 - Determine Grade

  • Always start with the default Grade of B
  • Consider history/rate of progression/age
  • Response to previous therapy (Plaque control/SRP)
  • Medical history/systemic conditions
  • Risk factors
  • Adjust default Grade using Table 10

Examples:

Stage 1 Grade B
Photo and x-ray showing Stage 1 Grade B periodontitis
Image Courtesy of Dr. C. Cobb.

Staging
PD = ≤ 4 mm
BOP = Yes
RBL < 15% & generally horizontal
CAL 1-2 mm
Biofilm = Slight–Heavy

Grading
No tooth loss due to periodontitis
Moderate Rate of Progression
Non-Smoker
Non-Diabetic

Stage 2 Grade B
Photo and x-ray showing Stage 2 Grade B periodontitis
Image Courtesy of Dr. C. Cobb.

Staging
PD ≤ 5 mm
BOP = Yes
RBL = 15% - 33% / mostly horizontal
CAL 3-4 mm
Biofilm = Slight–Heavy

Grading
No tooth loss due to periodontitis
Moderate Rate of Progression
Smoker <10 cigs per day
If Diabetic HbA1c <7.0%

Stage 3 Grade B
Photo and x-ray showing Stage 3 Grade B periodontitis
Image Courtesy of Dr. C. Cobb.

Staging
PD ≥ 6 mm
BOP = Yes
RBL = Horizontal ≥ 50% / Vertical ≥ 3 mm
CAL ≥ 5 mm
Biofilm = Slight–Heavy

Grading
Tooth loss due to periodontitis ≤ 4 teeth
Moderate Rate of Progression
Furcation Involvement = Class II or III
If Smoker <10 cigs per day
If Diabetic HbA1c <7.0%
Moderate ridge defect

Stage 4 Grade C
Photo and x-ray showing Stage 4 Grade C periodontitis
Image Courtesy of Dr. C. Cobb.

Staging
PD ≥ 6 mm
BOP = Yes
RBL = Horizontal ≥ 50% / Vertical ≥ 3 mm
CAL ≥ 5 mm
Biofilm = Slight–Heavy

Grading
Tooth loss due to periodontitis ≥ 5 teeth
Furcation Involvement = Class II or III
Moderate ridge defect
Need for complex rehabilitation
Bone loss exceeds expectations given biofilm
Rapid Rate of Progression
Smoker >10 cigs per day
If Diabetic HbA1c >7.0%

Please note: These examples do not include categorization of the extent of disease, thus keep in mind that localized would be any case that had less than 30% of teeth involved, while generalized would be more than 30% of teeth involved.