Classification of Periodontal Diseases and Conditions Dr. Bassam ELGHARABLY

Gingivitis: Refers to inflammation of soft tissues surrounding the teeth. Does not include inflammation of alveolar ridges, PDL, cementum or alveolar bone. Periodontitis is a set of inflammatory diseases affecting the periodontium. (PL,Sementum & alveolar bone)

Healthy Gingivitis

Gingivitis or periodontitis Extent of the lesion % 30 ? LOCALIZED GENERALİZED

GİNGİVİTİS Distribution of the lesion PAPİLLAR PAPİLLAR and MARGINAL (diffused) MARGINAL

PAPİLLAR GİNGİVİTİS PAPİLLAR GİNGİVİTİS MARGINAlL GİNGİVİTİS MARGINAlL GİNGİVİTİS

GİNGİVİTİS Distribution of the lesion PAPİLLAR PAPİLLAR and MARGINAL (diffused) MARGINAL

Calssification of periodontitis based on ammont of attachment loss Slight : 1 to 2 mm clinical attachment loss (CAL) Moderate : 3 to 4 mm CAL. Severe : ≥5 mm CAL.

American Dental Association Classifications (ADA) The system developed by the American Dental Association classification These Case Types are commonly required for insurance billing. system is primarily based on the severity of attachment loss. The clinician uses the clinical and radiographic data gathered and classifies the patient into one of the four Case Types.

American Dental Association Classifications (ADA) 1. Case Type I: Gingivitis 2. Case Type II: Early Periodontitis 3. Case Type III: Moderate Periodontitis 4. Case Type IV: Advanced Periodontitis

American Academy of Periodontology (AAP) The American Academy of Periodontology classification system was established to identify distinct types of periodontal diseases by taking into consideration factors such as age of onset, clinical appearance, rate of disease progression, pathogenic microbial flora and systemic influences. The two major categories are Gingivitis and Periodontitis. Within each category there are specific types of diseases identified

Gingivitis Subdivisions (-) Chronic Gingivitis Acute Necrotizing Ulcerative Gingivitis Gingivitis Associated with Systemic Conditions or Medications Hormone-Induced Gingival Inflammation Drug-Influenced Gingivitis Linear Gingival Erythema (LGE) Gingival Manifestations of Systemic Diseases and Mucocutaneous Lesions Bacterial, Viral or Fungal Blood Dyscrasias (for example Acute Monocytic Leukemia) Mucocutaneous Diseases (Lichen Planus, Cicatricial Pemphigoid)

Periodontitis Subdivisions (-) Adult Periodontitis Early-Onset Periodontitis Prepubertal Juvenile Periodontitis Rapidly Progressive Periodontitis Associated with Systemic Diseases Necrotizing Ulcerative Periodontitis Refractory Periodontitis

Periapical radiographs of a 36-year-old patient, showing severe generalized bone loss. Diagnosis: ‘chronic adult periodontitis’ or ‘early-onset periodontitis’?

AAP Classification (-) The American Academy of Periodontology has recently published changes in the classification system for periodontal diseases These changes are from the 1999 International Workshop for a Classification of Periodontal Diseases and Conditions.

A AP Classification (+) Conditions. Highlights of the changes are as follows: 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" Replacement of "Necrotizing Ulcerative Periodontitis" with "Necrotizing Periodontal Diseases" Addition of a category on "Periodontal Abscess" Addition of a category on "Periodontic-Endodontic Lesions" Addition of a category on "Developmental or Acquired Deformities & Conditions"

A. Dental plaque-induced gingival diseases The 1999 International Workshop for the Classification of Gingival Diseases (+) A. Dental plaque-induced gingival diseases B. Non-plaque-induced gingival lesions

Dental plaque-induced gingival diseases (+) 1.Gingivitis associated with dental plaque only 2. Gingival diseases modified by systemic factors 3. Gingival diseases modified by medications 4. Gingival diseases modified by malnutrition

Classification of Gingival Diseases Non-Plaque induced gingival lesions (+) 1. Gingival diseases of specific bacterial origin 2. Gingival diseases of viral origin 3. Gingival diseases of fungal origin 4. Gingival diseases of genetic origin 5. Gingival manifestations of systemic conditions 6. Traumatic lesions 7. Foreign body reactions

Classification of Periodontitis (+) 1.    Chronic Periodontitis Localized Generalized 2.    Aggressive Periodontitis 3.    Periodontitis Associated with Systemic Diseases 4.    Necrotizing Periodontal Diseases 5.    Abscesses of the Periodontium 6.    Periodontal Diseases associated with Endodontic Lesions 7.    Developmental or Acquired Deformities and Conditions