American Academy of Periodontology releases proceedings from the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions
Updates include staging and grading system for periodontitis; classification of peri-implant disease
CHICAGO (June 21,
2018) — The American Academy of Periodontology (AAP) has published the official
proceedings from the 2017 World Workshop on the Classification of Periodontal
and Peri-Implant Diseases and Conditions. These proceedings provide a
comprehensive update to the previous disease classification established at the
1999 International Workshop for a Classification of Periodontal Diseases and
Conditions. Highlights from the 2017 proceedings 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 is 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: 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 Stage I to most severe 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,” says Kenneth
Kornman, DDS, PhD, editor-in-chief of the Journal
of Periodontology and member of the Workshop’s organizing committee. “A
personalized approach to patient care is essential for effective periodontal
case management. 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. 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 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,
a plaque-associated condition occurring in the tissue around dental implants,
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,” Dr. Kornman says. “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.”
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,” says Steven R. Daniel, DDS, president of
the AAP. “The new classification will also lay the foundation for future
research.”
Held Nov. 9-11, 2017, 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,” Dr. Daniel says. “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.”
Planning for the event began in 2015 with oversight from an organizing
committee composed of AAP and EFP members. The Workshop proceedings are also
published in the EFP’s Journal of
Clinical Periodontology.
“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,” Dr. Daniel says. “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.
The Workshop was presented with support from the AAP Foundation,
Colgate-Palmolive Company, Johnson and Johnson Consumer Inc., Geistlich
Biomaterials, SUNSTAR, and Procter and Gamble Professional Oral Health.
Visit perio.org/2017wwdc for
the Workshop proceedings and more information.
About the American Academy of Periodontology
The American Academy of Periodontology (AAP) represents over 8,000 periodontists—specialists in the prevention, diagnosis, and treatment of inflammatory diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontics is one of the nine dental specialties recognized by the American Dental Association. Learn more at perio.org.
The American Academy of Periodontology (AAP) represents over 8,000 periodontists—specialists in the prevention, diagnosis, and treatment of inflammatory diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontics is one of the nine dental specialties recognized by the American Dental Association. Learn more at perio.org.
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