Periodontitis Classification

The new global classification of periodontal diseases requires us to rethink our understanding of how this disease occurs and how it is diagnosed.

Milestones for Early Detection and Prevention

Periodontitis Classification 2018 – Staging and Grading

Most periodontal diseases develop insidiously. It may take decades for clinically manifest periodontitis to be diagnosed –and treated. As observed by the authors of the latest Barmer Tooth Report (2017), the treatment of periodontitis begins at such a late stage for many patients that adequate therapy can no longer prevent tooth loss.

One of the reasons for this is the diagnostic approach. Until now, the focus has been on the extent of the degeneration (probing depth, bleeding on probing etc.), rather than on the start of the collagen breakdown of the periodontal tissue.

With the introduction of the new, global classification system for periodontitis on 21 June 2018, the focus is now, more than ever, on the development and progression of periodontitis.
This comprehensive classification system incorporates the latest evidence and is based on standard WHO disease classifications, such as those for cancer (Caton et al. 2018). It includes a decision matrix with a “staging and grading” system for periodontitis (Tonetti et al. 2018).

Staging defines how periodontitis develops over time
Staging comprises four stages, from stage 1 (mild periodontitis) to stage 4 (severe periodontitis).

The stage of a patient’s periodontitis is determined by clinical findings and findings from x-ray examinations, including clinical attachment loss, radiographic bone degradation, probing depths, and vertical defects, as well as furcation involvement, tooth mobility, and tooth loss.

Grading defines the degree to which a patient is at risk of the periodontitis progressing further
The risk of disease and the degree of disease progression are divided into three grades, from grade A (low risk or slow progression) to grade C (high risk or rapid progression). Risk factors such as smoking and accompanying diseases like diabetes can be taken into account. 

The new staging and grading matrix, which replaces the previous classification of periodontitis as “aggressive” or “chronic” offers benefits in terms of an individualized diagnosis and therefore also treatment. If patients at risk can be detected in a reliable way and at an early stage of the disease, this simple yet effective approach potentially presents us with a huge opportunity to reduce the prevalence of periodontal diseases.

aMMP-8 Biomarker Analysis Detects the Early Stages of Collagen Breakdown

Early Detection is the Best Prevention

PerioSafe DRS offers fast quantitative detection of the risk of periodontitis and its progression. That’s because PerioSafe© DRS detects the enzyme aMMP-8, a biomarker for the degradation of the collagen network in the periodontium. This immunological prevention diagnostic can distinguish between cases of no to very low risk and cases of an elevated risk for periodontal tissue loss.

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