Figure 1.1.5 Nabers probe (Hu‐Friedy, IL, USA).
Glickman’s Furcation Classification
| Grade I | Incipient suprabony lesion. Radiographic changes are rarely found. |
| Grade II | Furcation bone loss with a horizontal component. Radiographs may not show bone loss in the furcation. |
| Grade III | A through‐and‐through lesion that is not clinically visible because it is filled. Radiographs show a radiolucency in the furcation. |
| Grade IV | A through‐and‐through lesion that is clinically visible. The soft tissue has receded apically. Radiolucency is clearly visible in the furcation area. |
Figure 1.1.6 Mucogingival anatomy.
Mucogingival Deformity
In general, to maintain gingival health (Figure 1.1.6), the presence of at least 2 mm width of remaining keratinized gingiva is preferred [10]. Mucogingival deformity may be recorded as present for any tooth with less than 2 mm width of remaining keratinized gingiva.
Pathologic Migration
A tooth with a significant periodontal breakdown with severe bone loss may undergo pathologic migration (Figure 1.1.7) [11]. In the case presented above, tooth #3 showed evidence of pathologic migration resulting in supraeruption as well as acquired open interproximal contact between tooth #3 and tooth #4. Clinicians should also evaluate any possible acquired pre‐mature occlusal contact in these teeth with pathologic migration, resulting in occlusal trauma or fremitus.
C. Stage [1] (Tables 1.1.1 and 1.1.2)
The greatest interdental clinical attachment loss of 14 mm (probing depth of 12 mm + gingival recession of 2 mm) was noted on tooth #3 mesiopalatal aspect, with bone loss extending beyond the apical third of the root. Tooth #3, as well as tooth #14 with interdental clinical attachment loss >5 mm, were assigned to stage III. Considering only two of 25 teeth were affected to the same severity, the extent and distribution descriptor “localized” was assigned.
Grade [1]
Figure 1.1.7 Resolution of pathologic migration after successful periodontal treatment, resulting in reduction in acquired diastema between the maxillary central incisors.
Table 1.1.1 Classification of periodontitis based on stages defined by severity (according to the level of interdental clinical attachment loss [CAL], radiographic bone loss and tooth loss), complexity and extent and distribution.
Source: Papapanou et al. [1].
| Periodontal stage | Stage I | Stage II | Stage III | Stage IV | |
|---|---|---|---|---|---|
| Severity | Interdental CAL at site of greatest loss | 1–2 mm | 3–4 mm | ≥5 mm | ≥5 mm |
| Radiographic bone loss | Coronal third (<15%) | Coronal third (15–33%) | Extending to middle or apical third of root | Extending to middle or apical third of root | |
| Tooth loss | No tooth loss due to periodontitis | Tooth loss due to periodontitis of ≤4 teeth | Tooth loss due to periodontitis of ≤5 teeth | ||
| Complexity | Local | Max. probing depth ≤4 mm Mostly horizontal bone loss | Max. probing depth ≤5 mm Mostly horizontal bone loss | In addition to stage II complexity:Probing depth ≥6 mmVertical bone loss ≥3 mmFurcation involvement Class II or IIIModerate ridge defect | In addition to stage III complexity, need for complete rehabilitation due to:Masticatory dysfunctionSecondary occlusal trauma (tooth mobility degree ≥2)Severe ridge defectBite collapse, drifting, flaringLess than 20 remaining teeth (10 opposing pairs) |
| Extent and distribution | Add to stage as descriptor | For each stage, describe extent as localized (<30% of teeth involved), generalized, or molar/incisor pattern | |||
Table 1.1.2 Classification of periodontitis based on grades that reflect biologic features of the disease including evidence of, or risk for, rapid progression, and anticipated treatment response, and systemic health.
Source: Papapanou et al. [1].
| Periodontitis grade | Grade A: slow rate of progression | Grade B: moderate rate of progression | Grade C: rapid rate of progression | ||
|---|---|---|---|---|---|
| Primary criteria | Direct evidence of progression | Longitudinal data (radiographic bone loss or CAL) | Evidence of no loss over 5 years | <2 mm over 5 years | ≥2 mm over 5 years |
| Indirect evidence of progression | % bone loss/age | <0.25 | 0.25–1.0 | ≥1.0 | |
| Case phenotype | Heavy biofilm deposits with low levels of destruction |
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