New Classification Of Periodontal Diseases Research Articles

Application of 2017 new classification of periodontal diseases and conditions: A commentary

Application of 2017 new classification of periodontal diseases and conditions: A commentary

Correlation Between Clinical and Radiographic Evaluation Using Custom-made Newly Developed Software Program as A Guide for Accurate Diagnosis of Periodontal Diseases

Purpose: to correlate between clinical and radiographic findings using custom– made newly developed software program that guide clinicians, for accurate diagnosis. This is based on clinical and radiographic data from 3D volumetric rendering of cone beam computed tomography. This has been done based on the new classification of periodontal diseases (of 2018). Materials and methods: A randomized clinical study was performed on hundred and fifty patients with periodontal diseases of both gender with age range (30-60) years old. Periodontal clinical parameters were taken. Radiographic analysis using CBCT and 3D volumetric rendering was done. Results: There is a moderate positive correlation between Clinical data (clinical attachment loss CAL and probing depth PD) and linear measurements (Mesial and distal bone loss). Moreover, there was positive correlation between Clinical data (CAL and Max PD) and volumetric measurements (Mesial and distal bone loss area) and between linear measurements (mesial and distal bone loss) and volumetric measurements (mesial and distal bone loss area). This correlation was statistically highly significant at the 0.01 level (P0.01 > & confidence 99 %(. Conclusion: There is moderate positive correlation between clinical and radiographic data that is statistically highly significant at the 0.01 level (P0.01 > & confidence 99 %).

Correlation Between Clinical and Radiographic Evaluation Using Custom-made Newly Developed Software Program as A Guide for Accurate Diagnosis of Periodontal Diseases

Purpose: to correlate between clinical and radiographic findings using custom– made newly developed software program that guide clinicians, for accurate diagnosis. This is based on clinical and radiographic data from 3D volumetric rendering of cone beam computed tomography. This has been done based on the new classification of periodontal diseases (of 2018). Materials and methods: A randomized clinical study was performed on hundred and fifty patients with periodontal diseases of both gender with age range (30-60) years old. Periodontal clinical parameters were taken. Radiographic analysis using CBCT and 3D volumetric rendering was done. Results: There is a moderate positive correlation between Clinical data (clinical attachment loss CAL and probing depth PD) and linear measurements (Mesial and distal bone loss). Moreover, there was positive correlation between Clinical data (CAL and Max PD) and volumetric measurements (Mesial and distal bone loss area) and between linear measurements (mesial and distal bone loss) and volumetric measurements (mesial and distal bone loss area). This correlation was statistically highly significant at the 0.01 level (P0.01 > & confidence 99 %(. Conclusion: There is moderate positive correlation between clinical and radiographic data that is statistically highly significant at the 0.01 level (P0.01 > & confidence 99 %).

Salivary biomarkers present in patients with periodontitis without clinical distinction: findings from a meta-analysis.

A new classification for periodontitis has been adopted in clinical practice. However, there are still discussions regarding this new classification and difficulties in its adoption, both by professionals and researchers. Thus, this study aimed to evaluate which salivary biomarkers are present in periodontitis, following the new classification of periodontal diseases through meta-analysis. A literature search was carried out in the scientific databases: PubMed, Scielo and Google scholar to select studies. The selection of studies was followed by two authors upon reading of the title, abstract and full text. The necessary data were collected and statistical analyses were performed using the Review Manager statistical software version 5.4, with calculation of Mean Difference, heterogeneity (I²) and funnel plot with P < 0.05. After following the selection criteria, 9 articles were selected for comparison. The studies address the presence of biomarkers in the saliva of patients with periodontitis and their possible use in the monitoring and diagnosis of the disease. For the meta-analytic comparison, a sample size of 1,983 individuals was used. Statistical analyses showed that nitric oxide, IL-6, IL-1B and osteoprotegerin are substances that are significantly present in patients with periodontitis (P < 0.05). IL-6, nitric oxide, IL-1B, TNF-α and osteoprotegerin are among the most present biomarkers in patients with periodontitis, and may be used in the future as a monitoring of periodontal disease. The present study also revealed that there was no statistically significant difference in the concentration of these biomarkers for clinical distinction from periodontitis.

Advanced Glycation End Product (AGE) and Soluble Receptor of AGE (sRAGE) Levels in Relation to Periodontitis Severity and as Putative 3-Year Outcome Predictors in Patients Undergoing Coronary Artery Bypass Grafting (CABG).

Tissue concentrations of advanced glycation end product (AGE) and peripheral soluble receptor of AGE (sRAGE) levels may be associated with periodontitis severity. Both parameters and periodontitis might serve as outcome predictors for patients undergoing coronary artery bypass grafting (CABG). This study aimed to investigate possible associations between periodontitis and AGE/sRAGE. Ultimately, we wanted to examine whether AGE, sRAGE, and severe periodontitis are associated with the incidence of new cardiovascular events within 3 years of follow-up after CABG. Ninety-five patients with coronary vascular disease (CVD) (age 69 years, 88.3% males) needing CABG surgery were included. Periodontal diagnosis was made according to the guidelines of the “Centers for Disease Control and Prevention (CDC)” (2007) and staged according to the new classification of periodontal diseases (2018). AGE tissue concentrations were assessed as skin autofluorescence (sAF). sRAGE levels were determined by using a commercially available enzyme-linked immunoabsorbance assay (ELISA) kit. Univariate and multivariate baseline and survival analyses were carried out with Mann–Whitney U test, Chi² test, Kaplan–Meier curves with Log-Rank test, and logistic and Cox regression. sAF was identified as an independent risk indicator for severe periodontitis with respect to the cofactors age, gender, plaque index, and diabetes (adjusted odds ratio [OR] = 2.9, p = 0.028). The degree of subgingival inflammation assessed as a percentage of sites with bleeding on probing (BOP) was inversely correlated with sRAGE concentration (r = −0.189, p = 0.034). Both sAF (Hazard Ratio [HR] = 2.4, p = 0.004) and sRAGE (HR = 1.9, p = 0.031) increased the crude risk for new adverse events after CABG. The occurrence of severe periodontitis trends towards a higher risk for new cardiovascular events (HR = 1.8, p = 0.115). Applying multivariate Cox regression, only peripheral arterial disease (adjusted HR = 2.7, p = 0.006) and history of myocardial infarction (adjusted HR = 2.8, p = 0.010) proved to be independent risk factors for cardiovascular outcome. We conclude that sAF may represent a new, independent risk indicator for severe periodontitis. In contrast, sAF, sRAGE, and severe periodontitis were not independent prognostic factors for postoperative outcome in patients undergoing CABG.

General dental practitioners’ perceptions on Team-based learning pedagogy for continuing dental education

Introduction: Team-based learning (TBL) pedagogy is a structured, flipped classroom approach to promote active learning. In April 2019, we designed a TBL workshop to introduce the New Classification of Periodontal Diseases 2017 to a group of general dental practitioners (GDPs). We aimed to investigate GDPs feedback on learning this new classification using TBL pedagogy. Methods: Two articles related to the 2017 classification were sent to 22 GDPs 2 weeks prior to a 3-hour workshop. During the face-to-face session, they were randomly assigned to five groups. They participated in individual and group readiness assurance tests. Subsequently, the GDPs had inter- and intragroup facilitated discussions on three simulated clinical cases. They then provided feedback using a pen-to-paper survey. Based on a 5-point Likert scale (1-strongly disagree to 5-strongly agree), they indicated their level of agreement on items related to the workshop and their learning experience. Results: Majority (94.7%, 18 out of 19 GDPs) agreed the session improved their understanding of the new classification and they preferred this TBL pedagogy compared to a conventional lecture. All learners agreed they can apply the knowledge to their work and there was a high degree of participation and involvement during the session. They found the group discussion and the simulated clinical cases useful. Conclusion: A TBL workshop is suitable for clinical teaching of the New Classification of Periodontal Diseases 2017 for GDPs. Its structure promotes interaction among learners with the opportunity to provide feedback and reflection during the group discussions. This model might be a good pedagogy for continuing dental education.

Development and testing of a mobile application for periodontal diagnosis

BackgroundThe new classification of periodontal diseases introduced a new set of rules for periodontal diagnosis. The objective of this study was to develop and test the implementation of a mobile device application for periodontal diagnosis. Material and MethodsAn integral algorithm that included periodontal health / related conditions and periodontitis was developed based on the classification of periodontal diseases of 2018. A mobile application for Android implementing the algorithm was developed using the framework MIT App Inventor. Once the app was debugged for glitches and performance of the algorithm, it was tested with 20 voluntary dental students, postgraduate students of periodontology, and professors in an academic setting. Participants were asked to determine the diagnosis of 10 predetermined clinical cases using two strategies: diagnosis based on knowledge and with the PerioSmart app. The results were tabulated, and the concordance rate was calculated. ResultsIn general, the use of the PerioSmart application had a better concordance rate than diagnosis based on knowledge. In particular, the mobile app was better in determining the type of diagnosis, stage/grade of periodontitis, and with better efficiency. ConclusionsThe mobile device application demonstrated efficiency and good concordance rate and therefore can improve the periodontal diagnosis. Key words:Mobile application, periodontal diagnosis, periodontitis, gingivitis.

The Influence of Periodontal Treatment on Salivary Visfatin Biomarker levels in Non-obese Indian Population with Different forms of Periodontal Disease- A Clinico-Biochemical Study

The ability to correctly diagnose and institute effective periodontal therapy is essential to control periodontal diseases. Rapid advances in diagnostic research are moving towards methods whereby periodontal disease risk can be identified and quantified by measuring biomarkers. This study investigated the effect of Non-Surgical Periodontal Treatment (NSPT) on clinical indices and salivary levels of visfatin in subjects with increasing severity of the periodontal disease. This interventional clinical trial was performed on 60 systemically healthy male and female subjects (20 to 50 years) who were categorised into Group-1, Twenty subjects with healthy periodontium, Group-2, Twenty subjects with generalized moderate gingivitis, and Group-3 (20 subjects with moderate to severe periodontitis (Stage III according to the new classification of periodontal diseases). The visfatin levels were measured in unstimulated saliva by using standard EnzymeLinked Immunosorbent Assay (ELISA) technique at baseline and six weeks after NSPT. The salivary visfatin levels were highest in Group-3 (38.22±3.38 ng/ml) followed by Group - 2 (26.66±2.24 ng/ml) and Group-1 (25.60±2.19 ng/ml) at baseline. After NSPT statistically significant reduction in salivary visfatin levels (p&lt;0.001) in Groups -2 and 3 were seen. Visfatin levels at baseline were almost equivocal in normal weight and overweight subjects, irrespective of body mass index and showed a statistically significant reduction in salivary visfatin levels in both groups six weeks after NSPT (p&lt;0.001). The present study suggests that salivary visfatin is a strong contributor in the pathology of periodontal disease and can be used as its diagnostic/therapeutic biomarker.

Performance of the 2017 AAP/EFP case definition compared with the CDC/AAP definition in population-based studies.

Classification of the periodontal conditions is indispensable for epidemiological data in order to guide situational awareness and therapeutic strategies. The new classification of periodontal diseases and conditions introduced by the American Academy of Periodontology and the European Federation of Periodontology (AAP/EFP), however, has not yet been applied to population-based studies. The aim of the present study was to compare the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification system and to evaluate the accuracy of the new AAP/EFP classification system against the CDC/AAP case definition for population-based studies. Epidemiological data from two cross-sectional studies were obtained. One of them was a population-based study on Chilean adults (1.456 individuals; 35-44 years; 65-74 years) and the other one a sample of adolescents (1.070 individuals; 15-19 years) from five countries; Argentina, Chile, Colombia, Ecuador, and Uruguay. All participants had undergone full-mouth periodontal examination by calibrated examiners. Epidemiological datasets were analyzed according to the AAP/EFP and the CDC/AAP case definitions. The accuracy of the AAP/EFP definition was examined by assessing the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating curve (ROC) using the CDC/AAP case definition as the reference standard. According to the AAP/EFP, the prevalence of periodontitis in adolescents was 75.6%. The majority of the adolescents were classified either as Stage I (39.2%) or Stage II (28.2%). By using the CDC/AAP classification the prevalence of periodontitis in adolescents was 27.2%. The most common form of periodontitis with the CDC/AAP classification was moderate periodontitis (15.3%) followed by mild periodontitis (11.4%). The AAP/EFP revealed high sensitivity in moderate (95.7%) and severe periodontitis (100%) as well as a moderate (75%) to high specificity (92%) in moderate and severe periodontitis, respectively. The PPV was 41.6% in moderate and 5.7% in severe periodontitis whereas the NPV was high in both categories (moderate=99%; severe=100%). The AUC was 0.91 (95% CI=0.89-0.93). In adults, the prevalence of periodontitis was 99% according to the AAP/EFP. The majority of adults were classified as Stage IV (81.3%) whereas Stage III amounted to 12.8%. By using the CDC/AAP classification, the prevalence of periodontitis in adults was 88.3% and the most common form of periodontitis was moderate periodontitis (57.2%) followed by severe periodontitis (29.7%). In adults, the AAP/EFP revealed high sensitivity for moderate (99.7%) and severe periodontitis (100%), but low specificity for both categories (moderate=6.8%; severe=8.3%). The PPV was 88.7% in moderate and 31.7% in severe periodontitis. The NPV was high in both categories (moderate=76.5%; severe=100%). The AUC was 0.57 (95% CI=0.53-0.62). This study revealed a clear discrepancy in the prevalence of periodontitis between the AAP/EFP and the CDC/AAP classification when using epidemiological data. The 2017 AAP/EFP classification system performs well when compared to the CDC/AAP case definition in identifying adolescents with periodontitis. The AAP/EFP system seems less accurate in adults with high prevalence of periodontitis.

New classification of periodontal diseases (NCPD): an application in a sub-Saharan country

PurposeTo determine the clinical and radiological profile of periodontitis according to the 2018 NCPD, in a Dakar (Senegal) based periodontal clinic.MethodsThis is a descriptive study based on patient’s records in the periodontology clinic. The study was conducted between November 2018 and February 2020 (15 months). All periodontitis cases were included in the study. Incomplete records (due to lack of radiographic workup or unusable periodontal charting) were excluded. Periodontitis diagnosis was established based on criteria used in the 2018 NCPD. Statistical analysis was carried out using SPSS version 20.0, with the significance threshold set at 0.05.ResultsA total number of 517 patient records were collected during the study period but only 127 periodontitis records were complete. The mean age of participants was 46.8 ± 13.8 years and 63.8% of participants were males. The mean plaque index and bleeding on probing (BOP) were 74% ± 21.3 and 58.1% ± 25.1, respectively. The mean maximum clinical attachment loss was 8.7 mm ±2.7, with a probing depth greater than 6 mm present in 50.4% of the sample. The median number of missing teeth was 3 (interquartile range 5–1). Pathological mobility was present in 60.6% of the patients and 78.0% had occlusion problems. Bone crest defect at the most affected site was moderate in 52.8% of cases. The ratio of bone loss to age greater than one concerned 66.1% of the sample. Generalised (81.9%), Stage IV (70.1%) and grade C (69.3%) were the most encountered diagnosis. The disease severity was associated with age (r = 0.241; P < 0.001), BOP (r = 0.230; P = 0.013) and the number of teeth with pathological mobility (r = 0.318; P < 0.001).ConclusionPatients with periodontitis in this study had advanced forms of the disease and required multidisciplinary care. Clinical hindsight is necessary to improve this classification.

Clinical decision-making in the treatment of periodontitis with new classification system of periodontal diseases

Clinical application of the new classification of periodontal diseases requires knowledge of case definitions, parameters, and criteria of different categories and subcategories to arrive at final diagnosis. Correct implementation of the new classification of periodontitis is possible by understanding of the basic rules and guidelines, clarification of complex issues, and use of evidence-based dental practices. Step-wise sequence should be adopted to diagnose a patient with periodontitis. The authors, based on the current scientific evidence and clinical experience, have described specific decision-making algorithms of the diagnostic process and treatment plans of various subcategories of periodontitis.

Interproximal attachment gain: The challenge of periodontal regeneration.

The new classification of periodontal diseases recognizes the key role of the interdental clinical attachment for defining the periodontal status and the extent of disease severity. Regenerating interdental clinical attachment not only improves the prognosis of the tooth, but it also lessens the severity of the disease condition. This manuscript provides a state-of-the-art review on surgical reconstructive approaches for treating papillary deficiency associated with soft and hard tissue interproximal defects. Combination therapy of papilla preservation, connective tissue grafting, and coronally advanced flaps may result in regeneration of the intrabony defect coupled with root coverage. Future research highlighted here may have the potential, especially in combination approaches, to repair challenging interproximal soft and hard tissue deficiencies.

The new classification of periodontal diseases

The new classification of periodontal diseases

Development of a nomogram for the prediction of periodontal tooth loss using the staging and grading system: A long-term cohort study.

To develop and internally validate a nomogram built on a multivariate prediction model including parameters from the new classification of periodontal diseases, able to predict, at baseline, the occurrence of tooth loss due to periodontal reason (TLP). A total of 315 individuals diagnosed with periodontal disease and receiving a minimum of one annual supportive periodontal therapy visit were included in the study. Patients were staged and graded based upon baseline data. The population was divided into a development (254 patients) and a validation (61 patients) cohort to allow subsequent temporal validation of the model. According to the TLP at the 10-year follow-up, patients were categorized as "low tooth loss" (≤ 1 TLP) or "high tooth loss" (≥ 2 TLP). Bootstrap internal validation was performed on the whole data set to calculate an optimism-corrected estimate of performance. The generated nomogram showed a strong predictive capability (AUC=0.81) and good calibration with an intercept=0 and slope=1. These findings were confirmed by internal validation using bootstrapping (average bootstrap AUC=0.83). The clinical implementation of the present nomogram guides the prediction of patients with high risk of disease progression and subsequent tooth loss for personalized care.

Periodontitis with Stage III, Grade C. Case report

Periodontal disease affects patients’ health compromising the shape, function and aesthetics of the entire stomatognathic system, leading to significant deterioration in the quality of life of the patient. Using the actual classification, we will evaluate the stages of disease of the periodontium depending on the severity, complexity of treatment and degrees according to the level of risk that the patient may present with. This clinical case proposes a comprehensive treatment of a 58-year-old male patient with periodontitis accompanied by the new classification of periodontal diseases to make an adequate diagnosis, based on updated scientific evidence. Both clinical and radiological assessments were performed as well as measurements of the depth of periodontal pockets using the WHO periodontal probe. These were recorded in the periodontogram to determine the pathology and staging of disease (Stage III, Grade C according to World Workshop), also taking into account the patient’s tobacco and coffee addiction. The treatment plan consists of different phases: Systemic phase, hygienic phase, corrective phase and maintenance phase. The amount of cigarettes the patient consumed per day affected the treatment, despite the advice about the harmful effects of smoking. However, the depths of periodontal pockets were reduced and the patient’s oral hygiene improved.

Clinical application of the new classification of periodontal diseases: Ground rules, clarifications and "gray zones".

Successful dissemination of the new classification of periodontitis is facilitated by emphasis on the basic ground rules, clarification of ambiguities, and identification of "gray zones" where thoughtful application of the guidelines by an informed, experienced clinician is paramount to arrive at a correct Stage and Grade. Highlighted ground rules are (1) Stage is a patient-based, not a tooth-based concept, therefore, a single Stage is assigned per patient; (2) Stage can shift upward over time, if the periodontal status deteriorates, but the initially assigned Stage is retained even after improvement post-therapy; (3) the complexity factors that determine Stage must be evaluated collectively, not in isolation, to arrive at a clinically meaningful assessment; (4) a single Grade is assigned to a patient based on a deliberate evaluation of the "biological fabric" of the case, in terms of history of/risk for further progression, interplay of risk factors, and the two-way effects of periodontitis or its treatment on general health; (v) shift of Grade over time is possible towards either direction, after thorough, collective, evaluation of changes in the above parameters. Exemplified gray zones include a radiographically intact patient with minimal attachment loss in older age; presence of "frank" periodontitis affecting a single tooth; and assessment of factors that do/do not lead to increased complexity of therapy. Differentiating between Stage I/II versus Stage III/IV periodontitis is relatively uncomplicated; further distinction between Stages and correct assignment of Grade requires nuanced, thorough interpretation of a broad array of findings by a knowledgeable clinician.

The relationship between periodontite and diabetes mellitus type ii facing the new classification of periodontal diseases: literature review

ABSTRACT Periodontal disease and type 2 diabetes mellitus are considered chronic diseases that at their core have a deep relationship with inflammation. It is assumed that there is a bidirectional relationship between periodontal disease and type 2 diabetes mellitus. It is estimated that approximately 10% of the world’s population is affected by periodontal disease, in its most severe form, almost the same percentage estimated for people with diabetes, which is considered a 21st century emergency. The World Workshop for the Classification of Periodontal and Peri-implant Diseases and Conditions took place from September 9-11, 2017. The aim of this study is to analyze the results of this workshop with regard to the relationship between periodontal diseases/conditions and diabetes mellitus, in addition to conducting an integrative review on the topic. A literature review was conducted, using the Medline electronic databases via Pubmed, Scientific Electronic Library Online, Scientific and Technical Literature of Latin America and the Caribbean and Virtual Health Library. A new classification of periodontal disease included tools for individual assessment of the patient and recognizing risk factors that might negatively interfere in response to treatment. The occurrence of metabolic lack of control in periodontal patients with type 2 diabetes mellitus is now considered a factor of great importance for the assessment of individual susceptibility to the progression of periodontitis. Diabetes is believed to promote a hyper inflammatory response to bacterial challenge by modifying the tissue response of periodontal tissues.

Effect of non-surgical periodontal treatment on three salivary adipokines in diabetic patients with periodontitis.

Background. This study investigated the effect of non-surgical periodontal treatment on clinical indices and salivary levels of visfatin, chemerin, and progranulin in diabetic patients with periodontitis. Methods. This interventional clinical trial was performed on 20 patients with type II diabetes mellitus (T2DM) with moderate to severe chronic periodontitis (periodontitis stages II or III according to the new classification of periodontal diseases). Clinical indices, including gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL) and plaque index (PI), were recorded and visfatin, chemerin, and progranulin adipokines levels were also measured in unstimulated saliva by ELISA technique at baseline and twelve weeks after non-surgical periodontal treatment. Results. GI dropped from 1.92±0.27 to 0.71±0.14 after the intervention (P<0.001). Also, there were significant changes in the PPD and PI (P<0.001). However, no significant changes were observed in the CAL (P<0.05). The concentrations of all three salivary adipokines decreased after treatment, but this change was statistically significant only for progranulin (P<0.05). Conclusion. Non-surgical periodontal therapy resulted in improvements in the clinical indices of GI, PPD, and PI in T2DM patients with periodontitis. Moreover, the significant reduction in the salivary level of progranulin after treatment suggests that it might be considered a target inflammatory marker in periodontal diseases.

The new classification of periodontal diseases

The new classification of periodontal diseases

Assessing periodontal health and the british society of periodontology implementation of the new classification of periodontal diseases 2017

Periodontal disease is a highly prevalent, chronic, inflammatory condition which is a major contributor to tooth loss and poor oral health-related quality of life. For the vast majority of patients, the disease is entirely preventable/manageable often aided by input from dental health professionals. As dental health professionals, understanding the periodontal disease process, the risk factors associated with it, standardized ways of detecting, diagnosing and monitoring the disease, along with the special tests needed to aid this process are essential skills for successful disease management. This article summarizes the need for assessing periodontal disease including key aspects of detection, a brief history of periodontal disease classification and the new classification. The paper goes on to discuss the British Society of Periodontology implementation plan of new classification and how this can be utilized for use in general dental practice. CPD/Clinical Relevance: This paper introduces the practitioner to the 2017 Classification of Periodontal Disease along with how this is implemented in general dental practice. The paper provides useful cases for practice as well as flowcharts to aid diagnosis.