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Staging and grading of periodontitis: Framework and proposal of a new classification and case definition
dc.contributor.authorTonetti, Maurizio S.
dc.contributor.authorGreenwell, Henry
dc.contributor.authorKornman, Kenneth S.
dc.date.accessioned2018-07-13T15:48:39Z
dc.date.available2019-08-01T19:53:24Zen
dc.date.issued2018-06
dc.identifier.citationTonetti, Maurizio S.; Greenwell, Henry; Kornman, Kenneth S. (2018). "Staging and grading of periodontitis: Framework and proposal of a new classification and case definition." Journal of Periodontology 89: S159-S172.
dc.identifier.issn0022-3492
dc.identifier.issn1943-3670
dc.identifier.urihttps://hdl.handle.net/2027.42/144705
dc.description.abstractBackgroundAuthors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state‐of‐the‐art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance.MethodsEvidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis.ResultsThe manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis‐associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A‐C). Risk factor analysis is used as grade modifier.ConclusionsThe paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.
dc.publisherWiley Periodicals, Inc.
dc.publisherAmerican Academy of Periodontology
dc.subject.othergrade A periodontitis
dc.subject.othergrade B periodontitis
dc.subject.othergrade C periodontitis
dc.subject.otherinflammatory burden
dc.subject.otherinfrabony defect
dc.subject.othermasticatory dysfunction
dc.subject.othernecrotizing periodontitis
dc.subject.otherperiodontal pocket
dc.subject.otherperiodontitis
dc.subject.otherperiodontitis as manifestation of systemic disease
dc.subject.otherperiodontitis/grade
dc.subject.otherperiodontitis/stage
dc.subject.otherradiographic bone loss
dc.subject.otherrisk factors
dc.subject.otherstage I periodontitis
dc.subject.otherstage II periodontitis
dc.subject.otherstage III periodontitis
dc.subject.otherstage IV periodontitis
dc.subject.otherstandard of care
dc.subject.othertooth hypermobility
dc.subject.othertooth loss
dc.subject.otherclinical attachment loss
dc.subject.otheraggressive periodontitis
dc.subject.otherbiomarkers
dc.subject.othercase definition
dc.subject.otherchronic periodontitis
dc.subject.otherclassification
dc.subject.otherdiagnosis
dc.subject.otherfurcation involvement
dc.titleStaging and grading of periodontitis: Framework and proposal of a new classification and case definition
dc.typeArticleen_US
dc.rights.robotsIndexNoFollow
dc.subject.hlbsecondlevelDentistry
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Reviewed
dc.description.bitstreamurlhttps://deepblue.lib.umich.edu/bitstream/2027.42/144705/1/jper10116.pdf
dc.description.bitstreamurlhttps://deepblue.lib.umich.edu/bitstream/2027.42/144705/2/jper10116_am.pdf
dc.identifier.doi10.1002/JPER.18-0006
dc.identifier.sourceJournal of Periodontology
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dc.owningcollnameInterdisciplinary and Peer-Reviewed


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