Steps for Determining a Diagnosis of Periodontitis

A simple 4-step process has been suggested by Kornman and Papapanou¹⁹ to assist clinicians in developing a diagnosis for each individual case using the new classification.

Step 1 - Case Overview

• Examine full mouth radiographs

• Examine full mouth probing depths

• Document number of missing teeth

This will help to first determine whether the case is: Mild/Moderate or Severe/Very Severe

Step 2 - Determine Stage

• Determine maximum Clinical Attachment Loss (CAL) or Radiographic Bone Loss (RBL)

• Confirm pattern of bone loss (horizontal or vertical)

• Determine number of missing teeth due to periodontitis

• Determine complexity of case (i.e., probing depths, furcations, occlusion/function, need for extensive rehabilitation, etc.)

• Decision made using Table 9

Step 3 - Determine Grade

• Always start with the default Grade of B

• Consider history/rate of progression/age

• Response to previous therapy (Plaque control/SRP)

• Medical history/systemic conditions

• Risk factors

• Adjust default Grade using Table 10

Examples:

Stage 1 Grade B

Stage 1 Grade B

Image Courtesy of Dr. C. Cobb.

Staging

PD = ≤ 4 mm

BOP = Yes

RBL < 15% & generally horizontal

CAL 1-2 mm

Biofilm = Slight–Heavy

Grading

No tooth loss due to periodontitis

Moderate Rate of Progression

Non-Smoker

Non-Diabetic

Stage 2 Grade B

Stage 2 Grade B

Image Courtesy of Dr. C. Cobb.

Staging

PD ≤ 5 mm

BOP = Yes

RBL = 15% - 33% / mostly horizontal

CAL 3-4 mm

Biofilm = Slight–Heavy

Grading

No tooth loss due to periodontitis

Moderate Rate of Progression

Smoker <10 cigs per day

If Diabetic HbA1c <7.0%

Stage 3 Grade B

Stage 3 Grade B

Image Courtesy of Dr. C. Cobb.

Staging

PD ≥ 6 mm

BOP = Yes

RBL = Horizontal ≥ 50% / Vertical ≥ 3 mm

CAL ≥ 5 mm

Biofilm = Slight–Heavy

Grading

Tooth loss due to periodontitis ≤ 4 teeth

Moderate Rate of Progression

Furcation Involvement = Class II or III

If Smoker <10 cigs per day

If Diabetic HbA1c <7.0%

Moderate ridge defect

Stage 4 Grade C

Stage 4 Grade C

Image Courtesy of Dr. C. Cobb.

Staging

PD ≥ 6 mm

BOP = Yes

RBL = Horizontal ≥ 50% / Vertical ≥ 3 mm

CAL ≥ 5 mm

Biofilm = Slight–Heavy

Grading

Tooth loss due to periodontitis ≥ 5 teeth

Furcation Involvement = Class II or III

Moderate ridge defect

Need for complex rehabilitation

Bone loss exceeds expectations given biofilm

Rapid Rate of Progression

Smoker >10 cigs per day

If Diabetic HbA1c >7.0%

Please note: These examples do not include categorization of the extent of disease, thus keep in mind that localized would be any case that had less than 30% of teeth involved, while generalized would be more than 30% of teeth involved.