Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions
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Background: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non‐carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. Methods: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. Results: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon‐Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm‐induced inflammation (such as neoplastic diseases); 2) diabetes‐associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking – now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues – is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non‐carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm‐induced gingival inflammation and loss of periodontal supporting tissues. Conclusion: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
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Traumatic occlusal forces can result in occlusal trauma (the lesion) and excessive wear or fracture of the teeth.
“Traumatic occlusal forces can result in occlusal trauma (the lesion) and excessive wear or fracture of the teeth.21”
From A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification (2018) · cites this paper as [21]
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- Authors
- Jepsen, S., Caton, J. G., Albandar, J. M., Bissada, N. F., Bouchard, P., Cortellini, P., Demirel, K., de Sanctis, M., Ercoli, C., Fan, J., Geurs, N. C., Hughes, F. J., Jin, L., Kantarci, A., Lalla, E., Madianos, P. N., Matthews, D., McGuire, M. K., Mills, M. P., Preshaw, P. M., Reynolds, M. A., Sculean, A., Susin, C., West, N. X., & Yamazaki, K.
- Affiliations
- University of Bonn (DE)
- University of Rochester Medicine (US)
- Temple University (US)
- Case Western Reserve University (US)
- Hôpital Rothschild (FR)
- Private practice, Firenze, Italy; European Research Group on Periodontology Bern Switzerland
- Istanbul University (TR)
- Department of Periodontology Università Vita e Salute San Raffaele Milan Italy
- University of Alabama at Birmingham (US)
- King's College London (GB)
- Prince Philip Dental Hospital (CN)
- Forsyth Institute Cambridge MA USA
- Columbia University Irving Medical Center (US)
- National and Kapodistrian University of Athens (GR)
- Dalhousie University (CA)
- Perio Health Professionals (US)
- The University of Texas at San Antonio Health Science Center (US)
- Newcastle University (GB)
- University of Maryland, Baltimore (US)
- University of Bern (CH)
- Augusta University (US)
- University Of Bristol Dental Hospital (GB)
- Niigata University (JP)
- Corresponding author
- Jepsen, Søren
- ORCID
- Jepsen, Søren
- Caton, Jack G.
- Albandar, Jasim M.
- Bouchard, Philippe
- Cortellini, Pierpaolo
- Demirel, Korkud
- Ercoli, Carlo
- Fan, Jingyuan
- Geurs, Nicolaas C.
- Hughes, Francis J.
- Lalla, Evanthia
- Madianos, Phoebus N.
- Matthews, Debora
- Preshaw, Philip M.
- Reynolds, Mark A.
- Sculean, Anton
- Susin, Cristiano
- West, Nicola X.
- Yamazaki, Kazuhisa
- Venue
- Journal of Periodontology
- Publisher
- Wiley
- Published
- 2018-06
- Volume
- 89
- Issue
- S1
- Pages
- S237-S248
- ISSN
- 0022-3492 (ISSN-L)
- 1943-3670
- OpenAlex
- W2809600205
- Cited by
- 602
- References
- 43
- Citations by year
- 2026: 49 · 2025: 106 · 2024: 75 · 2023: 97 · 2022: 99 · 2021: 77 · 2020: 54 · 2019: 31 · 2018: 10 · 2014: 1 · 2012: 1
- FWCI
- 49.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Periodontology (publishedVersion)
- PubMed (publishedVersion)
- BORIS (University Library Bern) (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Discovery Research Portal (University of Dundee) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Funders
- American Academy of Periodontology Foundation
- Colgate-Palmolive Company
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Health Professions › Pharmacy › Oral and gingival health research
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Keywords
- periodontal disease, systemic disease, periodontitis, gingival recession, occlusal trauma, prosthodontics, diabetes mellitus, smoking, Papillon-Lefèvre syndrome, non-carious cervical lesions, gingival phenotype, case definition, periodontal attachment loss, periodontal classification, cancer
- MeSH terms
- Esthetics, Dental, Gingivitis, Humans, Periodontal Diseases, Periodontitis, Peri-Implantitis
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