Staging and grading of periodontitis: Framework and proposal of a new classification and case definition
Open accessAbstract
Background: Authors 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. Methods: Evidence 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. Results: The 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. Conclusions: The 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.
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- Authors
- Tonetti, M. S., Greenwell, H., & Kornman, K. S.
- Affiliations
- University of Hong Kong (HK)
- University of Louisville (US)
- University of Michigan (US)
- Corresponding author
- Tonetti, Maurizio S.
- Venue
- Journal of Clinical Periodontology
- Publisher
- Wiley
- Published
- 2018-06
- Volume
- 45
- Issue
- S20
- Pages
- S149-S161
- ISSN
- 0303-6979 (ISSN-L)
- 1600-051X
- OpenAlex
- W4230233764
- Cited by
- 1,033
- References
- 66
- Citations by year
- 2026: 117 · 2025: 118 · 2024: 135 · 2023: 164 · 2022: 128 · 2021: 155 · 2020: 133 · 2019: 67 · 2018: 11
- FWCI
- 13.56
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-06-17)
- Open access
- bronze
- doi.org
- Locations
- Journal Of Clinical Periodontology (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- Procter and Gamble
- Unilever
- Osteology Foundation
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
- Health Sciences › Dentistry › Oral Surgery › Dental Implant Techniques and Outcomes
- Keywords
- periodontitis, case definition, periodontal disease classification, disease severity, disease progression rate, risk factors, furcation involvement, intrabony defects, tooth loss, masticatory dysfunction, precision medicine, biomarkers, disease surveillance
- MeSH terms
- Humans, Periodontitis, Risk Factors, Tooth Loss
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