Applying the NEW Periodontal Classification

Table of Contents

This is a systematic method to classify periodontitis based on severity, complexity, risk, and progression by the AAP
The notes below do not reflect the AAP’s views- these are notes generated by Odontome based on the document.

Identify Interdental Clinical Attachment Loss (CAL):
- ≥2 non-adjacent teeth with CAL ≥1 mm.
Confirm Radiographic Bone Loss (RBL):
- Correlate with CAL to confirm diagnosis.
Rule Out Non-Periodontal Causes:
- Examples: Trauma, gingival recession, root fractures, or dental caries.

Base on Severity:
- Key Measures:
  - Interdental CAL
  - RBL percentage
  - Tooth loss due to periodontitis
Assess Complexity:
- Consider probing depths, bone defects, furcation involvement, and restorative needs.
Stages Summary:
- Stage I: Initial (1-2 mm CAL, RBL <15%)
- Stage II: Moderate (3-4 mm CAL, RBL 15-33%)
- Stage III: Severe with potential for tooth loss (≥5 mm CAL, RBL mid-third or beyond)
- Stage IV: Advanced with significant rehabilitation needs (≥5 mm CAL, RBL mid-third or beyond, ≥5 teeth lost).

Assess Rate of Progression:
- Use direct evidence of progression (e.g., bone loss/CAL over time).
- Use indirect evidence (e.g., bone loss to age ratio).
Consider Risk Factors:
- Smoking and diabetes are the main systemic modifiers.
Grades Summary:
- Grade A: Slow progression (no CAL or RBL over 5 years, low systemic risk).
- Grade B: Moderate progression (≤2 mm CAL or RBL over 5 years, moderate risk factors).
- Grade C: Rapid progression (>2 mm CAL or RBL over 5 years, heavy smoking, or poorly controlled diabetes).

Patient Data Collection:
- Interdental CAL: 5 mm
- RBL: Extends to mid-third of root
- Tooth loss: 3 teeth
- Risk factors: Smokes 15 cigarettes/day
- HbA1c: 8.5%
Stage: Stage III (based on severity and complexity).
Grade: Grade C (based on smoking and HbA1c levels).

Systemic Health Integration:
- Grading considers both local and systemic factors.
Reassess Regularly: Changes in clinical condition may require stage/grade updates.
Simplify Patient Communication:
- Use staging and grading to explain disease severity and progression risk.

Radiographic Bone Loss (RBL) Calculation is critical to staging periodontitis. Here’s how to determine RBL:

Identify the Total Root Length:
- Measure from the cementoenamel junction (CEJ) to the root apex on a radiograph.
Determine the Extent of Bone Loss:
- Measure the distance from the CEJ to the current bone level on the radiograph. Focus on the worst-affected site.
Calculate the Percentage of Bone Loss:
- Use the formula

Total Root Length (CEJ to Apex): 13 mm
Bone Loss (CEJ to Bone Level): 7 mm
RBL=(7/13)×100=54%
Stage: Based on this RBL, the patient would be Stage III or IV (≥33% bone loss).