Most Recent Re-Classification of Periodontal Diseases (1999)
As demonstrated in the chapter “Forms of Plaque-associated Diseases” (p. 79), new scientific and clinical findings, accumulating long-term experiences as well as the rapid exchange of this knowledge (internet) resulted in the necessity to freshly define the classifications and nomenclature of diseases and clinical “conditions.”
Toward the end of 1999, a workshop in Oak Brook, Illinois, was convened with members of the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP), and the result of this meeting is presented on the following two pages as the original and unabridged illustration of the new classification (Types I-VIII), as published by Armitage (1999) in Annals of Periodontology.
730Periodontal Disease Types—Classification, 1999The new classification of periodontal disease in eight primary groups/types will be depicted on the following two pages, including all subclassifications.
Classification 1999—For and Against
The “old classification” (AAP 1989) described five disease classes. This classification too heavily weighted the patient age at disease onset—e.g., “early onset periodontitis,” EOP and “adult periodontitis,” AP, as well as the course of the disease, e.g., rapidly-progressing (EOP/RPP). It was necessary to change this type of classification because “rapidly progressive periodontitis” (RPP) does not occur only in young patients, and also a chronic periodontitis (AP) in elderly patients with reduced immune function can unexpectedly and quickly evolve into an acute status.
But even the new 1999 classification will only last for a limited period of time: It is too all-inclusive and combines the disease entities that are practice-relevant and most common with those disease entities that are rather quite rare. The 1999 classification is similar in many ways to the extensive catalog provided by the WHO list of diseases, but does not consider the multifactorial character of periodontal diseases (risks!).
This problem has been described thematically in numerous subsequent publications (Van der Velden 2000, Burgermeister & Schlagenhauf 2002, Brunner et al. 2002, DGP 2002, Bengel 2003, Lang 2003).
731Classification—Original Version (AAP 1999)This classification of periodontal diseases has been universally accepted world-wide, and is presented here in its original and unabridged English text version (abbreviated classification, p. 78).Gingival DiseasesThese occur in the periodontal tissues without simultaneous periodontal attachment or bone loss.(Even with periodontitis, one of the primary symptoms is gingival disease.)Plaque-induced Gingival Diseases (A)Above all, plaque-induced gingivitis (type I A) is a ubiquitous disease. It occurs more or less in all oral, periodontal diseases and is easy to treat. Deeper periodontal structures are not affected within this definition.Non Plaque-induced Gingival Lesions (B)Also with these disease processes, an “additional” plaque-induced gingivitis may be present. This is a group of diseases/lesions that are relatively seldom observed. Exceptions: Viral lesions that affect the periodontal tissues as well as the oral mucosa. Treatment may be difficult, with varying success results. In many cases, medical specialists must be called upon, especially in life-threatening forms (e.g., Pemphigus vulgaris; I B 5a 3).732Periodontitis—Types II to VIIIChronic (II) and Aggressive (III) PeriodontitisChronic periodontitis (previously AP) is the most common form of the disease (> 80% of all cases).More aggressive forms (formerly EOP, as PP, LJP, RPP are rare).In addition to the pathobiologic form (p. 96), the pathomorphologic expanse (p. 98) and the localization of the attachment loss must be considered:** Localized/GeneralizedIn a case with less than 30% involvement of all sites, the case is categorized as localized.More serious and expansive involvement is categorized as generalized.** Degree of SeverityClinical attachment loss (CAL) is described as follows:– “slight” up to 2 mm– “moderate” 3–4 mm– “severe” 5+ mm** In addition to the globally accepted AAP-Classification (1999), one must also consider the degree of severity (CAL) alone and with the corresponding prospective therapeutic involvement, as described in the ADA/AAP classification of “case patterns” or “case types” (American Dental Association):ADA—“Case Types”• Grade Severity EvaluationIGingivitis – 3 degrees of severityIIEarly periodontitisIIIModerate periodontitisIVAdvanced periodontitis
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