Brought to you by

Continuing Education

Classification of Periodontal and Periimplant Diseases and Conditions
Course Author(s):Marianne Dryer, RDH, Med
CE Credits: 2.5 hours
Intended Audience: Dentists, Dental Hygienists, Dental
Students, Dental Hygiene Students, Dental Assistants, Dental
Assisting Students, Dental Educators, Office Managers
Date Course Online: 07/15/2024
Last Revision Date: NA
Course Expiration Date: 07/14/2027
Cost: FreeMethod: Self-instructional
AGD Subject Code(s): 490,690
Online Course: www.dentalcare.com/en-us/ce-courses/ce681
Disclaimers:• P&G is providing these resource materials to dental professionals. We do not own this content nor are we responsible for any material herein.
• Participants must always be aware of the hazards of using limited knowledge in integrating new techniques or procedures into their practice.
Only sound evidence-based dentistry should be used in patient therapy.

Conflict of Interest Disclosure Statement• Ms. Dryer reports no conflicts of interest associated with this course. She has no relevant
financial relationships to disclose.
Short Description
This course will examine the concepts of staging and grading to classify each patient by complexityof case management, likelihood of less predictable response to therapy, and potential for
periodontitis development.

1Crest® + Oral-B® at dentalcare.com

Course Contents••••••Overview
Learning Objectives
Video: Classification of Periodontal and Peri-implant Diseases and Conditions
Course Test
References / Additional Resources
About the Author

Overview

The updated American Academy of Periodontology (AAP) classification system represents a multidimensional staging and grading framework for periodontitis and implant disease status. This course willexamine the concepts of staging and grading to classify each patient by complexity of case management,
likelihood of less predictable response to therapy and potential for periodontitis development.
The systemic connection as it relates to the grading portion of the classification system will be examined
and its relationship to oral health/periodontal disease. Diagnosing, treatment planning and executing
appropriate and necessary periodontal therapies will be reviewed utilizing case presentations. The
need to have specific homecare recommendations according to the patient’s oral health status will be
discussed which brings opportunities for more case specific patient care. The need for calibration andclinician alignment with the new classification system will be discussed along with narrative examples for
documentation recommendations.

Learning Objectives

Upon completion of this course, the dental professional should be able to:• Discuss staging/grading for periodontal disease and its evolution.
• Create evidence-based protocols for specific types of periodontal diseases according to the newclassification system.
• Identify patients who may benefit from adjunctive strategies of disease management and overall
reduction of bioburden.
• Illustrate the impact of acid on tooth wear and its amplification of tooth loss.
• Develop individualized homecare regimens utilizing staging and grading to motivate and encourage
patients to improve their oral health.

Video: Classification of Periodontal and Peri-implant Diseases and Conditions

Click on image to view video online.

2
Crest® + Oral-B® at dentalcare.com

Course Test Preview

To receive Continuing Education credit for this course, you must complete the online test. Please
go to: www.dentalcare.com/en-us/ce-courses/ce681/test
1. Which was NOT included as part of the 2018 AAP Classifications update?
A. A recategorization of various forms of periodontitis
B. The development of a novel staging and grading system for periodontitis
C. An inaugural classification for peri-implant diseases and conditions
D. Differentiation of CDT codes to align with the new system
2. The new classification, which introduces the concept of Staging, supports amultidimensional view of periodontitis. Which is NOT incorporated in Staging?
A. Severity of the interdental bone loss
B. Number of carious lesions
C. Complexity of management of the patient’s periodontal condition
D. Tooth loss due to periodontitis
3. Grading incorporates the presence and control of risk factors such as smoking anddiabetes. Direct or indirect evidence of bone loss clinically and/or radiographically is also
incorporated into grading decisions.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, and the second is false.
D. The first statement is false, and the second is true.
4. When evaluating radiographs, the height of the bone apical to the CEJ in health andgingivitis is considered up to this amount?
A. 0 mm
B. 0.5 mm
C. 1.0 mm
D. 2.0 mm

3Crest® + Oral-B® at dentalcare.com

5. Which of the following is true when using code D4346?
A. Is used in the presence of clinical attachment loss.
B. It can be used for any age.
C. It can be reported the same day as 1110 code.
D. It can be split into 2 appointments.
6. A patient classified as a Generalized Periodontitis Stage IV, Grade C would likely present
with the following periodontal characteristics:
A. CAL; 2mm, no teeth loss to perio, non-smoker
B. CAL 6-7 mm, 5 teeth loss to perio, smokes 2 packs of cigarettes a day
C. CAL; 3-4 mm, no teeth loss to perio, controlled type 2 diabetic
D. CAL; 1 mm, one tooth lost to periodontal disease, non-smoker
7. Which of the following is NOT associated with the new Staging and Grading system?
A. Clarify extent, severity, and complexity of the patient’s condition
B. Define potential rate of disease progression
C. Predict response to standard therapies
D. Eliminate the need for periodontal risk assessment
8. Which is NOT an effect of stannous fluoride on the soft tissue?
A. inhibits plaque growth
B. targets pathogenic red complex bacteria
C. suppresses pathogen virulence
D. increase metabolic production of bacteria
9. Which best describes the role of stannous fluoride in sensitivity relief?
A. depolarizes the nerve
B. occludes dentinal tubules
C. repairs exposed dentin
D. numbs the tooth

4
Crest® + Oral-B® at dentalcare.com

10. In order to Stage a periodontal patient, there needs to be evidence of clinical attachment
loss as a result of which of the following?
A. periodontal abscess
B. mucogingival deformities
C. bacterial inflammation
D. traumatic occlusive forces
11. According to the 2018 classification of peri-implant disease, when a dental implant has
inflammation with no attachment loss, this would be considered?
A. peri-implant gingivitis
B. peri-implant mucositis
C. peri-implantitis
D. peri-implant soft tissue deficiency
12. Which best describes the range of bone loss in Stage II periodontal disease?
A. <15%
B. 15-33%
C. 15-50%
D. > 50%
13. Which is NOT used to differentiate Stage III and Stage IV periodontal disease?
A. Interdental CAL > 5mm
B. Tooth loss due to periodontal disease >5
C. Flaring ridge defects
D. Bite collapse
14. When evaluating a new patient it is best to use which type of evidence to determine theirGrade?
A. direct
B. indirect
C. self reported
D. % bleeding sites

5Crest® + Oral-B® at dentalcare.com

15. What is the CAL (clinical attachment level) for a patient that has a 4mm probing on the
direct buccal of #19 with 2mm of recession.
A. 2mm
B. 4mm
C. 6mmD. cannot determine given the information
16. When evaluating indirect evidence in regard to case phenotype. A patient with heavyplaque, heavy calculus biofilm, but low levels of destruction would fall into whichGrade?
A. Grade A
B. Grade B
C. Grade C
D. Grade D
17. When Staging a patient, it is important to consider which of the following?
A. area of greatest destruction
B. recession
C. smoking
D. mobility
18. Bleeding on probing is the primary parameter to set thresholds for gingivitis. If a patientpresents with less than 10% bleeding sites, they are considered to have incipient
gingivitis.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, and the second is false.
D. The first statement is false, and the second is true.

6Crest® + Oral-B® at dentalcare.com

References

1. Albandar JM, Susin C, Hughes FJ. Manifestations of systemic diseases and conditions that affectthe periodontal attachment apparatus: case definitions and diagnostic considerations. J Clin
Periodontol. 2018;45(Suppl 20):S171–S189.
2. Araujo MG, Lindhe J. Peri-implant health. J Periodontol. 2018;89(Suppl 1):S249–S256.
3. Armitage GC. Development of a classification system for periodontal diseases and conditions. AnnPeriodontol. 1999 Dec;4(1):1-6. doi: 10.1902/annals.1999.4.1.1. PMID: 10863370.
4. Biesbrock, A et al. The Effects of Bioavailable Gluconate Chelated Stannous. Fluoride Dentifrice on
Gingival Bleeding: Meta-Analysis of Eighteen Randomized Controlled Trials. J Clin Periodontal, 2019
5. Caton JG. A new classification scheme for periodontal and peri-implant diseases and conditionsintroductions and key changes from the 1999 classification. J Periodontol. 2018; 89 (Suppl 1):S1–S8.
6. Cortellini P, Bissada NF. Mucogingival conditions in the natural dentition: narrative review, casedefinitions, and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S204–S213.
7. Drisko CL. Periodontal debridement: Still the treatment of choice. J Evid Base Dent Pract 2014; I
4S:33-41.
8. Fine DH, Patil AG, Loos BG. Classification and diagnosis of aggressive periodontitis. J Periodontol.
2018;89(Suppl 1):S103–S119.
9. Fan J, Caton JG. Occlusal trauma and excessive occlusal forces: narrative review, case definitions,and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S214–S222.
10. Giannobile WV, Kornman KS, Williams RC. Personalized medicine enters dentistry: what might
this mean for clinical practice? J Am Dent Assoc. 2013 Aug;144(8):874-6. doi: 10.14219/jada.
archive.2013.0200. PMID: 23904569.
11. Grender J, Ram Goyal C, Qaqish J, Adam R. An 8-week randomized controlled trial comparing
the effect of a novel oscillating-rotating toothbrush versus a manual toothbrush on plaque andgingivitis. Int Dent J. 2020 Apr;70 Suppl 1(Suppl 1):S7-S15. doi: 10.1111/idj.12571. PMID: 32243573;
PMCID: PMC9379164.
12. Heitz-Mayfield LJA, Lang NP. Surgical and nonsurgical periodontal therapy. Learned and unlearned
concepts. Periodontology 2000 2013; 62:218-231.
13. He T, Huang S, Yue F, Wang L, Liu J, Xu J. A randomized, controlled comparison of a stannouscontaining dentifrice for reducing gingival bleeding and balancing the oral microbiome relative to a
positive control. Am J Dent. 2021 Aug;34(4):222-227. PMID: 34370916.
14. Jepsen S, Caton JG, Albandar JM, et al. Periodontal manifestations of systemic diseases anddevelopmental and acquired conditions: consensus report of workgroup 3 of the 2017 WorldWorkshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J
Periodontol. 2018;89(Suppl 1):S237–S248.
15. Klukowska M, Haught JC, Xie S, Circello B, Tansky CS, Khambe D, Huggins T, White DJ. ClinicalEffects of Stabilized Stannous Fluoride Dentifrice in Reducing Plaque Microbial Virulence I:
Microbiological and Receptor Cell Findings. J Clin Dent. 2017 Jun;28(2):16-26. PMID: 28657701.
16. Kruse, A.B.; Schlueter, N.; Kortmann, V.K.; Frese, C.; Anderson, A.; Wittmer, A.; Hellwig, E.; Vach,K.; Al-Ahmad, A. Long-Term Use of Oral Hygiene Products Containing Stannous and Fluoride Ions:
Effect on Viable Salivary Bacteria. Antibiotics 2021, 10, 481.
17. Murakami S et al. Dental plaque-induced gingival conditions. J Periodontol. 2018;89 (Suppl 1):S17–
S27.
18. Papapanou PN, Sanz M, Buduneli N, et al. Periodontitis: consensus report of workgroup 2 ofthe 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases andConditions. J Periodontol. 2018;89(Suppl 1):S173–S182.
19. Renvert S et al. Peri-implant health, peri-implant mucositis, and peri-implantitis: case definitions
and disgnostic considerations. J Periodontol. 2018;89(Suppl 1):S304–S312.
20. Sbricoli L, Schiavon L, Brunello G, Brun P, Becker K, Sivolella S. Efficacy of different mouthwashes
against COVID-19: A systematic review and network meta-analysis. Jpn Dent Sci Rev. 2023
Dec;59:334-356. doi: 10.1016/j.jdsr.2023.09.003. Epub 2023 Oct 11. PMID: 37854066; PMCID:PMC10579871.
21. Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Periodontol. 2018;89(Suppl 1):S267–S290.

7
Crest® + Oral-B® at dentalcare.com

22. Smiley CJ, Tracy SL, Abt E, Michalowicz BS et al. Evidence-based clinical practice guideline on thenonsurgical treatment of chronic periodontitis by means of scaling and root planning with ourwithout adjuncts. J Am Dent Assoc 2015; 146(&): 525-535.
23. Sorsa et al. Oral Dis 2004, Sorsa et al. Ann Med 2006, Tuomainen et al. ATVB 2007, Reinhardt et al.
J Periodontol 2010.
24. Starke EM, Mwatha A, Ward M, et al. A Comparison of the Effects of a Powered and Manual
Toothbrush on Gingivitis and Plaque: A Randomized Parallel Clinical Trial. J Clin Dent. 2019;30(SpecNo A):A24-A29.
25. Stefan RG et al. Perimplant health, perimplant mucositis, and periimplantitis: Case definitions anddiagnostic considerations, J Periodontol 2018 ; 89, S1, (S304-S312).
26. Suvan JE. Effectiveness of mechanical nonsurgical pocket therapy. Periodontology 2000 2005;
37:48-71.
27. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework andproposal of a new classification and case definition. Periodontol. 2018;89(Suppl 1):S159–S172.
28. Yaacob M, Worthington HV, Deacon SA, Deery C, Walmsley AD, Robinson PG, Glenny AM.
Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014
Jun 17;2014(6):CD002281. doi: 10.1002/14651858.CD002281.pub3. PMID: 24934383; PMCID:PMC7133541.
Additional Resources• 2017 Classification of Periodontal and Peri-implant Diseases and Conditions• ADA - Evidence-based databases• ADA. Policy on Evidence-Based Dentistry• Bonebox Lite Anatomy APP• AAP -2017 Classification of Periodontal and Peri-implant Diseases and Conditions
Codeology• IFDH Oral Hygiene Instruction Practices Survey• 2017 World Workshop on Disease Classification - FAQs
• Waterpik Risk Based Periodontal Therapy• Clinical Applications for the 2018 Classification of Peri-implant Diseases and Conditions• Journal of Periodontology: Volume 89, Issue S1• American Academy of Periodontology - Staging and Grading Periodontitis PDF• Point-of-Care Periodontitis Testing: Biomarkers, Current Technologies, and Perspectives

About the Author
Marianne Dryer, RDH, MedMarianne Dryer is a dynamic speaker, educator and corporate consultant incurriculum development. She has lectured nationally and internationally onperiodontal instrumentation with a focus on ultrasonic technique, risk assessment,infection prevention and radiology technique. Marianne’s experience in dentistryspans over 30 years. She is a graduate of Forsyth School for Dental Hygienists,Old Dominion University and received her Master’s in Education from St Joseph’s
College of Maine. Marianne was the first year coordinator at Collin College inDallas Texas for six years where she was selected for the Outstanding FacultyAward and was nominated for the Advisor of the Year. She has been a faculty
member at Cape Cod Community College since 2007, and Program Director since 2019. She has beena strong advocate for introducing ultrasonic instrumentation into dental hygiene curriculums earlier
and with more structured, foundational content.
Email: mdryer@capecod.edu8Crest® + Oral-B® at dentalcare.com