Comparison of Two Different Periodontal Classification
Condition: Periodontal Diseases
MeSH terms: Periodontal Diseases
Study type: Observational

Summary: 
      Due to some deficiencies in the classification defined by Armitage in 1999, a new periodontal
      classification was published in 2018. New periodontitis A staging and grading system was used
      for classification. Staging depends largely on the severity of the disease, while grading is
      based on the rate of disease progression to the past. It provides additional information on a
      risk-based analysis and assessment of risk.The aim of this study is to reveal the differences
      between the old periodontal classification and the new periodontal disease classification
      published in 2018. Periodontitis in the literature review. The two classifications were
      compared in patients. However, a study on gingival recession not done. Anamnesis, routine
      periodontal indices, routine radiographs of 300 patients, first of all According to the 1999
      Periodontal Disease Classification, after it will be classified according to the New
      Periodontal Disease Classification developed in 2018. Thus, two different Periodontal Disease
      Classifications, old and new, comparison will be made.
    

Detailed description: 
      In the 1999 periodontal disease classification, the diagnosis of chronic and aggressive
      periodontitis was subdivided into localized and generalized. Chronic periodontitis is an
      inflammatory disease of supporting tissues followed by pocket formation, gingival recession,
      periodontal ligament, alveolar bone and attachment loss. Aggressive periodontitis is
      characterized by rapid periodontal attachment loss and alveolar bone loss in which the
      patient is systemically healthy, inherited, and the presence of Aggregatibacter
      Actynomyecetemcomitans in diseased areas.

      Due to some deficiencies in the classification defined by Armitage1 in 1999, the need for a
      new periodontal classification emerged in 2018. These shortcomings are;

      1. There is no specific evidence of pathophysiology that differentiates cases into
      "aggressive" or "chronic" periodontitis or guides different types of treatment.

      2 There is little evidence that aggressive and chronic periodontitis are different diseases.
      However, there is evidence that multiple factors and their interactions influence clinically
      observable disease outcomes (phenotypes) at the individual level.

      3. On a population basis, average rates of periodontitis progression are consistent across
      all populations observed worldwide. However, there is evidence that certain segments of the
      population exhibit different levels of disease progression.

      4. A classification system based solely on disease severity; It fails to capture important
      dimensions of an individual's disease, such as the complexity of treatment approaches and the
      risk factors that affect disease outcomes.

      For this reason, a new periodontal classification was published in 2018.2 The staging and
      grading system was used in the new periodontitis classification. Staging largely depends on
      the severity of the disease at presentation and the complexity of disease management. Staging
      consists of four categories (stages 1 to 4) and is determined by considering various
      variables such as clinical attachment loss, amount and percentage of bone loss, probing
      depth, presence and extent of angular bone defects, and furcation involvement, tooth
      mobility, and tooth loss. Grading, on the other hand, provides additional information about a
      historical analysis of the rate of disease progression, further progression of the biological
      characteristics of the disease, including an assessment of risk, the expected poor outcome of
      treatment, and the assessment of the risk that the disease or its treatment may adversely
      affect the patient's overall health.

      The Miller3 classification used for gingival recession is based on the position of the
      marginal gingiva3. In the new classification, the classification of gingival recessions has
      also been updated. Recent case definitions for the treatment of gingival recession are based
      on interproximal loss of clinical attachment and also include assessment of exposed root and
      enamel-cementum margin. A new classification of gingival recession, including clinical
      parameters, has added the gingival phenotype as well as the features of the exposed root
      surface. The term periodontal biotype has been replaced by periodontal phenotype.

      The aim of this study is to reveal the differences between the old periodontal classification
      and the new periodontal disease classification published in 2018. In the literature4 review,
      two classifications were compared in patients with periodontitis. However, no research has
      been conducted on gingival recessions. Our aim is to compare the cases of gingivitis,
      periodontitis and gingival recession according to two different classifications.

      Anamnesis of all patients who applied to KSBU Faculty of Dentistry, Department of
      Periodontology, routine periodontal indices and routine radiographs are taken. This index of
      all patients and Radiographs are used in the diagnosis and classification of periodontal
      diseases. disease Classification is important for guiding treatment. For this reason, all
      patients Classification is routinely done. This study was conducted for periodontal surgery
      after pre-examination.

      300 patients with indications will be included. Routine periodontal surgery from these
      patients, like other patients, indexes and radiographs will be taken. Comparison of the two
      classifications these indexes and radiographs will be made through By examining the indices
      and radiographs taken from the patients, the patients were first It will be classified
      according to the old Periodontal Disease Classification. The same indexes and New
      Classification of Periodontal Diseases developed in 2018 using radiographs will be
      determined. Thus, two different Periodontal Disease Classifications, old and new, comparison
      will be made.

      Routine indexes used:

        -  Plaque index (Löe & Silness) and gingival index (Silness & Löe) are obtained by
           measuring 4 regions of a tooth (mesial, distal, buccal and lingual) with Williams
           periodontal probe.

        -  Attachment loss: The distance between a tooth and the free gingiva based on the
           enamel-cementum boundary is measured using a Williams periodontal probe.

        -  Bleeding index on probing (Ainamo & Bay): In this index, probing is performed by gently
           walking around the pocket. As a result of probing, the evaluation is made by looking at
           the presence or absence of bleeding in the gingiva. A positive value is given if
           bleeding occurs within 10-15 seconds after probing in the mesial, distal, buccal and
           lingual parts of all teeth. The ratio of the bleeding area to the examined area is
           expressed as %.

        -  Keratinized gingival width: It is the distance from the free gingival margin to the
           mucogingival junction line.

        -  Pocket depth: It is the vertical distance between the base of the periodontal sulcus and
           the gingival margin with a standard periodontal probe measured.

        -  Peri-implant pocket depth: The vertical distance between the base of the peri-implant
           sulcus and the gingival margin

        -  Presence of diabetes: It is questioned whether the patient has diabetes or not.

        -  Smoking: Whether the patient smokes or not, and if so, the amount is questioned.

        -  Gingival recession: It is the apical migration of the marginal gingiva from the
           enamel-cementum junction. It can be evaluated clinically by measuring the distance in mm
           between the enamel-cementum junction (MSB) and the gingival gingival margin.

        -  Chronic Periodontitis: It is the presence of interdental clinical attachment loss in
           more than 2 non-adjacent teeth, or a pocket depth ≥3 mm in the buccal or oral region in
           more than 2 teeth, in addition to clinical attachment loss ≥3 mm.

        -  Localized Aggressive Periodontitis: Attachment loss is observed in the proximal regions
           of the first molar and incisors. Loss of proximal attachment is observed in at least 2
           permanent teeth, one of which is the first molar. More than two teeth should be
           unaffected except for the molars and incisors.

        -  Generalized Aggressive Periodontitis: 1. At least 3 more teeth are affected except
           molars and incisors.

      Routine radiographs used:

        -  Panoramic Radiography: X-ray imaging that allows the evaluation of the lower and upper
           jaws and all teeth on the same film. It is routinely taken from all patients for the
           diagnosis of periodontal disease.

        -  Periapical Radiography: It is an X-ray imaging that provides a more detailed examination
           of one or several adjacent teeth. It is routinely taken from all patients for the
           diagnosis of periodontal disease.

      Periodontal disease classification of patients is made by determining the number of missing
      teeth, type of bone destruction and the tooth with the highest bone loss on panoramic and
      periapical radiographs, and calculating the bone loss/age ratio of this tooth in millimeters.

        -  Panoramic Radiography: X-ray imaging that allows the evaluation of the lower and upper
           jaws and all teeth on the same film. It is routinely taken from all patients for the
           diagnosis of periodontal disease.

        -  Periapical Radiography: It is an X-ray imaging that provides a more detailed examination
           of one or several adjacent teeth. It is routinely taken from all patients for the
           diagnosis of periodontal disease.

      Periodontal disease classification of patients is made by determining the number of missing
      teeth, type of bone destruction and the tooth with the highest bone loss on panoramic and
      periapical radiographs, and calculating the bone loss/age ratio of this tooth in millimeters.

      Statistical analysis method: Descriptive assessments will be made. SPSS software will be
      used. Chi-square test will be applied for analysis.
    

Intervention name(s): Periodontal classification
Intervention type(s): Diagnostic Test
Intervention description(s): 300 patients will be classified according to 1999 armitage and 2018 new periodontal classification and compared.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Apply to Kütahya University of Health Sciences, Faculty of Dentistry, Department of
        Periodontology.
      
Keywords: 2018 new periodontal classification; periodontal diseases; Armitage periodontal classification