Periodontics | New Classification System | INBDE, ADAT

Ryan introduces the video's focus on the new periodontal classification system announced by the American Academy of Periodontology (AAP) at the EuroPerio9 conference in June 2018. The previous guidelines had not been updated since 1999, making this update significant. The video aims to cover the changes and help viewers understand how to apply the new system for diagnosing periodontal cases. A brief history of periodontal classifications is provided, from the 1970s to the new staging and grading system introduced in 2018. The four main categories of disease processes are outlined: periodontal health and gingival diseases and conditions, periodontitis, peri-implant diseases and conditions, and periodontal manifestations of systemic diseases and developmental and acquired conditions.

The video delves into the definitions of periodontal health, gingivitis, and periodontitis under the new classification system. Periodontal health is characterized by healthy soft and hard tissues surrounding the teeth, with some acceptable inflammation. Gingivitis is defined by clinical signs of inflammation, such as redness, swelling, and bleeding on probing affecting more than one or two sites. Periodontitis is described as the loss of periodontal tissue support due to microbially associated host-mediated inflammation, with deeper probing depths and interproximal attachment loss. The staging of periodontitis is based on the severity and extent of disease at presentation, while grading is determined by the rate of disease progression, responsiveness to therapy, and the overall assessment of risk.

The video explains the staging and grading process for periodontitis. Staging is a static measurement that classifies the patient's disease based on the amount of destroyed or damaged tissue, with stages ranging from one (slight) to four (severe). Factors considered include severity, complexity, and extent/distribution. Grading, on the other hand, is a dynamic measurement that considers the rate of disease progression, therapy responsiveness, and risk assessment, with grades ranging from A (slow) to C (rapid). The video provides criteria for upgrading stages and grades based on factors such as probing pocket depth, bone loss, tooth loss, and local complexity factors.

Ryan presents case studies to illustrate the application of the new classification system. The first case involves a 50-year-old male smoker with interdental CAL ranging from two to eight millimeters and 14 teeth with CAL greater than or equal to five millimeters. The staging process leads to a diagnosis of generalized stage 4 periodontitis. The second case features a periodontal chart for a patient with a history of smoking, and the analysis results in a localized stage 3 grade A periodontitis diagnosis. The video emphasizes the importance of considering the patient's history and clinical findings to determine the appropriate stage and grade.

Additional case studies are presented, including one with no measured clinical attachment loss, requiring the use of radiographic evidence for staging. The case is diagnosed as localized stage 3 grade B periodontitis. The fourth case involves a patient with a molar incisor pattern and significant bone loss, leading to a molar incisor stage 4 grade C periodontitis diagnosis. The video also discusses peri-implant diseases, ranging from peri-implant health to peri-implant mucositis to peri-implantitis, and notes the risk factors and indicators for these conditions.

The video concludes with a summary of the key changes in the 2018 AAP periodontal classification system. These include the new multi-dimensional staging and grading system for periodontitis, the consolidation of chronic and aggressive periodontitis into a single category, the addition of peri-implant diseases and conditions, and the clarification of health and gingivitis on an intact versus a reduced periodontium. A summary slide is provided to visually differentiate between the conditions, and the video ends with a call to like, subscribe, and support the channel for more dental education content.