Periodontics
Periodontics tests etiology, diagnosis, staging and grading, nonsurgical and surgical therapy, regeneration, implant health and maintenance.
Core concepts
- Gingivitis is reversible inflammation confined to the gingiva; periodontitis involves attachment loss and bone loss.
- Probing depth is not attachment loss. Clinical attachment level equals probing depth plus gingival recession, or probing depth minus gingival hyperplasia.
- The 2017 classification stages periodontitis by severity and complexity (I–IV) and grades by progression risk (A–C) using bone loss divided by age and risk factors.
- Horizontal bone loss is more common; vertical defects favor regeneration.
- Furcation involvement is classified I–IV; Grade II is treatable, while Grade III or IV often needs surgery or extraction.
- Risk factors include plaque, smoking, diabetes, genetics, medications, stress and poor access.
- Peri-implant mucositis is reversible inflammation without bone loss; peri-implantitis adds bone loss.
Worked example
A 50-year-old smoker has 6 mm probing depths, 4 mm recession and bone loss to the middle third. Clinical attachment level is 10 mm. Stage III (severe) and Grade C (bone loss divided by age greater than 1.0 plus smoking) are appropriate. Reasoning: stage reflects severity, grade reflects progression risk.
Traps
Do not equate deep pockets with periodontitis without attachment loss. Do not prescribe systemic antibiotics as routine monotherapy. Do not ignore smoking and diabetes. Do not scale implants with metal curettes.