Periodontics and Implantology
The 2018 classification
Periodontitis is staged by severity and complexity: Stage I, clinical attachment loss 1–2 mm with bone loss in the coronal third under 15%; Stage II, CAL 3–4 mm and 15–33%; Stage III, CAL ≥5 mm, mid-third bone loss, four or fewer teeth lost to periodontitis, probing depth ≥6 mm; Stage IV, bone loss into the apical third, five or more teeth lost, need for rehabilitation. Grading describes progression: bone loss ÷ age <0.25 = Grade A, 0.25–1.0 = B, >1.0 = C, modified upward by smoking ≥10 cigarettes/day, HbA1c ≥7.0% and systemic inflammation.
Diagnosis and therapy
Record bleeding on probing, probing depths, CAL, recession, furcation and mobility. Gingivitis is plaque-induced inflammation without attachment loss; peri-implant mucositis is its implant equivalent. Non-surgical therapy (oral hygiene instruction, scaling, root planing, risk-factor control) is re-evaluated at 6–8 weeks before any surgery. Adjunctive systemic amoxicillin plus metronidazole is reserved for specific aggressive or necrotising cases and is never a substitute for debridement. Peri-implantitis is bleeding on probing with progressive bone loss; risk factors are smoking, a history of periodontitis and poor plaque control.
Worked example
A 50-year-old with 40% bone loss on the worst tooth, CAL 5 mm and two teeth lost to periodontitis gives bone loss/age = 0.8, so Stage III, Grade B. If bone loss/age were 1.2, the grade would be C regardless of hygiene, and maintenance would move to three-monthly.
Traps
- Labelling plaque-induced gingivitis as Stage I periodontitis.
- Using antibiotics instead of mechanical debridement.
- Placing implants before periodontal stabilisation.
- Forgetting that smoking and diabetes shift both grade and maintenance interval.