Overview of the New Peri-implant and Periodontal Disease Classification System

Peri-implant and Periodontal Disease Classification

In 2018, a group of the world's top gum disease experts got together in Chicago to create a brand new system for classifying gum and implant diseases. This new system helps dentists better understand, diagnose, and treat gum disease.

Why Was a New System Needed?

The old 1999 system had some problems:

• It sometimes over-diagnosed gum disease because of inaccurate measurements

• It didn't include dental implants, which are now extremely common

• Our understanding of gum disease has advanced significantly over the past 20+ years

The Two Main Categories

1. Gum (Periodontal) Diseases and Conditions

Gum Health

Healthy gums come in different forms. Here's a simple breakdown:

• Perfectly healthy gums — No bleeding, no bone loss, no inflammation

• Clinically healthy — Minimal signs of inflammation

• Stable (after treatment) — Gum disease was treated successfully and is under control

• Managed (partial control) — Treatment helped, but the disease isn't completely resolved

Gingivitis (Mild Gum Inflammation)

This is the early stage of gum disease, caused by plaque buildup on teeth. Signs include red, swollen, or bleeding gums. The good news is that gingivitis is reversible with proper cleaning and care.

Things that can make gingivitis worse include:

• Puberty or pregnancy (hormonal changes)

• Certain medications

• Poor oral hygiene

Things that can actually mask gingivitis:

• Smoking (it reduces visible bleeding, making disease harder to detect)

Periodontitis (Serious Gum Disease)

This is where gum disease gets more serious — it involves damage to the bone and tissue that hold your teeth in place. The new system eliminated confusing old terms like "chronic" and "aggressive" periodontitis, simplifying everything into just "periodontitis."

Periodontitis is now diagnosed in three steps:

1. Confirm there is actual bone/tissue loss

2. Identify what type of periodontitis it is

3. Assign a Stage and Grade

The New Staging and Grading System

Think of this like a report card for your gum health:

Stages (How Bad Is It?)

Grades (How Fast Is It Progressing?)

Dental Implant Health

For the first time ever, the classification system included rules for dental implant health, since implants are now so widely used.

Four Categories for Implants:

1. Healthy Implant

• No bleeding or inflammation

• Bone loss after placement is minimal (less than 2mm)

2. Peri-implant Mucositis

• Think of this as gingivitis around an implant

• The gum tissue around the implant is inflamed

• It's reversible with treatment, but takes about 3 weeks to heal

3. Peri-implantitis

• Think of this as serious gum disease around an implant

• The bone around the implant is being lost

• Risk factors include a history of gum disease and leftover cement from the implant crown

• Regular dental check-ups can reduce this risk

4. Tissue Deficiencies Around Implants

• Sometimes there isn't enough bone or gum tissue around an implant

• This can happen before or after the implant is placed

• Caused by factors like tooth extractions, infections, or implant positioning
  
  

Key Changes From the Old System

Conclusion

The 2018 classification system is a major upgrade in how dentists understand and communicate about gum disease. By introducing a clearer staging and grading system, and finally including dental implants, it helps dentists:

• Give more accurate diagnoses

• Create more personalized treatment plans

• Better predict how a patient's disease might progress

• Have clearer conversations with patients about their gums

Continuing Education Course

For the complete course on the updated classification system, and 2 hours of self study credit, see the entirety of the article here.