In 2017 the American Academy of Periodontology (AAP) and European Federation of Periodontology (EFP) met and developed updates to the 1999 classification of periodontal diseases and conditions.  They announced the new guidelines at EuroPerio9 in the summer of 2018. Included in the guide was inaugural classifications for peri-implant diseases and conditions.¹  The American Academy of Implant Dentistry estimates more than 500,000 dental implants are placed every year in the United States.  It is important as clinicians to stay current on implant care trends as implant treatment continues to rise.

An overview of the updates are as follows:

 Periodontal health, gingival disease/conditions

1. Periodontal health and gingival health
2. Gingivitis – dental biofilm-induced
3. Gingival diseases – non-dental biofilm induced

Forms of periodontitis

1. Necrotizing Periodontal Diseases
2. Periodontitis as Manifestations of Systemic Diseases
3. Periodontitis – Stages and Grades

https://www.perio.org/sites/default/files/files/Staging and Grading Periodontitis.pdf

https://www.perio.org/sites/default/files/files/Three%20Steps%20to%20Staging%20and%20Grading%20a%20Patient.pdf

Periodontal manifestations or systemic diseases and development and acquired conditions

1. Systemic disease or conditions affecting the periodontal supporting tissues
2. Other Periodontal Conditions
3. Mucogingival deformities and conditions around teeth
4. Traumatic occlusal forces
5. Prostheses and tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis

Peri-implant diseases and conditions

1. Peri-implant health
2. Peri-implant mucositis
3. Peri-implantitis
4. Peri-implant soft and hard tissue deficiencies

Peri-implant health: Absence or peri-implant signs of inflammation (redness, swelling, profuse bleeding on probing) and the absence of additional bone loss following initial healing. Peri-implant health can exist around implants with normal or reduced bone support.

Peri-implant mucositis: Presence or peri-implant signs of inflammation (redness, swelling, line or drop of bleeding within 30 seconds following probing) combined with no additional bone loss following initial healing. Strong evidence that biofilm is the etiologic factor.

Peri-implantitis: Presence or peri-implant signs of inflammation, radiographic evidence of bone loss following initial healing and increasing probing depth as compared to probing depth values collected after placement of the prosthetic reconstruction. In the absence of previous radiograph’s, radiographic bone level 3mm in combination with bleeding on probing and probing depths  6mm is indicative of peri-implantitis.

Peri-implant soft- and hard-tissue deficiencies:  Normal healing after tooth loss leads to diminished dimensions of the alveolar process/ridge that results in both hard and soft tissue inadequacies. Examples are, extraction trauma, endodontic infections, root fractures, poor tooth position, thin buccal bone plates and systemic diseases. ²

In an article published in Perio Implant Advisory, Susan Wingrove, BS, RDH, developed a guide for clinical applications, case definition and diagnostic considerations published in her article titled Clinical applications for the 2018 classification of peri-implant diseases and conditions, that gave a simple, easy reference when working with implant patients.³

Understanding current guidelines set by the AAP and EFP is the first step to seeing the patient’s complete picture of their conditions and then giving clinicians the ability to then diagnose and treat for proper individualized patient care.

¹  Caton G, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification. J Clin Periodontol. 2018;45(suppl 20):S1-S8. https://aap.onlinelibrary.wiley.com/doi/full/10.1002/JPER.18-0157

² Hämmerle CHF, Tarnow D. The etiology of hard‐ and soft‐tissue deficiencies at dental implants: A narrative review. J Periodontol. 2018;89(Suppl 1):S291–S303 https://pubmed.ncbi.nlm.nih.gov/29926950/

³  https://www.perioimplantadvisory.com/clinical-tips/hygiene-techniques/article/16412254/clinical-applications-for-the-2018-classification-of-periimplant-diseases-and-conditions

Special thank you to Susan Wingrove, BS, RDH,  author of Peri-Implant Therapy for the Dental Hygienist, researcher and instrument designer. Please visit her website: https://wingrovedynamics.com