Mastering Periodontitis Classification: Staging and Grading Cases
Case 1
A 45-year-old patient presents for a new patient exam. Your clinical and radiographic examination reveals:
Clinical Attachment Loss (CAL): The greatest interdental CAL is 2 mm.
Radiographic Bone Loss (RBL): Horizontal bone loss in the coronal third of the roots (approximately 10%).
Probing Depths: Maximum probing depth is 4 mm.
Tooth Loss: No teeth have been lost due to periodontitis.
Extent: The bone loss is localized to less than 30% of the teeth.
Question 1: Based on the Staging criteria, what is the correct stage for this patient?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Question 2: How would you describe the extent?
Case 2:
A 58-year-old patient presents with the following findings:
CAL: The greatest interdental CAL is 6 mm.
RBL: Radiographs show bone loss extending to the middle third of the root on several teeth.
Tooth Loss: The patient has lost 3 teeth due to periodontitis in the past.
Complexity: Furcation involvement (Class II) is noted on two molars, and there is a vertical bone defect of 4 mm.
Extent: The bone loss is generalized.
Question 3: What is the correct stage for this patient?
A) Stage I
B) Stage II
C) Stage III
D) Stage IV
Case 3
You are evaluating a 62-year-old patient with a history of periodontitis. You compare today's radiographs with ones taken 5 years ago. You measure 2.5 mm of increased bone loss at the site of greatest destruction. The patient is a non-smoker and has no diagnosis of diabetes.
Question 4: Based on the primary criteria for progression, what Grade would you assign?
A) Grade A
B) Grade B
C) Grade C
Question 5: Do the risk factor modifiers (smoking/diabetes) change this grade?
Case 4:
A 35-year-old patient presents with:
CAL: Generalized 5-6 mm interdental CAL.
Destruction vs. Biofilm: The level of tissue destruction appears to be severe and excessive given the relatively minimal amount of plaque and calculus.
Smoking: The patient smokes 1 pack (20 cigarettes) per day.
Diabetes: The patient has diabetes with a recent HbA1c of 7.5%.
Question 6: Using the indirect evidence of progression (case phenotype and risk factors), what is the most likely Grade for this patient?
A) Grade A
B) Grade B
C) Grade C
Answers
Answer to Question 1: A) Stage I
Justification: The patient has 1-2 mm CAL (or <15% RBL), no tooth loss, and maximum probing depth ≤4 mm. All these criteria align with Stage I.
Answer to Question 2: Localized
Justification: The bone loss affects less than 30% of the teeth.
Answer to Question 3: C) Stage III
Justification: The patient has CAL ≥5 mm, RBL extending to the middle third of the root, and tooth loss of ≤4 teeth. The presence of furcation involvement and vertical bone loss ≥3 mm are complexity factors that confirm Stage III. It is not Stage IV because there is no masticatory dysfunction, severe ridge defects, or bite collapse mentioned, and they have not lost ≥5 teeth.
Answer to Question 4: C) Grade C
Justification: Direct evidence shows ≥2 mm of bone loss over 5 years, which is the primary criterion for a Rapid rate of progression (Grade C).
Answer to Question 5: No.
Justification: The primary criteria (direct evidence of progression) take precedence. Furthermore, the patient's risk factors (non-smoker, no diabetes) are actually associated with a lower grade, but they do not override the direct evidence of rapid progression.
Answer to Question 6: C) Grade C
Justification: The case phenotype ("Destruction exceeds expectations given biofilm deposits") strongly suggests a rapid rate of progression (Grade C). This is further supported by the grade modifiers: smoking ≥10 cigarettes/day and HbA1c ≥7.0% in a patient with diabetes.