Søren Jepsen1, Jack G Caton2, Jasim M Albandar3, Nabil F Bissada4, Philippe Bouchard5, Pierpaolo Cortellini6, Korkud Demirel7, Massimo de Sanctis8, Carlo Ercoli9, Jingyuan Fan2, Nicolaas C Geurs10, Francis J Hughes11, Lijian Jin12, Alpdogan Kantarci13, Evanthia Lalla14, Phoebus N Madianos15, Debora Matthews16, Michael K McGuire17, Michael P Mills18, Philip M Preshaw19, Mark A Reynolds20, Anton Sculean21, Cristiano Susin22, Nicola X West23, Kazuhisa Yamazaki24. 1. Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany. 2. University of Rochester, Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA. 3. Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA, USA. 4. Case Western Reserve University, Cleveland, OH, USA. 5. U.F.R. d'Odontologie, Université Paris Diderot, Hôpital Rothschild AP-HP, Paris, France. 6. Private practice, Firenze, Italy; European Research Group on Periodontology, Bern, Switzerland. 7. Department of Periodontology, Istanbul University, Istanbul, Turkey. 8. Department of Periodontology, Università Vita e Salute San Raffaele, Milan, Italy. 9. University of Rochester, Prosthodontics & Periodontics, Eastman Institute for Oral Health, Rochester, NY, USA. 10. Department of Periodontology, University of Alabama at Birmingham, School of Dentistry, Birmingham, AL, USA. 11. King's College London Dental Institute, London, UK. 12. Discipline of Periodontology, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Hong Kong SAR, China. 13. Forsyth Institute, Cambridge, MA, USA. 14. Columbia University College of Dental Medicine, Division of Periodontics, New York, NY, USA. 15. Department of Periodontology, School of Dentistry, National and Kapodistrian University of Athens, Greece. 16. Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia. 17. Private practice, Perio Health Professionals, Houston, TX, USA. 18. Department of Periodontics, University of Texas Health Science Center at San Antonio, TX, USA. 19. Centre for Oral Health Research and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. 20. University of Maryland, School of Dentistry, Department of Advanced Oral Sciences and Therapeutics, Baltimore, MD, USA. 21. Department of Periodontology, University of Bern, Switzerland. 22. Department of Periodontics, Augusta University Dental College of Georgia, Augusta, GA, USA. 23. Restorative Dentistry and Periodontology, School of Oral and Dental Sciences, Bristol Dental School & Hospital, Bristol, UK. 24. Research Unit for Oral-Systemic Connection, Division of Oral Science for Health Promotion, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Abstract
BACKGROUND: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
BACKGROUND: A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attachment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non-carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and periodontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The aim of this working group was to review and update the 1999 classification with regard to these diseases and conditions, and to develop case definitions and diagnostic considerations. METHODS: Discussions were informed by four reviews on 1) periodontal manifestions of systemic diseases and conditions; 2) mucogingival conditions around natural teeth; 3) traumatic occlusal forces and occlusal trauma; and 4) dental prostheses and tooth related factors. This consensus report is based on the results of these reviews and on expert opinion of the participants. RESULTS: Key findings included the following: 1) there are mainly rare systemic conditions (such as Papillon-Lefevre Syndrome, leucocyte adhesion deficiency, and others) with a major effect on the course of periodontitis and more common conditions (such as diabetes mellitus) with variable effects, as well as conditions affecting the periodontal apparatus independently of dental plaque biofilm-induced inflammation (such as neoplastic diseases); 2) diabetes-associated periodontitis should not be regarded as a distinct diagnosis, but diabetes should be recognized as an important modifying factor and included in a clinical diagnosis of periodontitis as a descriptor; 3) likewise, tobacco smoking - now considered a dependence to nicotine and a chronic relapsing medical disorder with major adverse effects on the periodontal supporting tissues - is an important modifier to be included in a clinical diagnosis of periodontitis as a descriptor; 4) the importance of the gingival phenotype, encompassing gingival thickness and width in the context of mucogingival conditions, is recognized and a novel classification for gingival recessions is introduced; 5) there is no evidence that traumatic occlusal forces lead to periodontal attachment loss, non-carious cervical lesions, or gingival recessions; 6) traumatic occlusal forces lead to adaptive mobility in teeth with normal support, whereas they lead to progressive mobility in teeth with reduced support, usually requiring splinting; 7) the term biologic width is replaced by supracrestal tissue attachment consisting of junctional epithelium and supracrestal connective tissue; 8) infringement of restorative margins within the supracrestal connective tissue attachment is associated with inflammation and/or loss of periodontal supporting tissue. However, it is not evident whether the negative effects on the periodontium are caused by dental plaque biofilm, trauma, toxicity of dental materials or a combination of these factors; 9) tooth anatomical factors are related to dental plaque biofilm-induced gingival inflammation and loss of periodontal supporting tissues. CONCLUSION: An updated classification of the periodontal manifestations and conditions affecting the course of periodontitis and the periodontal attachment apparatus, as well as of developmental and acquired conditions, is introduced. Case definitions and diagnostic considerations are also presented.
Authors: C Walter; P Ower; M Tank; N X West; I Needleman; F J Hughes; R Wadia; M R Milward; P J Hodge; I L C Chapple; T Dietrich Journal: Br Dent J Date: 2019-01-25 Impact factor: 1.626
Authors: T Dietrich; P Ower; M Tank; N X West; C Walter; I Needleman; F J Hughes; R Wadia; M R Milward; P J Hodge; I L C Chapple Journal: Br Dent J Date: 2019-01-11 Impact factor: 1.626
Authors: Alexia Vinel; Antoine Al Halabi; Sébastien Roumi; Hélène Le Neindre; Pierre Millavet; Marion Simon; Constance Cuny; Jean-Sébastien Barthet; Pierre Barthet; Sara Laurencin-Dalicieux Journal: Adv Exp Med Biol Date: 2022 Impact factor: 2.622