Abstract
Periodontitis has long been a research topic due to the necessity of its proper classification. According to Tonetti et al. (2018), the authors of the present paper were tasked to develop a new classification system for periodontitis cases. The new framework had to utilize the knowledge acquired after the 1999 classification to improve the old view of the condition. Upon reviewing the historical perspective on periodontitis, four types of infection were recognized: necrotizing, chronic, and aggressive periodontitis, as well as periodontitis caused by other systemic diseases (Tonetti et al., 2018). Although this system allowed one to differentiate between conditions of different origins, it failed to appraise the condition’s severity and potential factors that could worsen the patient’s condition. Moreover, the older classification did not align with the existing research on underlying factors influencing the disease.
Purpose
The outdated nature of the previous classification encouraged the authors to reconsider the framework of approaching periodontitis cases. As mentioned above, the categorization did not consider each patient’s condition individually. For example, the distinction between aggressive and chronic periodontitis was based on phenotype definitions and did not acknowledge the potential differences each case could possess (Tonetti et al., 2018). In “Staging and Grading of Periodontitis: Framework and Proposal of a New Classification and Case Definition,” the authors aimed to present an easy system for grading and staging a case of periodontitis.
Methods
To appraise the old classification and develop a new one, the researchers conducted a review of available evidence. The committee members considered the cases of acute periodontal lesions and manifestations of systemic conditions affecting the disease (Tonetti et al., 2018). These cases were examined to see whether the previous classification could adequately assess each patient’s condition and treatment. The materials were used as the basis for discussing a new system. Moreover, the authors included three papers on aggressive and chronic periodontitis in their discussion. These works raised the question of whether such a distinction agreed with the existing knowledge about the disease (Tonetti et al., 2018). The researchers created and described a new classification system based on current evidence reviews and papers considering the older classification.
Results
Considering four reviews and three papers about periodontitis, the authors found several weaknesses in the old classification and developed a new framework. First, the examination of contemporary evidence showed that the distinction between aggressive and chronic periodontitis cases could not be supported. While various factors influence the progression of periodontitis in each case, there is little confirmation that the two types have consistent descriptions (Tonetti et al., 2018). Thus, these two types of periodontitis were excluded from the classification. Instead, the authors distinguished “necrotizing periodontitis, periodontitis as a direct manifestation of systemic diseases,” and periodontitis (Tonetti et al., 2018, p. S153). Second, they proposed a matrix of grading and staging periodontitis cases.
The matrix includes four stages from I to IV and three grades from A to C. The stages correspond to the point of the deceases’ progression. For example, State I is termed Initial periodontitis, and such a case is defined by the patient having only initial signs of attachment loss (Tonetti et al., 2018). The grading part includes factors influencing each case, such as risks, expected treatment responses, and the link to systemic health. As a result, the new classification is individualized to each case, and it acknowledges the origins of the disease and each patient’s underlying factors.
Reference
Tonetti, M. S., Greenwell, H., & Kornman, K. S. (2018). Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Clinical Periodontology, 45(Suppl 20), S149-S161. Web.