THIS PAPER DISCUSSES THE STRENGHTS AND LACUNAE OF THE NEW 2O17 AAP WORKSHOP CLASSIFICATION

1. CRITICAL APPRAISAL OF 2018 CLASSIFICATION OF
PERIODONTAL DISEASE- STRENGTH AND
LACUNAE
DR.S.S.YASMIN PARVIN
POST GRADUATE STUDENT
DEPARTMENT OF PERIODONTICS
MADHA DENTAL COLLEGE AND HOSPITAL
GUIDED BY DR.J.SELVALUMAR
PROFESSOR AND HEAD OF
DEPARTMENT

2. PERIODONTAL DISEASES
“It is defined as the
inflammation of the
supporting tissue of the
teeth caused by specific
micro organism or groups of
specific micro organism,
resulting in progressive
destruction of the
periodontal ligament and
alveolar bone with increased
probing depth formation
,recession or both”.

3. What is classification defined as?
•Systemic arrangement of classes or
groups based on perceived common
characteristics.
•Classification of diseases helps in
diagnosis, prognosis and treatment
planning

4. SO WHY DO WE NEED TO CLASSIFY
PERIODONTAL DISEASES?
Helps to develop framework to study
the aetiology, pathology and treatment
of periodontal disease.
To communicate among clinicians,
researches, students , epidomologist
and public health workers.

5. AIM OF MY PAPER:
AIMS TO CRITICALLY APPRAISE THE MOST
RECENT CLASSIFICATION SYSTEM IN
PERIODONTOLOGY .
THE 2017 WORKSHOP ON CLASSIFICATION OF
PERIODONTAL AND PERI IMPLANT DISEASE
AND CONDITION CO SPONSERED BY AAPAND
EFP WITH EXPERTS FROM ALL OVER THE
WORLD HELD ON NOV 9 T0 11 2017.

6. SO HOW DID THE CLASSIFICATION BEGIN WITH?

12. WHY WAS THE 2017 CLASSIFICATION
DEVELOPED?
•Since the 1999 workshop, substantial new information has
emerge from population studies, basic science
investigations, and the evidence from prospective studies
evaluating environmental and systemic risk factors.
•The analysis of this evidence has prompted the 2017
workshop to develop a new classification framework for
periodontitis

13. HOW WAS 2017 CLASSIFICATION FRAMED?
• The world workshop held in chicago november 9 to 11 2017.
• Two organisation involved –AAP & EFP.
• Aimed to create a consensus knowledge base to enable the two
organisation to promote a new classification globally.
• Involved 130 experts & review authors who reviewed the scientific
evidence to update the classification scheme.
• 4 working groups of the world workshop are:
1. Periodontal health, gingival health and conditions
2.Periodontitis
3. Periodontal manifestation of systemic disease
4. Peri implant health and condition

14. • The organising committee commissioned 19
review paper and 4 consensus reports
• One of the key task of working group was to
define what is meant by periodontal health ,
because unless you define health you cannot
define disease.

15. •Long awaited consensus on the new
classification of periodontal and peri
implant disease and condition is now a
reality – PERIO INSIGHT
•Of great importance is the view of the
clinicians who are going to use this as a
common language to facilitate
diagnosis and personalized treatment.

16. THE 2017 CONSENSUS WORKSHOP IS
A MAJOR STEP FORWARD NOT ONLY
FOR PERIODONTOLOGY BUT ALSO
FOR PERIODONTOLOGY AS A
WHOLE. – PERIO INSIGHT

17. WHAT IS CRITICAL APPRAISAL?
CRITICAL APPRAISAL IS A LITERARY & SCIENTIFIC
SYSTEMATIC DISSECTION IN A ATTEMPT TO ASSIGN
MERIT TO THE CONCLUSION OF AN ARTICLE.
FINALLY, THE ARTICLE HAS TO UNDERGO SCRUTINY
AND RETAIN ITS FINDINGS AS VALID.
CRITICAL APPRAISAL IS A NECESSARY SKILL FOR
HEALTHCARE STUDENTS

18. DOES THE PRESENT REVISION OF CLASSIFICATION
ADDRESS THE LACUNAE/ DRAWBACKS OF 1999
CLSSIFICATION?
•YES. IT DOES ADDRESS THE MAJOR DRAWBACKS
IN THE 1999 CLASSIFICATION SUCH AS
OVERLAPPING NATURE OF CRITERIA OF DISEASES,
CREATING CONFUSION FOR CLINICIANS TO
DIAGNOSE THE CASE PROPERLY.
•IT DID NOT ELABORATE THE EFFECT OF RISK
FACTORS SUCH AS SMOKING AND DIABETES.

20. DID THE REVIEW AUTHORS AND EXPERTS
LOOK FOR APPROPRIATE TYPES OF PAPERS?
YES. APPROPRIATE TYPE OF PAPERS WERE
CONSIDERED FOR REVIEW BY EXPERTS TO
FORM A CONSENSUS.

21. IS THE SEARCH LIKELY TO HAVE IDENTIFIED ALL THE
RELEVANT EVIDENCE?
Yes. The a group of one thirty experts and four
working groups were assigned as experts and review
authors who collected relevant evidences from all
over the world , population studies, basic science
investigations, and the evidence from prospective
studies evaluating environmental and systemic risk
factors.

22. Did the review’s authors do enough to assess
the quality of the included studies?
The review experts and authors were given a 2
years span of time to meticulosly asses the
quality of the included study.

23. Are results provided for all included studies?
Were all the important outcomes considered?
Yes.all the four study group gave their
results.and result outcome of all the study
group were considered.

24. If the results of the review have been combined,
was it reasonable to do so?
YES. The results of the review have been
combined. Four working gropus gave their results
independently, finally all the results of 4 working
group were combined to give a single result.
It is very much reasonable to combine it coz to
avoid complicated classification rather than a
single combined one.

25. Can the results be applied to the local
population?
Yes.it can applied to local population. The
study aimed to create a consensus
knowledge base and common language to
promote a new classification globally all
over the world.its really imporatant to
convey a international language so that
there is always a link between global and
local population.

26. Is any sponsorship/conflict of interest
reported?
The study was co sponsered by AAP and EFP
togather.
The authors claim no conflict of intrest.

27. IMPORTANCE OF NEW CLASSIFICATION:
 THE NEW CLASSIFICATION IS IMPORTANT
FOR THREE REASONS:
1.IT IS NEEDED
2.IT IS TRANSFORMATIVE
3.IT IS GLOBAL
 THIS IS THE TYPE OF CONTENT THAT
EMPOWERS EVERY ONE OF US TO BE MUCH
BETTER PRACTITIONERS THROUGH
READIND, STUDTING AND IMPLEMENTING
THESE STUDIES IN PRACTICE.

28. FOUR MAJOR ADVANCES FROM PREVIOUS
CLASSIFICATION:
THERE IS A WIDESPREAD WELCOME FOR AN UPDATED
CLASSIFICATION .
1) DEFINITION OF PERIODONTAL HEALTH
2) REPLACEMENT OF CHRONIC AND AGGRESSIVE
PERIODONTITIS WITH A MODEL BASED ON STAGES
AND GRADES.
3) THE SUPPORT GIVEN TO PERSONALISED MEDICINE.
4) THE INCLUSION OF PERI IMPLANT DISEASE AND
CONDITION

29. COMMENTS AND REVIEWS BY INTERNATIONAL
PERIODONTAL CLINICIANCS:
1. “MILESTONE FOR PERIOWORLD”
2. “REAL IMPROVEMENT IN
PERIODONTAL FIELD”
3. “ A VERY USEFUL SYSTEM ,WITH
GRADING AND STAGING FOR CLINICAL
DECISION AND TREATMENT
PLANNING”

30. KEY CHANGES IN 2017 CLASSIFICATION:
 PERIODONTAL HEALTH , GINGIVAL HEALTH ,DISEASES AND
CONDITIONS WAS INTRODUCED.
 DEFINITION OF PERIODONTAL HEALTH GIVEN.
 TERM PLAQUE INDUCED REPLACED BY DENTAL BIOFILM
INDUCED.
 SYSTEMIC RISK FACTORS NEWLY ADDED ARE SMOKING,
HYPERGLYCEMIA, NUTRTIONAL FACTORS, PHARMACOLOGICAL
AGENTS, SEX STEROID HARMONES, HAEMATOLOGICAL
CONDITION.
 MYCOBACTERIUM TUBERCULOSIS ADDED TO SPECIFIC
INFECTION OF BACTERIAL ORIGIN.
 SPECIFIC INFECTION OF VIRAL ORIGIN IS DISCUSSED IN DETAIL
– COXSACKIE VIRUS, MOLLUSCUM CONTAGIOSUM, HUMAN
PAPILLOMA VIRUS.

31. CANDIDOSIS IS ADDED TO SPECIFIC INFECTION OF
FUNGAL ORIGIN.
LINEAR GINGIVAL ERTHYMA IS REMOVED.
ERYTHEMA MULTIFORME AND DRUG INDUCED
CATEGORY IS REMOVED.
GRANULOMATOUS INFLAMMATORY LESION AND
REACTIVE PROCESS CATEGORY IS ADDED.
NEOPLASMAS AND GINGIVAL PIGMENTATION
CATEGORY IS NEWLY ADDED.
CHRONIC AND AGGRESSIVE PERIODONTITIS IS
REMOVED .
MULTI DIMENSIONAL STAGING AND GRADING ADDED
FOR PERIODONTITIS.

32. NECROTIZING STOMATIS IS ADDED.
TERM GINGIVAL PHENOTYPE IS INTRODUCED .
GINGIVAL ABSCESS AND ABSCESS OF
PERIODONTIUM IS REMOVED.
OCCLUSAL TRAUMA IS RENAMED AS
TRAUMATIC OCCLUSAL FORCES.
MUCOCUTANEOUS DISORDER REPLACED BY
AUTO IMMUNE DISEASE OF SKIN AND MUCOUS
MEMBRANE.
HYPERSENSITIVITY CATEGORY IS INTRODUCED.
HISTOPLASMOSIS REPLACED BY MUCOSES AND
ASPERGILLOSIS.

33. DRAWBACKS OF 2017 CLASSIFICATION:
No classificaton system is perfect ,all will change as
knowledge increases.
The new classification systems has many critics,but
it had tried to accommodate a number of important
areas that was lacking in 1999 system.
The clinicians have raised concern about
practicalities of implementing the new classification in
everyday practice.

34. Some periodontist find the new classification
complex and skeptical wether general
practitioners in busy dental office will find it
easy to use.

35. FUTURE PLAN?
THE AAP AND THE EFP IS SETTLING DOWN TO
WORK ON A WIDE RANGE OF EVENTS AND
PROJECTS TO IMPLEMENT ITS STRATEGIC VISION
OF “ PERIODONTAL LIFE FOR A BETTER HEALTH”
TO CONDUCTS CAMPAIGNS TO DISSEMINATE
THE NEW CLASSIFICATION SYSTEMS
DRAW UP A DETAILED PLAN TO PROVIDE
MATERIALS TO EXPLAIN THE NEW
CLASSIFICATION

36. TO TRAIN ORAL HEALTHCARE TEAMS ON HOW
TO IMPLEMENT IT IN DAILY CLINICAL PRACTICE.
TO CONDUCT PERIO WORKSHOPS TO
FAMILIARISE THE NEW CLASSIFICATION.
DEVISE A METICULOUS PLAN FOR
DISSEMINATING AND EXPLANING THE NEW
CLASSIFICATION TO TH PRACTITIONERS.

37. TO CONCLUDE:
Time will decide how the new classification will be
helpful to the general dentist and Periodontist to
choose optimal treatment plan to the patient.
 Due to many number of changes from 1999
classification the ease of transistion in implementing
this new classification is yet to be determined .
However, as nothing is guaranteed, the systems of the
future are also likely to be controversial, stimulate
much debate, and require further modification.

38. THE FUTURE LOOKS EXTREMELY BRIGHT FOR THE
FIELD OF PERIODONTOLOGY BUT WE NEED TO
MANAGE IT CAREFULLY THAT OUR SUPERB
PERIODONTOLOGY PROFESSION IS NOT , OVER –
BURDENED AND PROTECT OUR PERIO ASSESTS
BY PLANNING CAREFULLY AND TAKING ONE STEP
AT A TIME.

39. Specialist Unit for Review Evidence (SURE) Questions to assist with the critical
appraisal of a systematic review ,
Adapted and updated from the former Health Evidence Bulletins Wales
(HEBW) checklist with reference to the NICE Public Health Methods Manual
(2012) and previous versions of the Critical Appraisal Skills Programme (CASP)
checklists.
REFRENCES:
Critical Appraisal Skills Programme (CASP), Public Health Resource Unit,
Institute of Health Science, Oxford.
Oxman AD, Cook DJ, Guyatt GH. Users’ guides to the medical literature.
VI.
How to use an overview. JAMA 1994; 272:1367-1371.

40. clinical textbook of periodontology carranza.
Perio insight
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conditions – Introduction and key changes from the 1999 classificationJ
Periodontol. 2018;89(Suppl 1):S1–S8.
newer classification of periodontal and peri- implant diseases and conditions- a
critical review volume-7, issue-7, july-2018 • issn no 2277 – 8160a new classification
scheme for periodontal and peri‐implant diseases and conditions – introduction and
key changes from the 1999 classification j clin periodontol. 2018;45:45(suppl 20);s1–
s8.
Classification of Periodontal Diseases: Where were we? Where are we now? Where
are we going? Article in Dental update · January 2003 DOI:
10.12968/denu.2003.30.1.37 · Source: PubMed
 A new classification scheme for periodontal and peri-implant diseases and
conditions - Introduction and key changes from the 1999 classification
doi.org/10.1002/JPER.18-0157.