Columbia University, New York, NY, USA.
Universidad Complutense Madrid, Madrid, Spain.
J Periodontol. 2018 Jun;89 Suppl 1:S173-S182. doi: 10.1002/JPER.17-0721.
A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.
一种新的牙周病分类方案已经被采用,其中以前被认为是“慢性”或“侵袭性”的疾病形式现在被归为一个单一的类别(“牙周病”),并根据一个多维的分期和分级系统进一步进行特征描述。分期主要取决于疾病在出现时的严重程度以及疾病管理的复杂性,而分级则提供了关于疾病生物学特征的补充信息,包括基于病史的牙周病进展速度分析;对进一步进展的风险评估;对治疗可能产生不良结果的分析;以及对疾病或其治疗可能对患者整体健康产生负面影响的风险评估。坏死性牙周病,其特征性临床表型包括典型特征(乳头坏死、出血和疼痛),并与宿主免疫反应受损有关,仍然是一个独特的牙周病类别。牙髓-牙周病变,定义为在特定牙齿的牙髓和牙周组织之间存在病理性的连通,分为急性或慢性形式,并根据对其预后和治疗有直接影响的症状和体征进行分类。牙周脓肿被定义为特征为牙周袋/沟牙龈壁内局部积聚脓液、快速组织破坏,并伴有全身播散风险的急性病变。