INBDE Bootcamp High-Yield Periodontics | Bootcamp.

com
Healthy periodontium Gingivitis Periodontitis

● Absence or up to two sites of clinically detectable
inflammation
● Minimal or no bleeding on probing
● Normal (≤3 mm) probing depths
● Can be on an intact (no attachment or bone loss) or
reduced (previous attachment or bone loss) periodontium
● Inflammation
● Erythema, edema, bleeding on probing
● Normal (≤3 mm) probing depths
● Stable periodontium with no current
progressive attachment or bone loss
● Loss of periodontal support due to
microbial-associated, host-mediated
inflammation
● Deeper (≥4 mm) probing depths
● Presence of interproximal attachment
loss from current disease state; not
including attachment loss from a history of
disease in currently stable patients

Periodontal Staging

Stage Stage I Stage II Stage III Stage IV

Greatest interdental 1-2 mm 3-4 mm ≥5 mm

clinical attachment loss

Percent bone loss ≤15% 15%-33% ≥33%

Severity
Teeth lost to periodontitis No tooth loss ≤4 teeth ≥5 teeth

Max. probing depth ≤4 Probing depths ≤5 mm Probing depths ≥6 mm In addition to Stage III:
mm Mostly horizontal bone Vertical bone loss ≥3 mm Need for rehabilitation
Complexity Mostly horizontal bone loss Furcation involvement Masticatory dysfunction
loss Class II or III Tooth mobility ≥ Class II
<20 remaining teeth

● Localized (<30% of teeth involved)

Extent ● Generalized (>30% of teeth involved)
● Molar/incisor pattern

Periodontal Grading

Grade Grade A: Slow rate Grade B: Moderate Grade C: Rapid rate

rate

Radiographic bone No loss over 5 years <2 mm over 5 years ≥2 mm over 5 years
Direct evidence
loss or CAL

Primary criteria Percent bone loss/age <0.25 0.25 to 1.0 >1.0

Indirect evidence Case phenotype Heavy deposits with Destruction Destruction

little destruction correlates disproportionate to
with deposits deposits

Smoking Non-smoker <10 cigarettes/day ≥10 cigarettes/day

Grade modifiers Risk factors
Diabetes No diabetes diagnosis HbA1c <7.0% in HbA1c ≥7% in
diabetic patient diabetic patient
 INBDE Bootcamp High-Yield Periodontics | Bootcamp.com
Peri-implant Diseases and Conditions

Healthy Peri-implant Periodontium Peri-implant Mucositis Peri-implantitis

● No visual signs of inflammation or bleeding on probing
● Health around implants with normal or reduced bone
support
● Isolated timepoint probing depths are not used since
normal probing depths are not defined for implants
● Signs of inflammation and bleeding on ● Signs of inflammation, bleeding on
probing probing, and progressive bone loss
● Absence of progressive bone loss ● Increased probing depths compared to
baseline

Tooth Mobility: Miller Classification

Class I Class II Class III

Mobility greater than physiologic Buccolingual mobility <1 mm Buccolingual mobility >1 mm or tooth depressable

Furcation Involvement

Hamp Classification

Class I Class II Class III

Horizontal furcation involvement <3 mm Horizontal furcation involvement >3 mm Through-and-through furcation involvement

Glickman Classification

Class I Class II Class III Class IV

Pocket formation into flute Pocket formation into furca Through-and-through furcation Through-and-through furcation
involvement involvement, can visualize
clinically

Recession: Miller Classification

Class I Class II Class III Class IV

● Recession does not extend to
mucogingival junction (MGJ)
● No loss of interdental bone or soft tissue
● 100% root coverage expected after
connective tissue graft
● Recession extends to or beyond
MGJ
● No loss of interdental bone or soft
tissue
● 100% root coverage expected
after connective tissue graft
● Recession extends to or
beyond MGJ
● Mild/moderate interproximal
bone or soft tissue loss present
● Partial root coverage expected
after connective tissue graft
● Recession extends to or
beyond MGJ
● Severe interdental bone or
soft tissue loss
● No root coverage expected
after connective tissue graft
 INBDE Bootcamp High-Yield Periodontics | Bootcamp.com
Bone Loss

Horizontal Vertical

● Bone loss is perpendicular to the long axis of the tooth along the whole alveolar crest ● Angular/oblique orientation of bone loss

Infrabony Defects

1 Wall 2 Wall 3 Wall 4 Wall

Hemiseptal defect Crater defect Trough defect Circumferential defect

Most common type of defect Most predictable regeneration

Example: extraction socket

Bacteria Involved in Periodontal Disease

Red Complex Orange Complex

P. gingivalis Associated with chronic periodontitis P. intermedia Associated with pregnancy gingivitis

T. denticola Associated with acute necrotizing F. nucleatum Bridging microorganism that binds
ulcerative periodontitis (ANUG) early and late colonizers

T. forsythia C. rectus

● A. actinomycetemcomitans - associated with aggressive periodontitis

● Pseudomonas sp. - associated with failing implants
●
 INBDE Bootcamp High-Yield Periodontics | Bootcamp.com
Treatment Planning for Periodontal Disease

Phase Treatment Goals

0. Preliminary Phase ● Emergency treatment

● Extraction of all hopeless teeth

1. Non-surgical Phase ● Plaque control, scaling and root planing, correction of local factors
● Patient education
● Local and systemic antibiotics
● Re-evaluation 4-8 weeks after initial therapy

2. Surgical Phase ● Reduce/eliminate pockets and correction of defects to soft or hard tissue
● If necessary, endodontics and/or implant placement

3. Restorative Phase ● Any definitive restorative or prosthodontic treatment

4. Maintenance Phase ● Periodic ongoing re-evaluation every 3 months for the first year
● Periodontal maintenance for life

Prognosis of Periodontally Involved Teeth

Bone Level Clinical Factors Local Factors

Excellent No bone loss None Gingival health

Good Adequate alveolar support None Potential to maintain

Fair Inadequate alveolar support Mobility and class I furcation Potential to maintain

Poor Moderate bone loss Mobility and class I or II furcation Difficult areas to maintain

Questionable Advanced bone loss Mobility and class II or III furcation Inaccessible areas

Hopeless Advanced bone loss Extraction indicated Unable to maintain