Impact of the 2018 periodontal classification on diagnosis, treatment strategies, and assessment of prognosis by dental hygienists in Swedish general dental care

Inter-examiner reliability in periodontal diagnosis and treatment planning using the 2018 classification and the EFP S3 clinical guideline

The 2018 Classification of Periodontal and Peri-Implant Diseases and Conditions introduced a multidimensional diagnostic framework incorporating staging, grading, and extent, the European Federation of Periodontology (EFP) S3-level clinical practice guidelines provided structured treatment recommendations. Although these frameworks aim to improve diagnostic precision and therapeutic standardization, their inter-examiner reliability in routine clinical settings remains insufficiently validated. This study evaluated diagnostic and treatment planning agreement between clinicians with different levels of experience. In this single-center cross-sectional inter-examiner reliability study, 148 recruited patients diagnosed with periodontitis were included. Comprehensive clinical and radiographic records were obtained for each patient. Two blinded examiners, a first-year periodontology resident and an experienced periodontist, independently classified stage, grade and extent according to the 2018 Classification, and developed treatment plans based on the EFP S3 Clinical Practice Guidelines. Inter-examiner agreement was assessed using Cohen’s kappa (κ) with statistical significance set at p  < 0.05. Inter-examiner agreement for staging was moderate (κ = 0.463), whereas grading (κ = 0.899) and extent (κ = 0.816) demonstrated almost perfect agreement. Complexity-related variables showed variable reliability, with substantial agreement for flaring (κ = 0.715) but lower kappa values for bite collapse (κ = 0.231) and drifting (κ = 0.116), influenced by low prevalence. Treatment planning agreement was perfect for supragingival biofilm control and diabetes management (κ = 1.000) and almost perfect for smoking cessation counseling (κ = 0.973). Moderate agreement was observed for subgingival instrumentation (κ = 0.487), adjunctive chemotherapeutic agents (κ = 0.543), systemic antibiotics (κ = 0.519), resective surgery (κ = 0.549), and regenerative surgery (κ = 0.603). Risk-based components of the 2018 Classification demonstrate high reproducibility, whereas staging, particularly differentiation between Stage III and Stage IV, remains challenging. Treatment decisions for non-surgical therapy are more consistent than those involving surgical or adjunctive interventions. Enhanced calibration and structured decision-support tools may improve uniformity in advanced case management.

Prevalence and structure of periodontal diseases in the Ukrainian population based on the AAP/EFP 2017 classification.

OBJECTIVE Aim: To determine the prevalence and structure of periodontal diseases among the population of Ukraine using the AAP/EFP 2017 Classification. PATIENTS AND METHODS Materials and Methods: A retrospective analysis of electronic outpatient medical charts of dental patients aged 25 to 75 years was conducted; the patients were divided into 3 groups depending on age. According to the data contained in the charts, each patient was diagnosed according to the AAP/EFP 2017 Classification. Statistical methods were used to determine the associations between age, gender and periodontal tissue condition, prevalence of inflammation, stage and grade of periodontitis. RESULTS Results: There were 12.8% of patients with intact periodontal tissues, 54.4% of patients were diagnosed with gingivitis, and 32.8% of patients were diagnosed with periodontitis. The most common diagnosis among patients with periodontitis was generalized periodontitis of stage II, grade B (25.9%). Statistically significant relationships were found between age and the presence of periodontal pathology, its prevalence, stage and grade of periodontitis. In addition, associations between gender and the condition of periodontal tissues and the stage of periodontitis were found. CONCLUSION Conclusions: In patients of different age groups and genders, gingivitis was the most common diagnosis, and generalized moderate form prevailed in the structure of periodontitis. Age and gender affect the risk of occurrence and clinical course of periodontal diseases. The use of AAP/EFP 2017 Classification in clinical practice provides an individualized approach to treatment planning for patients with various periodontal tissue lesions.

Evaluation of Dentists' Diagnostic and Treatment Approaches to Dental Erosion Cases

Objective: Studies on the etiology, prevalence, and treatment options of dental erosion have recently increased in the dental literature. This study aims to investigate the dental erosion experiences, awareness, diagnostic knowledge, and treatment option preferences of a group of dentists practicing in Turkey.Methods: A total of 250 Turkish dentists participated in the study. The dentists were asked to answer an evaluation form consisting of 16 questions, including a case evaluation. The data obtained were analyzed using descriptive statistics and the Pearson Chi-Square test (P<.05).Results: The study involved 173 female and 77 male dentists, averaging 32.48 ± 9.94 years old. Most dentists graduated between 2010 and 2019 (49.2%) and were non-specialists (62%). Dental erosion was most commonly seen in participants over 35 years of age (64.4%) and in male patients (36%), which were on the palatal/lingual surfaces of the anterior teeth (28.5%). Around 84.4% of the participants received training on dental erosion during their undergraduate studies. Only 6.8% of those who received this training used an index to assess erosion severity. The most commonly used index was the Basic Erosive Wear Evaluation (BEWE) (62.5%). Also, in this case study, it was seen that dentists most frequently advised their patients to avoid acidic beverages to prevent dental erosion (25.5%) and the most preferred treatment approach was composite resin restoration (25%). In addition, it was observed that the dentists who participated in the study were confident in the diagnosis and treatment of dental erosion lesions and needed more training in the grading of dental lesion severity.Conclusion: More education and awareness on the use of indexing and scoring systems for dental erosion is needed. Therefore, it is recommended that such systems be incorporated into both undergraduate and postgraduate education and that standard clinical guidelines be established.Keywords: Basic erosive wear examination, dental erosion, dentists, erosive tooth wear

Periodontal Disease and Endo-Periodontal Lesion Subtypes: A Retrospective Study

Background/Objectives: Endo-periodontal lesions (EPLs) represent complex pathological entities involving both periodontal and pulpal tissues, often implying diagnostic and therapeutic challenges. Limited evidence exists regarding the relationship between periodontal disease staging and grading and EPL subtype. The aim is to evaluate the clinical and statistical distribution of endo-periodontal lesions and investigate their association with periodontal stage and grade according to the European Federation of Periodontology (EFP) classification. Methods: An observational retrospective study was conducted in the Department of Periodontology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. Among 884 examined patients, 31 of them were diagnosed with EPLs and included in the analysis. Demographic variables, systemic conditions, affected tooth type, EFP stage and grade, and EPL type according to the Foce classification were recorded. Statistical analysis included Fisher’s exact test and univariable and multivariable binomial logistic regression models. Results: The mean age of the patients was 53.55 ± 9.42 years, with a nearly equal gender distribution. Most patients presented Stage III periodontitis (54.8%), Grade B periodontitis (71%), and EPL 3 (58.1%). Pluriradicular teeth were the most frequently affected (64.5%). The only statistically significant association identified was between EFP grading and EPL classification (p = 0.001). Grade B patients were significantly more likely to present EPL 3 than Grade C patients. Logistic regression analysis demonstrated that Grade B was a strong predictor of EPL 3 both in the univariable model (OR = 27.2; 95% CI: 2.712–272.828) and after adjustment for age and gender (OR = 32.676; 95% CI: 2.832–376.984). Neither age nor gender showed a significant association with EPL 3 occurrence. Conclusions: EPL 3 was the predominant lesion subtype in the study. EFP grading was significantly associated with EPL distribution, with Grade B emerging as an independent predictor of EPL 3. These findings suggest that periodontal disease progression may play a key role in the development and characterization of combined endo-periodontal lesions and highlight the importance of integrated periodontal–endodontic assessment in clinical practice.

Clinical decision-making in pulp therapy of primary teeth among Tunisian dental practitioners: a cross-sectional study.

Longitudinal immunological analysis of gingival crevicular fluid during treatment of aggressive periodontitis

Relevance . Aggressive periodontitis is increasingly encountered in clinical practice. Treatment of this condition is challenging for dental practitioners because it is characterized by progressive alveolar bone loss, while the clinical presentation does not always correspond to the radiographic findings. Cytokines are among the biomarkers that may be used to assess treatment response. Objective . To evaluate the efficacy of a combination treatment protocol in patients with periodontitis characterized by rapid progression using immunological analysis of gingival crevicular fluid. Materials and methods . The study included 64 young adults diagnosed with periodontitis (ICD-10 code K05.39), who underwent comprehensive clinical examination and were divided into two treatment groups. Group 1 comprised 31 patients treated according to the conventional protocol. Group 2 comprised 33 patients whose treatment regimen included topical applications of a bischofite-containing gel and injections of Cortexil into the marginal and attached gingiva. Results . Both treatment approaches were effective, although the course of healing differed between the groups. By day 3, patients in Group 2 demonstrated statistically significant improvements in immunological parameters relative to both baseline and Group 1. On day 7, the IL-1β/IL-4 ratio was 3.4 ± 0.1 in Group 1 and 3.1 ± 0.1 in Group 2, indicating a predominance of regenerative processes over inflammatory activity and a reduced risk of a protracted disease course. Conclusion . The combined use of Cortexil injections and topical applications of a bischofite-based gel was the most effective treatment approach in patients with aggressive periodontitis. The two agents had complementary and synergistic effects. However, serial monitoring and long-term follow-up at 1–2 years after treatment initiation are warranted to assess treatment efficacy.