Periodontal disease staged by degree of severity

	Periodontitis	Stage I	Stage II	Stage III	Stage IV
Severity	Interdental CAL (at site of greatest loss)	1 to 2 mm	3 to 4 mm	≥5 mm	≥5 mm
	RBL	Coronal third (<15%)	Coronal third (15% to 33%)	Extending to middle third of root and beyond	Extending to middle third of root and beyond
	Tooth loss (due to periodontitis)	No tooth loss	No tooth loss	≤4 teeth	≥5 teeth
Complexity	Local	Maximum probing depth ≤4 mm Mostly horizontal bone loss	Maximum probing depth ≤5 mm Mostly horizontal bone loss	In addition to Stage II complexity: Probing depths ≥6 mm Vertical bone loss ≥3 mm Furcation involvement Class II or III Moderate ridge defects	In addition to Stage III complexity: Need for complex rehabilitation due to: Masticatory dysfunction Secondary occlusal trauma (tooth mobility degree ≥2) Severe ridge defects Bite collapse, drifting, flaring <20 remaining teeth (10 opposing pairs)
Extent and distribution	Add to stage as descriptor	For each stage, describe extent as: Localized (<30% of teeth involved); Generalized; or Molar/incisor pattern

Staging intends to classify the severity and extent of a patient’s disease based on the measurable amount of destroyed and/or damaged tissue as a result of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management.
Initial stage should be determined using CAL. If CAL is not available, RBL should be used. Tooth loss due to periodontitis may modify stage definition. One or more complexity factors may shift the stage to a higher level. Refer to perio.org/2017wwdc for additional information.

CAL: clinical attachment loss; RBL: radiographic bone loss.

From: Tonetti MS, Green H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol 2018; 45(Suppl 20):S149-S161. https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpe.12945. Copyright © 2018 American Academy of Periodontology and European Federation of Periodontology. Reproduced with permission of John Wiley & Sons Inc. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (https://onlinelibrary.wiley.com/).

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Periodontal disease staged by degree of severity