The symposium honoring Dr. Steven Offenbacher: Four decades of research contributions to periodontal medicine

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163452/2/jper10592_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163452/1/jper10592.pd

Future of preventing and managing common chronic inflammatory diseases

Chronic inflammation has emerged as a key factor that contributes to some common chronic diseases and reduces lifespan. Studies have identified multiple types of chronic inflammation ranging from autoimmune disease, which attacks specific tissues, to autoinflammatory diseases, which cause low‐grade systemic inflammation and contribute to several common chronic diseases. This article highlights new perspectives on the role of chronic inflammation in cardiovascular disease (CVD). Such information is being leveraged to develop new treatment strategies for CVD and may inform how periodontal disease influences CVD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163431/2/jper10590.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163431/1/jper10590_am.pd

The subgingival microbial flora during pregnancy

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66023/1/j.1600-0765.1980.tb00265.x.pd

Clinical application of the new classification of periodontal diseases: Ground rules, clarifications and “gray zones”

BackgroundSuccessful dissemination of the new classification of periodontitis is facilitated by emphasis on the basic ground rules, clarification of ambiguities, and identification of “gray zones” where thoughtful application of the guidelines by an informed, experienced clinician is paramount to arrive at a correct Stage and Grade.MethodsHighlighted ground rules are (1) Stage is a patient‐based, not a tooth‐based concept, therefore, a single Stage is assigned per patient; (2) Stage can shift upward over time, if the periodontal status deteriorates, but the initially assigned Stage is retained even after improvement post‐therapy; (3) the complexity factors that determine Stage must be evaluated collectively, not in isolation, to arrive at a clinically meaningful assessment; (4) a single Grade is assigned to a patient based on a deliberate evaluation of the “biological fabric” of the case, in terms of history of/risk for further progression, interplay of risk factors, and the two‐way effects of periodontitis or its treatment on general health; (v) shift of Grade over time is possible towards either direction, after thorough, collective, evaluation of changes in the above parameters. Exemplified gray zones include a radiographically intact patient with minimal attachment loss in older age; presence of “frank” periodontitis affecting a single tooth; and assessment of factors that do/do not lead to increased complexity of therapy.ConclusionDifferentiating between Stage I/II versus Stage III/IV periodontitis is relatively uncomplicated; further distinction between Stages and correct assignment of Grade requires nuanced, thorough interpretation of a broad array of findings by a knowledgeable clinician.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154677/1/jper10481.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154677/2/jper10481_am.pd

The Effect of Intensive Antibacterial Therapy on the Sulcular Environment in Monkeys: Part I. Changes in the Bacteriology of the Gingival Sulcus

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141190/1/jper0034.pd

The Effect of Intensive Antibacterial Therapy on the Sulcular Environment in Monkeys: Part II: Inflammation, Mitotic Activity and Keratinization of the Sulcular Epithelium

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141516/1/jper0155.pd

Biologically guided implant therapy: A diagnostic and therapeutic strategy of conservation and preservation based on periodontal staging and grading

Biologically guided implant therapy is based on the new periodontitis classification system recently released by the American Academy of Periodontology and the European Federation of Periodontology that uses staging and grading for the diagnosis of periodontitis. This paper proposes that periodontitis staging and grading should be used in dental implant therapy as a means to ensure maximum conservation of teeth and maximum preservation of alveolar bone. These biologic principles should guide the treatment planning process and supersede a mechanically based, restoratively driven rationale that should be secondary to the biologic principles of conservation and preservation but part of the collaborative treatment planning process. And treatment alternatives throughout the patient’s lifetime should be provided for in case of prosthesis loss due to periâ implantitis. The use of grading will help with recognition of systemic aspects that can have a negative impact.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149297/1/jper10267_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149297/2/jper10267.pd

Staging and grading of periodontitis: Framework and proposal of a new classification and case definition

BackgroundAuthors were assigned the task to develop case definitions for periodontitis in the context of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. The aim of this manuscript is to review evidence and rationale for a revision of the current classification, to provide a framework for case definition that fully implicates state‐of‐the‐art knowledge and can be adapted as new evidence emerges, and to suggest a case definition system that can be implemented in clinical practice, research and epidemiologic surveillance.MethodsEvidence gathered in four commissioned reviews was analyzed and interpreted with special emphasis to changes with regards to the understanding available prior to the 1999 classification. Authors analyzed case definition systems employed for a variety of chronic diseases and identified key criteria for a classification/case definition of periodontitis.ResultsThe manuscript discusses the merits of a periodontitis case definition system based on Staging and Grading and proposes a case definition framework. Stage I to IV of periodontitis is defined based on severity (primarily periodontal breakdown with reference to root length and periodontitis‐associated tooth loss), complexity of management (pocket depth, infrabony defects, furcation involvement, tooth hypermobility, masticatory dysfunction) and additionally described as extent (localized or generalized). Grade of periodontitis is estimated with direct or indirect evidence of progression rate in three categories: slow, moderate and rapid progression (Grade A‐C). Risk factor analysis is used as grade modifier.ConclusionsThe paper describes a simple matrix based on stage and grade to appropriately define periodontitis in an individual patient. The proposed case definition extends beyond description based on severity to include characterization of biological features of the disease and represents a first step towards adoption of precision medicine concepts to the management of periodontitis. It also provides the necessary framework for introduction of biomarkers in diagnosis and prognosis.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144639/1/jcpe12945_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144639/2/jcpe12945.pd

Guest Editorial: Clarifications on the use of the new classification of periodontitis

This editorial provides clarifications on the application of the Stage and Grade classification of periodontitis. In particular it describes: (1) how to apply the extent criterion to the defined Stage of the disease; and (2) how to calculate tooth loss because of periodontitis in Stage III and IV cases presenting with evidently hopeless (irrational to treat) teeth with a clinical definition of such teeth.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155462/1/jcpe13286_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155462/2/jcpe13286.pd

Letter to the Editor: Authors’ response:

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141212/1/jper0182.pd