Severity Criteria

Periodontal disease is an inflammatory disease caused by a bacterial infection. It is characterized by a progressive destruction of the dental attachment tissues. Left untreated, it may lead to complete loss of dental attachment structures and subsequently loss of teeth.

The primary objective of treatment is to arrest the progressive destruction of periodontal tissue and thus to arrest loss of attachment structures. However, the infectious process involved in periodontal disease is complex. Host susceptibility and the presence of pathogenic bacterial species, whether exogenous or commensal, interact and either promote or hinder the progression of the disease. Simultaneously, numerous local or environmental factors exert an influence on the etiologic agents and the course of disease. Because of its multifactorial nature, periodontal disease is difficult to manage. In formulating treatment strategies, both the patient’s periodontal susceptibility and the amount of periodontal destruction need to be taken into account. Repair and regeneration have become realistic objectives in the current context of periodontal therapeutics. For this reason, a methodic assessment of severity factors is a crucial step in treatment planning.

Severe periodontal disease is characterized by:

• Destruction of periodontal attachment tissue exceeding one third of the root’s length

• Class II or III furcation invasion

• Probing depths exceeding 6 mm

• Attachment loss exceeding 4 mm

Some teeth have already been lost or are unlikely to be maintained. The indication of prosthetic restorations for the replacement of missing teeth denotes the irreversible aspect of treatment in the periodontal patient. However, prosthetic rehabilitation may seem a risky endeavor in the context of uncontrolled periodontal disease. This raises several questions concerning both the disease itself and the global treatment strategy:

• Is infection control possible in all forms of periodontitis?

• Are there severity factors? How can they be detected? Can they be eliminated?

• What are the risk factors?

• What would be the best treatment strategy?

• To what extent can a conservative approach be applied?

• What are the different criteria that indicate the decision to extract?

• When should the decision to extract be made?

• What is the prognosis for the remaining teeth?

• Is it possible to place implants in the context of advanced periodontal disease?

• Should we carry out periodontal treatments less often an