); diagnosis of GPIIIIVC [. Lastly, certain risk factors are associated with progressive bone loss including smoking and diabetes. The American Academy of Periodontology (AAP) announced new periodontal classifications for the AAP Guidelines. ; Lee, J.H. Results: The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting,. While associations between periodontitis and various systemic conditions and diseases have been suggested by research, evidence of causality is mixed and the strength of the evidence differs for various conditions. Orthodontic treatment (OT) is more often included in the multidisciplinary treatment for adult patients with stage III-IV periodontitis due to impaired smile aesthetics, functional problems, or as an . 2015;69:717. Mengel R, Behle M, Flores-de-Jacoby L. Osseointegrated implants in subjects treated for generalized aggressive periodontitis: 10-year results of a prospective, long-term cohort study. Periodontitis as a Manifestation of Systemic Diseases, Patient education and oral hygiene instruction, Complete removal of supragingival calculus, Restoration or temporization of carious lesions. Graetz C, Slzer S, Plaumann A, Schlattmann P, Kahl M, Springer C, et al. If the plaque becomes very thick because of poor oral hygiene and oxygen within the plaque is depleted, the bacterial population can become more pathogenic, with a higher percentage of nonmotile, gram-negative anaerobic rods. In these situations, significantly rapid progressive damage to the attachment apparatus, which can lead (especially in stage IV) to tooth loss and occlusion impairment, is appreciated [ 4 ]. Some dogs and cats may not allow regular toothbrushing, so the plaque should be removed by wiping with a gauze pad at least every second or third day. The goal of periodontal treatment is to eliminate dysbiotic plaque biofilm from the tooth surface and to establish an environment that allows the maintenance of health. A novel surgical approach for the management of soft tissues in regenerative procedures. 2022 May;52(3):511-525. Abstracts of Presentations at the Association of Clinical Scientists 143. Periodontal disease increases with age, 70.1% of adults 65 years and older have . EFP Workshop Participants and Methodological Consultant. Stage 4: There is advanced periodontitis, with >50% of attachment loss as measured by probing of the clinical attachment level or by radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root, or there is a stage 3 furcation involvement in multirooted teeth (see below). F: 904-398-1810, 9432 Baymeadows Road, Suite 200, Products that slow or prevent the attachment of pellicle or the adhesion of pioneering plaque bacteria may provide some benefit. A stage 0 mobility up to 0.2 mm is physiologic. Background: Subsiding of Periodontitis in the Permanent Dentition in Individuals with Papillon-Lefvre Syndrome through Specific Periodontal Treatment: A Systematic Review. The simplified papilla preservation flap. The link you have selected will take you to a third-party website. Martin-Cabezas R, Seelam N, Petit C, et al. The aim of this study was to understand if important factors such as smoking, gender, age, plaque, pus, and probing pocket depth could influence the histomorphological pattern of generalized stage III-IV, grade C periodontitis (GPIII-IVC), which is a particular form of periodontitis. Lost bone may be augmented by use of bone grafts or bone graft substitutes. However, biofilms are easily and effectively removed mechanically with a toothbrush. Berglundh, T., Armitage, G., Araujo, M. G., Avila-Ortiz, G., Blanco, J., Camargo, P. M., . By including these grade modifiers, your periodontist can discuss taking an active role in the management of these conditions as well. The worst periodontal condition is evident in patients with generalized stage III-IV, grade C periodontitis. Periodontol 2000. Tonetti, M. S. (2018). National Library of Medicine This website is using a security service to protect itself from online attacks. Published by John Wiley & Sons Ltd. Ann Clin Lab Sci. Int. Diagnosis and Classification of Periodontitis, American Academy of Periodontology: Resources for Patients, National Institute of Dental and Craniofacial Research: Periodontal (Gum) Disease, Centers for Disease Control and Prevention: Periodontal Disease, https://www.perio.org/for-patients/periodontal-treatments-and-procedures/surgical-procedures/, ADA supports USDA proposal to modernize WIC, Gallup Indian Medical Center holds first GKAS event, Cardiac Implantable Devices and Electronic Dental Instruments, Roughly 42 percent of all dentate U.S. adults 30 years of age or older have periodontitis. Materials and methods: This can reverse gingivitis, returning the gingiva to a healthy, uninflamed state. contributed reagents/materials/analysis tools; B.B. Maxillary canine teeth with pockets on their palatal side that have already progressed to form an oronasal fistula require extraction and oronasal fistula repair. A stage 2 mobility is present when tooth mobility is increased in any direction other than axial over a distance of >0.5 mm and up to 1 mm. Ma KS, Hasturk H, Carreras I, et al. 0000001859 00000 n A recent CDC report 1 provides the following data related to prevalence of periodontitis in the U.S.: 47.2% of adults aged 30 years and older have some form of periodontal disease. Jepsen, S.; Caton, J.G. Probing depth (PD), bleeding on probing (BOP) and percentage of relative bone height (RBH%) were measured and calculated. Federal government websites often end in .gov or .mil. 2012 Oct;39(8):541-4, 547-8, 551-2. The exclusion criteria included pregnant or breastfeeding women; women practicing birth control methods; cancer; allergy or other severe adverse reactions to amoxicillin and metronidazole; use of local and/or systemic antibiotics in the 6 months previous to the beginning of the study. future research directions and describes possible research applications. 2017 Nov;28(11):1354-9. Extraction treatment on orthodontic patients with Stage /Grade C periodontitis: a preliminary study October 2021 Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese . The bacteria themselves and their metabolic products also contribute to the bone damage. The teeth should be brushed daily to remove plaque and prevent calculus (tartar) accumulation. 0000027419 00000 n 2017 Dec;18(4):272-6. aging; histomorphometric analysis; periodontitis; plaque; smoke. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Our results showed that the vascular area was also more than halved in subjects with residual plaque on tooth surfaces. This is determined usually by comparing the patients disease level to their age. Periodontol 2000 2020;83(1):213-33. CASE PRESENTATION Chief complaints 2014;65(1):107-33. o [pig guinea] Patients in stage IV, grade C had TLPD rates of 0.24 0.31, 0.15 0.24 (number of teeth/patient/year . Tooth loss and radiographic bone loss in patients without regular supportive care: A retrospective study. 0000090727 00000 n Severe or very severe periodontitis will be considered Stage III or Stage IV. Conclusions: The paper describes a simple matrix based on stage and grade to appro- Risk factor analysis is used as grade modier. Once the determination of periodontitis has been made, the disease is classified according to one of four Stages (I-IV) based upon the most severe area of disease presentation, which describe the disease severity and extent of disease, focusing on attachment and bone loss (Table 1A). Plaque is a typical biofilm, composed of many microorganisms that differ from their planktonic forms. In 2018, the American Academy of Periodontology and the European Federation of Periodontology published the World Workshop Classification System for Periodontal and Peri-Implant Diseases and Conditions, which established a new approach to diagnosing periodontal disease to replace the system developed in 1999. P: 904-278-1175 Hu KF, Ho YP, Ho KY, Wu YM, Wang WC, Chou YH. PMC Your IP: A stage 1 mobility is present when tooth mobility is increased in any direction other than axial over a distance of >0.2 mm and up to 0.5 mm. . A patient is said to have periodontitis if: interdental clinical. For the future, new Randomized Clinical Trials RCTs will be needed to verify whether smoking is a key factor in inflammatory and vascular periodontal alteration. 2022 Feb;26(2):1937-1945. doi: 10.1007/s00784-021-04172-4. Visit our dedicated information section to learn more about MDPI. Today's Digital Media, LLC d/b/a Today's RDH, New AAP Periodontal Classification Guidelines, Periodontal Maintenance: Taking the Guesswork out of the 4910, Top 10 Essentials for Every Hygienists Toolkit, http://perio.org/sites/default/files/files/Staging%20and%20Grading%20Periodontitis.pdf, Periodontal Inflammation Linked to Vision Loss. Treatment of early periodontitis includes tooth scaling and root planingaccompanied by improved oral hygiene. and transmitted securely. [Introduction and interpretation of the European Federation of Periodontology S3 level clinical practice guideline for treatment of periodontitis]. All rights reserved. Shallow periodontal pockets are treated in a closed fashion, but pockets >6 mm deep require open surgery (creation of a periodontal flap) to expose the root surface and alveolar bone for adequate treatment (root scaling/planing and alveoloplasty). 0000029217 00000 n We use cookies on our website to ensure you get the best experience. All in all, this Staging and Grading system helps your periodontist provide a patient-centered evaluation and treatment plan as well as an effective way to communicate more clearly with our patients. Journal of Periodontology, 89. doi:10.1002/jper.17-0739. The binary coded variable BoP was summarized as counts and percentages. Dent Update. doi: 10.1016/S0140-6736(05)67728-8. https://doi.org/10.3390/biomedicines7020043, Buffoli B, Garzetti G, Calza S, Scotti E, Borsani E, Cappa V, Rimondini L, Mensi M. Periodontitis Stage IIIIV, Grade C and Correlated Factors: A Histomorphometric Study. The inclusion criteria were age older than 18 years; no systemic illnesses or disorders; no medical treatment that may impair healing (immunodepression, immunosuppression, diabetes, etc. Next, we look at the patient-specific factors that contribute to the complexity of long-term management such as probing depths, the number of lost teeth, the shape of bone loss, access for hygiene, occlusal trauma, tooth alignment, and many others. Chen JT, Wu IT, Huang RY, Lin YC, Chou YH, Lin T, Kuo PJ, Tu CC, Hou LT, Lai YL, Lu HK, Tsai CC, Yuan K, Chen CJ, Ho CS, Yang YC, Wu AY, Huang KC, Chiang CY, Chang PC. 0000065735 00000 n All articles published by MDPI are made immediately available worldwide under an open access license. This treatment of periodontal disease can be non-surgical or surgical with the optimal treatment being based on individual patient, site, and systemic factors. P: 904-398-1136 Two key processes involved in the evolution of this pathology are angiogenesis and inflammatory infiltrate. Liu Z, Gao X, Liang L, Zhou X, Han X, Yang T, Huang K, Lin Y, Deng S, Wang Z, Wang C. J Inflamm Res. A periodontal pocket is defined as a pathologically deepened gingiva sulcus, according to the definition reported by the American Academy of Periodontology. Al-Zahrani, M. S., Alhassani, A. Methods and Results A 62-year-old South Asian female presented with unstable Stage IV Grade C periodontitis, poor oral hygiene and multiple autoimmune conditions including oral lichen planus. ; E.S. Dental comos. Methods: The study included 27 adult patients (13 smoker, 14 non-smoker) with stage III/IV-grade C periodontitis and 25 healthy adult subjects. o [alopecia OR hair loss ], , Dipl. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Int J Periodontics Restorative Dent. %i}F/5>e3cv4qg j. Despite the bone damage, the amount of bone loss in this stage of periodontal disease is minor so that usually no additional treatment is required. permission is required to reuse all or part of the article published by MDPI, including figures and tables. Bookshelf Meyer-Bumer, A.; Pritsch, M.; Cosgarea, R.; el Sayed, N.; Kim, T.S. American Academy of Periodontology. Measuring the effect of intra-oral implant rehabilitation on health-related quality of life in a randomized controlled clinical trial. doi: 10.7759/cureus.5586. J Clin Periodontol. A sample size of 18 subjects (11 non-smokers and 7 smokers) is sufficient to detect a clinically important difference of 0.45% between groups in reducing the vascular area, assuming a mean in healthy and non-smoking patients of 1% [, Similarly, as the mean of inflammatory infiltrates reported by literature in healthy and non-smoking patients is 9% with a standard deviation of 1.5% [. Division of Anatomy and Physiopathology, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy, Section of Periodontics, School of Dentistry, Department of Surgical Specialties, Radiological Science and Public Health, University of Brescia, 25123 Brescia, Italy, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy, Big & Open Data Innovation Laboratory (BODaI-Lab), University of Brescia, 25123 Brescia, Italy, Department of Health Sciences, University of Piemonte Orientale UPO, 28100 Novara, Italy, Center for Translational Research on Autoimmune & Allergic DiseasesCAAD, University of Piemonte Orientale UPO, 28100 Novara, Italy. Rheumatoid arthritis: A 2020 systematic review indicates that periodontitis may increase the risk of developing rheumatoid arthritis. Step 2: Establish Stage is divided into two sections. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. 1 (2021): Jan - Mar / 2021 - published Dec 2020, https://doi.org/10.14295/bds.2021.v24i1.2238, Magnetic resonance imaging texture analysis of the temporomandibular joint for changes in the articular disc in individuals with migraine headache, Impact of photoinitiator quality on chemical-mechanical properties of dental adhesives under different light intensities, Knowledge and attitudes related to erosive tooth wear of professional wine tasters: a cross-sectional study, Insights on the role of cytokines in carious lesions, Biomechanics of implant-supported restorations, Diagnostic accuracy of dental pulse oximeter with customized sensor holder, thermal test and electric pulp test for the evaluation of pulp vitality: An in vivo study, Comparative evaluation of post-operative pain after pulpectomy with k-files, kedo-s files and mtwo files in deciduous molars-a randomized clinical trial, Treatment Considerations for Patient With Amelogenesis Imperfecta: A Review, Randomized, double-blind, placebo-controlled clinical trial on the effects of propolis and chlorhexidine mouthrinses on gingivitis, Effects of Typified Propolis on Mutans Streptococci and Lactobacilli: A Randomized Clinical Trial. Inflammatory mediators produced by the host directly result in bone and tissue damage around the root. Journal of Periodontology, 93, 354-363. J Indian Soc Periodontol. 2022 John Wiley & Sons A/S. Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment. Stage 2: There is early periodontitis with < 25% of attachment loss or, at most, there is a stage 1 furcation involvement in multirooted teeth (see below). Tooth loss in generalized aggressive periodontitis: Prognostic factors after 17 years of supportive periodontal treatment. BACKGROUND The current study's aim was to evaluate and compare demineralized freeze-dried bone allograft (DFDBA) with and without concentrated growth factor (CGF) membrane in the treatment of periodontal intrabony defects on both a clinical . She previously taught in two dental hygiene programs as clinical and didactic faculty. Use to remove results with certain terms ; Bursiewicz, W.; Socha, M.; Ozorowski, M.; Pawlak-Osiska, K.; Wiciski, M. The role of Tannerella forsythia and Porphyromonas gingivalis in pathogenesis of esophageal cancer. generalized). Ask Kara RDH: Why Isnt Todays RDH Addressing New Infection Control QUIZ: Test Your Ultrasonic Insert Knowledge! Stockholm: Swedish Council on Health Technology Assessment (SBU); 2004 Oct. SBU Yellow Report No. Systemic antibiotics in the treatment of aggressive periodontitis. NOTE: In 2017, the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) convened panels of experts to develop a classification system for periodontal and peri-Implant diseases and conditions.1 In 2018, these panels published consensus reports that described periodontal diseases including: periodontal health, gingival diseases and conditions2; periodontitis3, 4; and other conditions affecting the periodontium3, 4; as well as a system describing for peri-implant diseases (peri-implant health, peri-implant mucositis, and peri-implantitis).5 This Oral Health Topic page will focus on classifications related to periodontitis. 2017 Mar;21(2):485-503. The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. ; Bissada, N.F. 0000018315 00000 n 0000101613 00000 n Cochrane Database Syst Rev 2018;1:CD009376. 2010 Jun;53:154-66. J Prosthet Dent. Pregnancy complications: An umbrella review of 23 systematic reviews found that periodontitis during pregnancy seems to contribute to increased risk of preterm birth, low birthweight infants and preeclampsia. Stage III/grade C (55.77%) was the most common in the study by Graetz et al. This case report shows that within the limitations of this study a successful outcome can be achieved with an early diagnosis and treatment involving elimination of infectious microorganisms and meticulous long-term maintenance combined with regenerative techniques and implant placement to restore the masticatory function and improve the quality of life for the patient. 0000057263 00000 n Aim: Statistical analyses were performed by statistician from the University of Brescia. (2006). See this image and copyright information in PMC. Federal government websites often end in .gov or .mil. Use OR to account for alternate terms A 40-year-old patient with a severe periodontitis (Stage IV, Grade C) was treated with active, nonsurgical periodontal therapy. Firm, fibrous items that allow tooth penetration can wipe plaque from the tooth surfaces during chewing. Scaling and root planing (SRP) complemented by systemic antibiotics, access surgery, regenerative techniques and implant placement are among the treatments used for patients with this condition. 0000056742 00000 n Depending on disease distribution and extent, periodontitis can be categorized into a localized (<30% of teeth involved) generalized or molar/incisor pattern [, The worst periodontal condition is evident in patients with generalized stage IIIIV, grade C periodontitis. For mild to moderate periodontitis, the focus will be on clinical attachment loss (CAL). Stage 3: There is moderate periodontitis, with 25%50% of attachment loss as measured by probing of the clinical attachment level or by radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root, or there is a stage 2 furcation involvement in multirooted teeth (see below). Gingivitis is common in dogs and cats and refers to inflammation of the gingiva in response to plaque antigen. J Clin Periodontol. Young patients showed a significant increase in vascular area percentage compared to older patients (0.60% vs. 0.46%, p-value = 0.0006) and this percentage was also higher in non-smokers compared to smokers (0.41% vs. 0.55%, p-value = 0.0008). 2008 Mar;39(3):211-5. Clinical Periodontology and Implant Dentistry, Help us to further improve by taking part in this short 5 minute survey, The Role of Wnt and R-spondin in the Stomach During Health and Disease, Zimmermann-Laband-1 Syndrome: Clinical, Histological, and Proteomic Findings of a 3-Year-Old Patient with Hereditary Gingival Fibromatosis, Neuromyelitis Optica Spectrum Disorder and Anti-MOG Syndromes, Oral and Psychological Alterations in Haemophiliac Patients, https://doi.org/10.3390/biomedicines7020043, Malignant and Potentially Malignant Disorders of the Oral Cavity: Updates from Pathogenesis to Therapy, http://creativecommons.org/licenses/by/4.0/. 2015 May;113(5):371-82. Bacterial plaque on the crown surface of a tooth constantly presents antigen to the marginal gingiva, stimulating an inflammatory response and resulting in gingivitis. Periodont. P: 904-443-7000 ; Mealey, B.L. Quantitative analysis of the percentage of inflammatory cells and the vascular area were performed using a camera equipped with an image analysis system (Image-Pro Premier 9.1; Immagini e Computer, Milan, Italy). ; Johnson, N.W. Teeth that have become mobile because of loss of attachment should be extracted. 22. Diabetes: Periodontal disease and diabetes are considered to have a bidirectional relationship: hyperglycemia has an effect on oral health and periodontitis has an effect on glycemic control. doi: 10.1111/jcpe.12945. Root scaling (removing plaque and calculus on exposed root surfaces) and planing (smoothing the root surfaces by removing textural irregularities and diseased cementum) are performed, followed by gingival curettage that removes the infected and inflamed inside layer of a periodontal pocket. It occurs with the destruction of the supporting periodontal tissue and migration of alveolar bone, periosteum, and periodontal ligament versus the tooth apex. Periodontal disease is infection and inflammation of the periodontium (the tissues that surround and support the teeth) due to plaque bacteria and the hosts response to the bacterial insult. West N, Chapple I, Claydon N, D'Aiuto F, Donos N, Ide M, Needleman I, Kebschull M; British Society of Periodontology and Implant Dentistry Guideline Group Participants. She is currently completing a doctorate program in health sciences. 0000131229 00000 n Get Directions Journal of Dental Research, 79(9), 1659-1663. https://doi.org/10.3390/biomedicines7020043, Subscribe to receive issue release notifications and newsletters from MDPI journals, You can make submissions to other journals. . Treatment of areas where plaque and food debris can collect, including orthodontic treatment and removal of plaque retentive factors. 104.236.29.24 Int J Periodontics Restorative Dent. Prevention of gingivitis is the same as its treatment: plaque removal and control. Recent epidemiologic trends in periodontitis in the USA. Merck & Co., Inc., Rahway, NJ, USA(known as MSD outside of the US and Canada) is dedicated to using the power of leading-edge science to save and improve lives around the world. Staging intends to classify the severity and extent of a patient's disease based on a measurable amount of destroyed/damaged tissue from periodontitis. The treatment plan for the management of stage IV periodontitis should include a successful outcome after completing the interventions in steps 1, 2 and 3, according to the EFP S3 Level clinical practice guideline for treatment of stage I-III periodontitis (Sanz, Herrera, et al., 2020 . The bacteria in plaque are predominantly nonmotile, gram-positive aerobes, including Staphylococcus spp and Streptococcus spp, but many others are also present. Clipboard, Search History, and several other advanced features are temporarily unavailable. J Periodontol. J Clin Periodontol 2018;45 Suppl 20:S219-S29. Although this microbiota does stimulate an immune response, the bacteria in an otherwise healthy mouth exist in relative commensal harmony with the host. 0000026481 00000 n Journal of Public Health Dentistry, 81(3), 206-213. Bezrukova IV.The concept of maintenance therapy for periodontal inflammations characterized by an aggressive course .Stomatologiia (Mosk). Leow NM, Moreno F, Marletta D, et al. In this study, we did not compare the percentage of the vascular area and inflammatory cells with healthy patients, but we evaluated how some factors (smoking, age, PPD, plaque) influenced these percentages in GPIIIIVC patients. During the one and two-year follow-ups, the teeth and implants did not show any signs of instability, attachment loss or bone loss. Allen, P. F., Thomason, J. M., Jepson, N. J., Nohl, F., Smith, D. G., & Ellis, J. Malinowski, B.; Wsierska, A.; Zalewska, K.; Sokoowska, M.M. concluded that periodontitis is associated with (1) higher HbA1c levels in individuals without diabetes and in individuals with type 2 diabetes, (2) worsened diabetes-related complications in individuals with type 2 diabetes, and (3) an increased prevalence of complications in individuals with type 1 diabetes. HHS Vulnerability Disclosure, Help 0000056248 00000 n Effectiveness of systemic amoxicillin/metronidazole as an adjunctive therapy to full-mouth scaling and root planing in the treatment of aggressive periodontitis: a systematic review and meta-analysis. Considering the vascular area, young patients showed a significant increase compared to older patients (0.60% vs. 0.46%. Clin Oral Implants Res. Multiple external root resorptions in a patient with Stage IV, Grade C periodontitis and autoimmune diseases: A case report - Thandi - Clinical Advances in Periodontics - Wiley Online Library Epub 2021 Oct 28. BMC Cardiovasc Disord 2017;17(1):50. J Public Health Dent 2013;73(2):112-9. F: 904-443-7012, 252 15th Avenue South, A randomized controlled trial of implant-retained mandibular overdentures. Prevention of periodontitis is more complicated. Keywords: The results are reported as the estimates and 95% confidence intervals. Durable bonds at the adhesive/dentin interface: an impossible mission or simply a moving target. Recurrence and progression of periodontitis and methods of management in long-term care: A systematic review and meta-analysis. F: 904-278-1176, Copyright Drs. -, Caton J.C., Armitage G., Berglundh T., Chapple I.L.C., Jepsen S., Kornman K.S., Mealey B.L., Papapanou P.N., Sanz M., Tonetti M. A new classification scheme for periodontal and peri-implant diseases and conditionsIntroduction and key changes from the 1999 classification. Get Directions 8600 Rockville Pike Stage 4: There is advanced periodontitis, with >50% of attachment loss as measured by probing of the clinical attachment level or by radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root, or there is a stage 3 furcation involvement in multirooted teeth (see below). Comparison of the Marginal Bone Loss in One-stage versus Two-stage Implant Surgery. Written informed consent was obtained from all patients. J Clin Periodontol. Continuous variables such as PPD and CAL loss were summarized as geometric mean and standard deviation (sd). 2018 May;16(2):210-218. doi: 10.1111/idh.12290.