Implementation of the 2018 Classification of Periodontal Diseases: A Questionnaire-Based Survey

Abstract

Objectives

The new classification of periodontal and peri-implant diseases and conditions (2018) includes definitions of the respective diseases, modifications, and new additions to the 1999 classification. The purpose of the study was to present the opinion and level of understanding of Greek dentists regarding the new classification and to determine the approach for its establishment.

Materials and Methods

A questionnaire consisting of 26 multiple-choice questions was distributed to Greek dentists in paper or digital form.

Statistical Analysis

Data were collected, recorded using Microsoft Excel, and were analyzed with SPSS 29.0 (IBM, United States).

Results

A total of 203 questionnaires were collected (49.3% male/50.2% female; mean age 39.02 years). 36.8% of the participants exclusively practiced periodontology and 44.8% general dentistry. Seventy-one participants were members of the Hellenic Society of Periodontology (HSP). 58.9% used the old classification system, which is reported as preferred by 53.5% of HSP members. Also, 53.3% of participants characterized the new classification as difficult to be applied, 47.1% of whom were HSP members. The most frequent reason for not using it (63/133) was the convenience of the older system application. A statistically significant higher percentage of HSP members correctly answered the comprehension questions (diagnostic criteria and clinical cases) of the questionnaire (z-test with Bonferroni correction < 0.05). Note that 79.7% of the participants stated that they should improve their knowledge regarding the new classification, mainly through seminars/courses.

Conclusion

Most Greek dentists appear not to implement the 2018 classification system due to reported difficulty in understanding, while recognizing the need to comprehend and apply it to their clinical practice.

Keywords

classification - periodontal diseases - questionnaire - diagnosis

Publication History

Article published online:
23 April 2025

• References

• 1 Sanz M, Herrera D, Kebschull M. et al; EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol 2020; 47 (Suppl. 22) 4-60
• 2 Herrera D, Sanz M, Kebschull M. et al; EFP Workshop Participants and Methodological Consultant. Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol 2022; 49 (Suppl. 24) 4-71
• 3 Caton JG, Armitage G, Berglundh T. et al. A new classification scheme for periodontal and peri-implant diseases and conditions - introduction and key changes from the 1999 classification. J Periodontol 2018; 89 (Suppl. 01) S1-S8
• 4 Papapanou PN, Sanz M, Buduneli N. et al. Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 2018; 45 (Suppl. 20) S162-S170
• 5 Graetz C, Mann L, Krois J. et al. Comparison of periodontitis patients' classification in the 2018 versus 1999 classification. J Clin Periodontol 2019; 46 (09) 908-917
• 6 Ravidà A, Travan S, Saleh MHA. et al. Agreement among international periodontal experts using the 2017 World Workshop classification of periodontitis. J Periodontol 2021; 92 (12) 1675-1686
• 7 Abrahamian L, Pascual-LaRocca A, Barallat L. et al. Intra- and inter-examiner reliability in classifying periodontitis according to the 2018 classification of periodontal diseases. J Clin Periodontol 2022; 49 (08) 732-739
• 8 Hefti AF, Preshaw PM. Examiner alignment and assessment in clinical periodontal research. Periodontol 2000 2012; 59 (01) 41-60
• 9 Marini L, Tomasi C, Gianserra R. et al. Reliability assessment of the 2018 classification case definitions of peri-implant health, peri-implant mucositis, and peri-implantitis. J Periodontol 2023; 94 (12) 1461-1474
• 10 Alshehri MK, Alamry N, AlHarthi SS. et al. The 2018 Classification of Periodontal Diseases: an observational study on inter-examiner agreement among undergraduate students. Oral Health Prev Dent 2024; 22: 519-524
• 11 Saleh MHA, Dias DR, Araújo MG, Wang H-Lay. Staging and grading of periodontitis: setting standards for use in general practice. Curr Oral Health Rep 2022; 9 (04) 167-184
• 12 Holtfreter B, Kuhr K, Borof K. et al. ACES: a new framework for the application of the 2018 periodontal status classification scheme to epidemiological survey data. J Clin Periodontol 2024; 51 (05) 512-521
• 13 Dannan A. An academic experience regarding the implementation of the 2018 Classification System of Periodontal Diseases in the curriculum of the International University for Science and Technology. Clin Stud Med Case Rep 2022; 9 (02) 1-7