PERIODONTAL PROTOCOL

Periodontitis Staging

AAP/EFP Clinical Framework 2026

AAP
Validated

RADIOGRAPHIC BONE LOSS (RBL)

< 15% (Stage I) 15% - 33% (Stage II) > 33% (Stage III) Complex (Stage IV)

MAX PROBING DEPTH (mm)

RISK FACTORS (FOR GRADING)

Smoking Status

Diabetes (HbA1c)

FINAL CLASSIFICATION

--?

Awaiting Full Data

CLINICAL CHARTING NOTE

The AAP Periodontal Framework

The 2018 World Workshop on the Classification of Periodontal and Peri-Implant Diseases introduced a multi-dimensional system. **Staging** describes the severity and complexity of the disease, while **Grading** describes the risk of progression and systemic impact.

How is Stage IV different from Stage III?

Stage IV is defined by more severe tooth loss (≥ 5 teeth due to periodontitis) and a high complexity of rehabilitation, often involving bite collapse or masticatory dysfunction.

Can a Grade change?

Yes. If a patient stops smoking or achieves better glycemic control (HbA1c), their Grade may be downgraded from C to B or A over time, reflecting a slower progression risk.

Dr. Nikhil Mahajan, PT

Clinical Research Reviewer

Evidence

Tonetti MS, et al. J Periodontol. 2018.
AAP Best Practices Guidelines.