{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T01:34:09Z","timestamp":1792892049977,"version":"4.5.0"},"reference-count":71,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2018,6,21]],"date-time":"2018-06-21T00:00:00Z","timestamp":1529539200000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100004357","name":"Procter and Gamble","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004357","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007190","name":"Unilever","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007190","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007619","name":"Osteology Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aap.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Periodontology"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Authors 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\u2010Implant 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\u2010of\u2010the\u2010art 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Evidence 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 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\u2010associated 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\u2010C). Risk factor analysis is used as grade modifier.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jper.18-0006","type":"journal-article","created":{"date-parts":[[2018,6,21]],"date-time":"2018-06-21T06:43:40Z","timestamp":1529563420000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1985,"title":["Staging and grading of periodontitis: Framework and proposal of a new classification and case definition"],"prefix":"10.1002","volume":"89","author":[{"given":"Maurizio S.","family":"Tonetti","sequence":"first","affiliation":[{"name":"Periodontology Faculty of Dentistry University of Hong Kong  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Greenwell","sequence":"additional","affiliation":[{"name":"Graduate Periodontics School of Dentistry University of Louisville  Louisville KY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth S.","family":"Kornman","sequence":"additional","affiliation":[{"name":"Department of Periodontics and Oral Medicine University of Michigan School of Dentistry  Ann Arbor MI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,6,21]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Proceedings of the World Workshop in Clinical Periodontics","author":"Nevins M","year":"1989"},{"key":"e_1_2_8_3_1","first-page":"1994","volume-title":"Proceedings of the 1st European Workshop on Periodontics, 1993"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1998.tb02419.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1902\/annals.1996.1.1.1"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/00220345910700110701"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2000.71.11.1699"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1997.tb01187.x"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1902\/annals.1999.4.1.53"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1902\/annals.1999.4.1.38"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1902\/annals.1999.4.1.1"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2015.157001"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.16-0642"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.16-0480"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.16-0712"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.17-0062"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.17-0670"},{"issue":"1","key":"e_1_2_8_18_1","first-page":"S28","article-title":"Non\u2013plaque\u2010induced gingival diseases","volume":"89","author":"Holmstrup P","year":"2018","journal-title":"J Periodontol"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12808"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1986.tb01487.x"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0765.1986.tb01454.x"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1994.65.5s.479"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1991.62.5.293"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.17-0426"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.17-0424"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/JPER.17-0427"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034514527288"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1977.tb01879.x"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1902\/annals.1999.4.1.39"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1990.tb01059.x"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1986.tb00852.x"},{"key":"e_1_2_8_32_1","first-page":"7","article-title":"Periodontal risk assessment (PRA) for patients in supportive periodontal therapy (SPT)","volume":"1","author":"Lang NP","year":"2003","journal-title":"Oral Health Prev Dent"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12344"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2012.110664"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2005.00822.x"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2011.01768.x"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1984.tb01344.x"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1991.tb00435.x"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12497"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0757.1994.tb00002.x"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1996.67.7.666"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2010.01587.x"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1976.tb01861.x"},{"key":"e_1_2_8_44_1","unstructured":"Proceedings of the World Workshop in Clinical Periodontics. Princeton New Jersey July 23\u201327 1989. In: Nevins M Becker W Kornman K eds. Chicago: American Academy of Periodontology;1989."},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1999.70.1.49"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2013.1340016"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2013.1340019"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.2007.01173.x"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2000.71.10.1528"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.1997.270-ce1162.x"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12171"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1177\/154405910508400312"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.2013.134007"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.009990"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.13.1813"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2004.04.028"},{"key":"e_1_2_8_57_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000055014.62083.05"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042378"},{"key":"e_1_2_8_59_1","unstructured":"European Federation of Periodontology and American Academy of Periodontology.Periodontitis and systemic diseases \u2010 Proceedings of a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology. Tonetti M Kornman KS eds.2013."},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12473"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.282431"},{"key":"e_1_2_8_62_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12836"},{"key":"e_1_2_8_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2014.04.001"},{"key":"e_1_2_8_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1984.tb00902.x"},{"key":"e_1_2_8_65_1","doi-asserted-by":"publisher","DOI":"10.1902\/jop.1978.49.5.225"},{"key":"e_1_2_8_66_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034513492336"},{"key":"e_1_2_8_67_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12732"},{"key":"e_1_2_8_68_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12350"},{"key":"e_1_2_8_69_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-051X.1989.tb01668.x"},{"key":"e_1_2_8_70_1","first-page":"1","article-title":"Patterns of alveolar bone loss in the assessment of periodontal treatment priorities","volume":"66","author":"Papapanou PN","year":"1989","journal-title":"Swed Dent J Suppl"},{"key":"e_1_2_8_71_1","doi-asserted-by":"publisher","DOI":"10.1902\/annals.1998.3.1.88"},{"key":"e_1_2_8_72_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12392"}],"updated-by":[{"DOI":"10.1002\/jper.10239","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T00:00:00Z","timestamp":1543449600000}}],"container-title":["Journal of Periodontology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2FJPER.18-0006","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/JPER.18-0006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T10:13:53Z","timestamp":1760868833000},"score":1,"resource":{"primary":{"URL":"https:\/\/aap.onlinelibrary.wiley.com\/doi\/10.1002\/JPER.18-0006"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6]]},"references-count":71,"journal-issue":{"issue":"S1","published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1002\/JPER.18-0006"],"URL":"https:\/\/doi.org\/10.1002\/jper.18-0006","archive":["Portico"],"relation":{"is-referenced-by":[{"id-type":"doi","id":"10.1007\/s10266-026-01473-6","asserted-by":"object"}]},"ISSN":["0022-3492","1943-3670"],"issn-type":[{"value":"0022-3492","type":"print"},{"value":"1943-3670","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6]]},"assertion":[{"value":"2018-01-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-02-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}