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Although the new classification presented several benefits to the severity and risk of progression of disease, some limitations remain. This review highlights key gaps in the grade C and molar\u2010incisor pattern (C\u2010MIP) classification, particularly the exclusion of primary dentition involvement, which limits early awareness, diagnosis, treatment, and research. Additionally, the current \u201cgrade C\u201d category includes a broad spectrum of patients, ranging from systemically healthy young individuals with early onset and rapid disease progression to older adults whose disease is associated with modifying factors. This overlap masks key clinical and biological differences, complicating efforts to identify susceptibility profiles and tailor treatment. Moreover, cases extending beyond the molar\u2010incisor pattern, including premolars or atypical presentations, pose challenges to the current classification system. These patients often exhibit early onset, familial aggregation, rapid progression, and absence of systemic risk factors, suggesting a unique susceptibility profile that may not be adequately captured by the current classification and deserve proper categorization to be better studied and treated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the conclusion of this paper, we suggest expansion and clarification of the current classification system to: (1) recognize periodontitis in the primary dentition; (2) distinguish patients with grade C periodontitis by the presence or absence of modifying factors; and (3) introduce a subclassification for grade C cases predominantly affecting young patients. These refinements may improve diagnostic accuracy and support more targeted research, prevention, and treatment for at\u2010risk youth.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jper.70119","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T13:45:31Z","timestamp":1776087931000},"page":"1885-1899","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Grade C molar\u2010incisor pattern periodontitis classification and its challenges"],"prefix":"10.1002","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0731-9570","authenticated-orcid":false,"given":"Yasmin Teixeira das","family":"Gra\u00e7as","sequence":"first","affiliation":[{"name":"Center for Oral Health Research and Division of Periodontology, Department of Oral Health Practice, College of Dentistry University of Kentucky Lexington Kentucky 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