Dr. Gustavo Avila-Ortiz, a distinguished figure in periodontics, has an extensive educational and professional background. He obtained his Doctor of Dental Surgery degree and completed a PhD training program at the University of Granada in Spain. He furthered his education with an Master of Science degree and certification in periodontics from the University of Michigan.
Dr. Gustavo Avila-Ortiz.
Dr. Avila-Ortiz is a diplomate of the American Board of Periodontology and has more than 15 years of experience as an educator. He has served on numerous institutional committees and scientific organizations, contributing significantly to the field.
Avila-Ortiz is a former faculty member at the University of Michigan School of Dentistry and the University of Iowa College of Dentistry, where he held the Phillip A. Langston Professorship and chaired the periodontics department until 2022. Currently, he is a visiting professor in the Harvard School of Dental Medicine Division of Periodontics and practices periodontics and implant dentistry in Spain. His expertise extends to scholarly and continuing education activities, making him a leading authority in the field.
Periodontal health and disease classification
Avila-Ortiz's recent lecture at the American Academy of Periodontology meeting focused on the new classification system for periodontal diseases, introduced in 2018. Developed through a global consensus conference, this system provides a comprehensive framework for diagnosing and treating periodontal and peri-implant diseases and conditions.
The previous classification system, active from 1999, had limitations, particularly in defining periodontal health and peri-implant diseases. The new classification aims to address these and other gaps, incorporating new data and enhancing communication among clinicians, researchers, and educators.
Categories of periodontal health
The new classification delineates three types of periodontal health: health of an intact periodontium, health of a reduced periodontium in a non-periodontitis patient, and health of a reduced periodontium in a periodontitis patient.
An example of the health characteristics of an intact periodontium is a patient with normal gingival size, shape, consistency, and texture, with probing depths generally between 1 mm to 4 mm and minimal bleeding on probing (BOP). In contrast, the health characteristics of a reduced periodontium in a periodontitis patient involve a history of periodontitis, with attachment loss and possibly altered gingival contours due to previous treatment.
Periodontitis and the new classification
Periodontitis, a chronic multifactorial inflammatory disease, is characterized by the progressive destruction of the tooth-supporting apparatus. The new classification system eschews the distinction between "chronic" and "aggressive" periodontitis, instead adopting a staging and grading system that considers disease severity, complexity, and risk factors.
Staging reflects the extent and severity of the disease and treatment complexity, ranging from stage I (incipient disease) to stage IV (advanced disease). Grading assesses the rate of disease progression and the presence of established risk factors, such as smoking and diabetes, which may influence treatment outcomes and disease management.
The staging process primarily involves assessing clinical attachment loss (CAL), radiographic bone loss, and tooth loss due to periodontitis. For example, stage I periodontitis may involve a CAL of 1-2 mm, while stage IV may involve a more severe CAL of over 5 mm, with significant bone loss and tooth mobility.
Grading, on the other hand, involves evaluating the rate of disease progression, with grade A indicating a slow rate, grade B a moderate rate, and grade C a rapid rate. Factors such as smoking and uncontrolled diabetes can elevate a patient's risk profile, shifting the grade higher.
Case studies and practical application
Several case studies were presented to illustrate the practical application of the new classification. One notable case involved a 36-year-old woman with localized stage III, grade B periodontitis. The patient exhibited signs of clinical attachment loss exceeding 5 mm and bone loss extending beyond the middle third of the root, without tooth loss due to periodontitis. This classification highlighted the need for comprehensive periodontal therapy, including possible surgical intervention.
Another case featured a 49-year-old man with generalized stage III, grade C periodontitis. The patient, a heavy smoker, presented with significant bone loss and multiple sites with furcation involvement.
Despite the severe clinical presentation, the patient's periodontitis was managed through a combination of nonsurgical and surgical treatments, including pocket reduction surgery. The discussion emphasized the importance of individualized treatment plans tailored to the specific needs and risk factors of each patient.
Peri-implant diseases
The lecture also covered peri-implant health, mucositis, and peri-implantitis. Peri-implant health is defined by the absence of clinical signs of inflammation and bone loss.
In contrast, peri-implant mucositis involves inflammation without progressive bone loss one year after insertion of the final prosthesis, and peri-implantitis includes both inflammation and progressive bone loss. Regular radiographic monitoring and clinical assessments are crucial to detect and manage peri-implant diseases early.
Management of peri-implant diseases
The management of peri-implant diseases involves both preventive and therapeutic measures. The importance of meticulous oral hygiene and regular professional cleanings was stressed to prevent the onset of peri-implant diseases.
For peri-implant mucositis, nonsurgical interventions, including scaling, debridement, and the use of antimicrobial agents, are typically sufficient. However, peri-implantitis often requires more aggressive treatment, including surgical intervention to remove the infected tissue and decontamination of the implant surface.
A case of peri-implant mucositis highlighted the need for patient education on maintaining oral hygiene around implants. The patient had minimal probing depths and stable bone levels but exhibited signs of mucosal inflammation due to inadequate plaque control. The condition was managed successfully through nonsurgical interventions and improved oral hygiene practices.
In cases of peri-implantitis, addressing the etiology, which can be multifactorial (e.g., microbial biofilm accumulation due to inadequate prosthetic design or residual cement), is key. To treat the sequelae of disease, the use of regenerative techniques was discussed to restore lost tissues. The success of these treatments depends on a variety of factors such as the extent of bone loss, the patient's overall health, and the presence of systemic risk factors like diabetes and smoking.
Interdisciplinary collaboration and comprehensive care
The importance of interdisciplinary collaboration in managing patients with periodontal and peri-implant diseases was highlighted. Dental professionals are encouraged to work closely with other healthcare providers, such as endocrinologists and cardiologists, to manage systemic conditions that may impact periodontal health. This comprehensive approach ensures that all aspects of a patient's health are considered in their periodontal treatment plan.
Conclusion
Avila-Ortiz’s lecture underscored the significance of the new periodontal and peri-implant disease classification system in clinical practice. The system provides a comprehensive approach to diagnosing and managing periodontal diseases, considering the complexity and multifactorial nature of these conditions.
By integrating staging and grading, clinicians can tailor treatment plans to the individual needs of patients, ultimately improving outcomes. The classification also emphasizes the importance of regular monitoring and maintenance to prevent disease progression and manage peri-implant diseases effectively. The insights and case presentations offered valuable guidance for practitioners, reinforcing the importance of adopting the new classification system in everyday clinical practice.
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