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Discordance in the 2018 Periodontal Classification: Conceptual Challenges and a Biologically Grounded Framework for
Nada Tawfig Hashim1,2, Bakri Gobara Gismalla2, Bhavna Jha Kukreja3
1Department of Periodontics, RAK College of Dental Sciences, RAK Medical & Health Sciences University, Ras-AL Khaimah 12973, United Arab Emirates.
Dentistry Journal
|June 25, 2026
Summary
The 2018 periodontal disease classification faces challenges with discordant diagnostic components. A biologically grounded hierarchy is proposed for more accurate, phenotype-oriented interpretation of periodontal and peri-implant diseases.
Area of Science:
- Dentistry
- Periodontology
- Biomarkers
Background:
- The 2018 classification of periodontal and peri-implant diseases introduced a multidimensional diagnostic framework.
- This framework integrated staging, grading, and disease extent, moving beyond earlier severity-based systems.
- It aimed for individualized, biologically informed diagnoses by incorporating structural destruction, treatment complexity, spatial distribution, and progression risk.
Purpose of the Study:
- To examine interpretive challenges arising from discordant components within the 2018 classification system.
- To provide a conceptual and clinical lens on these challenges, focusing on staging, grading, and disease distribution.
- To propose a biologically grounded interpretive hierarchy for enhanced diagnostic coherence.
Main Methods:
- Conceptual analysis and clinical examination of discordant diagnostic components in periodontal disease classification.
- Focus on distinguishing focal severity from overall disease burden in staging.
- Analysis of disease distribution's biological meaning and tooth loss as a historical indicator.
Main Results:
- Clinical application revealed interpretive challenges, particularly when different classification components appear discordant.
- Discordances stem from applying categorical systems to a biologically heterogeneous and temporally dynamic disease.
- A proposed hierarchy prioritizes observed tissue behavior and realized destruction over probabilistic risk indicators.
Conclusions:
- The 2018 classification, while advanced, presents interpretive challenges due to disease heterogeneity.
- A biologically grounded interpretive hierarchy enhances diagnostic coherence for periodontal and peri-implant diseases.
- This approach supports a more phenotype-oriented interpretation, integrating various diagnostic parameters effectively.
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