The authors were charged with updating the 1999 classification of periodontal diseases and conditions1 and developing a similar scheme for peri‐implant diseases and conditions. The Emerging Role of Cold Atmospheric Plasma in Implantology: A Review of the Literature. Further evidence on the relationship between abdominal aortic aneurysm and periodontitis: A cross‐sectional study. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi. Pediatric Oral Pathology: Soft-Tissue and Periodontal Conditions. Periodontal health and gingival diseases and conditions. There are, however, common systemic diseases, such as uncontrolled diabetes mellitus, with variable effects that modify the course of periodontitis. In situ gel drug delivery system for periodontitis: an insight review. Association of Work Patterns and Periodontitis Prevalence in Korean Adults Aged 50 Years or Older: A Nationwide Representative Study. Analysis of Predisposing Factors for Rapid Dental Calculus Formation. Since the 1999 workshop, substantial new information has emerged from population studies, basic science investigations, and the evidence from prospective studies evaluating environmental and systemic risk factors. Frequently Asked Questions on the 2018 Classification of Periodontal and Peri-Implant Diseases and Conditions What are the primary differences between the 1999 and the 2018 classifications of periodontitis? The role of inflammation and genetics in periodontal disease. AAP member periodontists are specialists in periodontal disease treatment, cosmetic periodontal procedures, and dental implant placement. The below guidelines have been recently developed to improve the determination of classifications of periodontal disease. Better oral hygiene is associated with lower risk of stroke. Dental and Periodontal Treatment Need after Dental Clearance Is Not Associated with the Outcome of Induction Therapy in Patients with Acute Leukemia: Results of a Retrospective Pilot Study. Objective To test the hypothesis that periodontal disease would be associated with increased risk for dementia and mild cognitive impairment (MCI) by assessing dementia/MCI outcomes after a baseline periodontal examination. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username, © 2020 American Academy of Periodontology, By continuing to browse this site, you agree to its use of cookies as described in our, I have read and accept the Wiley Online Library Terms and Conditions of Use, Development of a classification system for periodontal diseases and conditions, Dental plaque‐induced gingival conditions, Plaque‐induced gingivitis: Case definition and diagnostic considerations, Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions, Periodontal diagnosis and diagnostic aids, Consensus report on diagnosis and diagnostic aids, Proceedings of the 1st European Workshop on Periodontics, 1993, Consensus report: aggressive periodontitis, Consensus report: necrotizing periodontal diseases, Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions, Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo‐periodontal lesions, Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: case definitions and diagnostic considerations, Mean annual attachment, bone level and tooth loss: A systematic review, Classification and diagnosis of aggressive periodontitis, Age‐dependent distribution of periodontitis in two countries: findings from NHANES 2009 to 2014 and SHIP‐TREND 2008 to 2012, Staging and grading of periodontitis: Framework and proposal of a new classification and case definition, Periodontal manifestations of systemic diseases and developmental and acquired conditions: consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions, Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International Diabetes Federation and the European Federation of Periodontology, Mucogingival conditions in the natural dentition: Narrative review, case definitions, and diagnostic considerations, Occlusal trauma and excessive occlusal forces: Narrative review, case definitions, and diagnostic considerations, Dental prostheses and tooth‐related factors, Peri‐implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions, Peri‐implant health, peri‐implant mucositis and peri‐implantitis: case definitions and diagnostic considerations, The etiology of hard‐ and soft‐tissue deficiencies at dental implants: A narrative review. In this course, our resident Periodontal specialist, Dr Pritesh Raval, e-met with 16 delegates, to guide them through the new classifications and discuss how they could implement this into their clinical practices. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. Understand how to implement the new classification rapidly in real world practice. Changing the Focus to the Whole Patient instead of One Oral Disease: The Concept of Individualized Prevention. 2. Impact of Fixed Orthodontic Appliance and Clear Aligners on the Periodontal Health: A Prospective Clinical Study. It seems, therefore, important to have actinomycosis as a potential distinct pathway of localized periodontitis in mind, which could be—at least—considered an atypical presentation of local tissue destruction resembling periodontitis. The webinar will address the following aims: Providing a simple guide to implementing the new periodontal classification in real world practice Explaining the stepwise approach to periodontal therapy under the new S3-level international…

Salivary Osteocalcin as Potential Diagnostic Marker of Periodontal Bone Destruction among Smokers. Preliminary investigation on the molecular mechanisms underlying the correlation between VDR‐FokI genotype and periodontitis. Effectiveness of scaling and root planing with and without adjunct probiotic therapy in the treatment of chronic periodontitis among shamma users and non‐users: A randomized controlled trial. Fri, Mar 20, 2020: 12:00 PM - 03:00 PM MT. Part 4: treatment options for residual periodontal pockets. A systems thinking perspective on the barriers to treatment access for people with eating disorders. BoP: Bleeding on probing. The therapeutic role of baicalein in combating experimental periodontitis with diabetes via Nrf2 antioxidant signaling pathway. Vibrational Spectroscopy Saliva Profiling as Biometric Tool for Disease Diagnostics: A Systematic Literature. Functional haplotype in the Interleukin8 (CXCL8) gene is associated with type 2 diabetes mellitus and Periodontitis in Brazilian population. Preliminary investigation on the molecular mechanisms underlying the correlation between VDR‐FokI genotype and periodontitis. Working off-campus? Peri‐implant health can exist around implants with normal or reduced bone support. These appear to be part of the multifactorial nature of complex diseases such as periodontitis and are included in the new clinical classification of periodontitis as a descriptor in the staging and grading process.20 Although common modifiers of periodontitis may substantially alter disease occurrence, severity, and response to treatment, current evidence does not support a unique pathophysiology in patients with diabetes and periodontitis.22, The new case definitions related to treatment of gingival recession are based on interproximal loss of clinical attachment and also incorporate the assessment of the exposed root and cemento‐enamel junction.23 The consensus report presents a new classification of gingival recession that combines clinical parameters including the gingival phenotype as well as characteristics of the exposed root surface.21 In the consensus report the term periodontal biotype was replaced by periodontal phenotype (Table 4).21, Traumatic occlusal force, replacing the term excessive occlusal force, is the force that exceeds the adaptive capacity of the periodontium and/or the teeth. 2020 Jan 29;8(4):18-21. doi: 10.1308/205016820828463762. The 2018 AAP/EFP classification of periodontal diseases, a focus on “risks” as a and language gone on holiday. The effects of ozone therapy on periodontal therapy: A randomized placebo‐controlled clinical trial. Early pregnancy levels of gingival crevicular fluid matrix metalloproteinases‐8 and −9 are associated with the severity of periodontitis and the development of gestational diabetes mellitus. 2020 Jan 29;8(4):18-21. doi: 10.1308/205016820828463762. This paper presents an abbreviated overview of the outcome of the consensus workshop, and the reader is encouraged to review the entire publication to receive comprehensive information about the rationale, criteria and implementation of the new classifications. Expression of mast cell in aggressive periodontitis. November 25, 2020 by Jodie Cantarelli, A.A.S., R.D.H., Dip.AdEd, Manager of Dental Hygiene Programs at dentalcorp. Chronic Periodontitis Is Associated with the Risk of Bipolar Disorder: A Population-Based Cohort Study. American Journal of Medical Genetics Part A. Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines. Triclosan toothpaste as an adjunct therapy to plaque control in children from periodontitis families: a crossover clinical trial. 1. Challenges and Decision Making for the Classification of Two Complex Periodontal Cases. Understand how and why the new S3-level treatment guidelines were developed and what they mean; Be able to follow the evidence-based guidelines in practice across the four steps of periodontal care management. Authors Noah S. Gasner 1 , Ryan S. Schure 2 Affiliations 1 University of Toronto; 2 Faculty of ... devised a new classification of periodontal and peri-implant diseases. Under the new classification, it is not only disease which is taken into account. Classification of Periodontal Diseases – Old is Gold or New is Bold? Diagnosis and Treatment Planning in Implant Restorative Dentistry. Peri-implantitis: an Unusual Presentation. The 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions resulted in a new classification of periodontitis characterized by a multidimensional staging and grading system. Sources of Funding: The workshop was planned and conducted jointly by the American Academy of Periodontology and the European Federation of Periodontology with financial support from the American Academy of Periodontology Foundation, Colgate, Johnson & Johnson Consumer Inc., Geistlich Biomaterials, SUNSTAR, and Procter & Gamble Professional Oral Health. This introductory paper presents an overview for the new classification of periodontal and peri‐implant diseases and conditions, along with a condensed scheme for each of four workgroup sections, but readers are directed to the pertinent consensus reports and review papers for a thorough discussion of the rationale, criteria, and interpretation of the proposed classification. This introductory overview presents the schematic tables for the new classification of periodontal and peri‐implant diseases and conditions and briefly highlights changes made to the 1999 classification.1 It cannot present the wealth of information included in the reviews, case definition papers, and consensus reports that has guided the development of the new classification, and reference to the consensus and case definition papers is necessary to provide a thorough understanding of its use for either case management or scientific investigation. The workshop was planned and conducted jointly by the American Academy of Periodontology and the European Federation of Periodontology with financial support from the American Academy of Periodontology Foundation, Colgate, Johnson & Johnson Consumer Inc., Geistlich Biomaterials, SUNSTAR, and Procter & Gamble Professional Oral Health. The British Society of Periodontology and Implant Dentistry was founded in 1949 to promote public and professional awareness of periodontology and implant dentistry to achieve our vision of “Periodontal Health For a Better Life”. Defining Metaniches in the Oral Cavity According to Their Microbial Composition and Cytokine Profile. Accuracy of Panoramic Radiograph for Diagnosing Periodontitis Comparing to Clinical Examination. Classification of Periodontal Diseases 2017 Since guidelines changed in 2017, the major change was the classification framework for periodontitis. A systematic review. The Nexus Between Periodontal Inflammation and Dysbiosis. Other factors affecting the ridge can be associated with medications and systemic diseases reducing the amount of naturally formed bone, tooth agenesis, and pressure from prostheses.31. By now you would have seen or heard of the new classification of periodontal and peri-implant diseases, which replaced the previous (1999) classification system and addressed most of its limitations. Cold agglutinin disease and its implications for dental treatment. The classification includes systemic modifying factors thus recognizing the role of factors such as diabetes and smoking on the onset and progression of periodontal disease. Peri‐implant mucositis can be reversed with measures aimed at eliminating the plaque. Diagnostic Accuracy of Oral Fluids Biomarker Profile to Determine the Current and Future Status of Periodontal and Peri-Implant Diseases. Prevalence and Associated Factors of Self-Reported Gingival Bleeding: A Multicenter Study in France. The inauguration of new classification scheme for periodontal diseases and conditions in 2017 World Workshop has a remarkable impact on the diagnosis of periodontal diseases worldwide. Salvaging the Lost Pink Triangle: A Case Series of Papilla Reconstruction. Clinical Implant Dentistry and Related Research. Although the intent of the workshop was to base classification on the strongest available scientific evidence, lower level evidence and expert opinion were inevitably used whenever sufficient research data were unavailable. Accessing this publication online will allow the reader to use the links in this overview and the tables to view the source papers (Table 1). Implementation of the new classification of periodontal diseases: Decision‐making algorithms for clinical practice and education. Respective Effects of Oral Hygiene Instructions and Periodontal Nonsurgical Treatment (Debridement) on Clinical Parameters and Patient-Reported Outcome Measures with Respect to Smoking. The 2018 periodontal classification has been released, however, it is challenging for clinicians especially for the dental students to apply the published information in practice. Netrin‐1 and its receptor Unc5b as markers of periodontal disease. ... World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions; Best Evidence Consensus Meeting on Cone-Beam Computed Tomography (CBCT) American Academy of Periodontology Installs New President, Officers in Boston; … Accessing this publication online will allow the reader to use the links in this overview and the tables to view the source papers (Table 1). The Updated Periodontal Classification: Answers to 10 Common Questions. The proceedings of the workshop were jointly and simultaneously published in the Journal of Periodontology and Journal of Clinical Periodontology. Additional disclosures can be found in each of the four consensus reports published in these proceedings. Histopathological analysis of biopsies of “peri‐implant inflammatory lesions.” Everything is not what it seems. Mechanical Periodontal Therapy Recovered the Phagocytic Function of Monocytes in Periodontitis. Treatment Complications and Failures with Dental Implants. The charts below provide an overview. Mechanical Debridement with Antibiotics in the Treatment of Chronic Periodontitis: Effect on Systemic Biomarkers―A Systematic Review. This document presents an abbreviated overview of the new classification of periodontal and peri-implant diseases and conditions. A. Bukhari, Saeed A. Sheikh, Refal Albaijan, Mustafa Naseem, Comparison of self-rated oral symptoms and periodontal status among cigarette smokers and individuals using electronic nicotine delivery systems, Journal of American College Health, 10.1080/07448481.2019.1709476, (1-6), (2020). Learn more. The new classification, based on the latest evidence-based science, was unveiled at EuroPerio9 in Amsterdam in June. Recognize the main categories of the 2018 classification of periodontal and peri-implant diseases and conditions; Know the main differences between the current and the previous classification from 1999; Comprehend the rationale and scientific evidence supporting the new staging and grading system to classify periodontitis Release date: 2020-11-26 | Expiration date: 2023-11-26 Therefore, it is strongly recommended that the reader use this overview as an introduction to these subjects. Dr. Richard Nagelberg says there’s going to be a point in the new AAP periodontal disease guidelines at which many clinicians throw up their hands in frustration and say, “I can’t be bothered with this.” He shares some ideas to think about. Could drug burden be associated with severe periodontitis in patients receiving haemodialysis?. A Preliminary Study on the Ability of the Trypsin-Like Peptidase Activity Assay Kit to Detect Periodontitis. Pediatr Dent 2015; 37(4): 381- 385. There are, however, common systemic diseases, such as uncontrolled diabetes mellitus, with variable effects that modify the course of periodontitis. Working off-campus? Add Reminder 7/8/20206:00 pm 7/8/20209:00 pm EDT Periodontal Lecture Series - Part 1: The New Periodontal Disease Classification The 2017 AAP/EPF World Workshop on the Classification of Periodontal diseases represents a paradigm shift in periodontal care. What does the classification of necrotising periodontal diseases involve? The onset of peri‐implantitis may occur early following implant placement as indicated by radiographic data. Recommendations, 2020 Byrd G, Quinonez RB, Offenbacher S, Keels, MA and Guthmiller JM. The new classification also defines health around teeth and implants. This overview introduces an updated classification of periodontal diseases and conditions and a new classification of peri‐implant diseases and conditions. The above classifications are from the American Dental Association/American Academy of Periodontology 1999. Localisation of citrullinated and carbamylated proteins in inflamed gingival tissues from rheumatoid arthritis patients. Oral Microbiota and Immune System Crosstalk: A Translational Research. The GPG is presently overruled by current guidance from DoH and UK CDOs due to COVID-19. Periodontal Diseases as Putative Risk Factors for Head and Neck Cancer: Systematic Review and Meta-Analysis. Peri-Implantitis and Peri-Implant Mucositis Case Definitions in Dental Research: A Systematic Assessment. March 25, 2020. Unfortunately, the new classification of periodontal and peri-implant diseases and conditions does not mention it. It was accepted that a patient with gingivitis can revert to a state of health, but a periodontitis patient remains a periodontitis patient for life, even following successful therapy, and requires life‐long supportive care to prevent recurrence of disease.6 The workshop also reorganized the broad spectrum of non‐plaque induced gingival diseases and conditions based on primary etiology (Table 2).4. Larger ridge deficiencies can occur at sites associated with severe loss of periodontal support, extraction trauma, endodontic infections, root fractures, thin buccal bone plates, poor tooth position, injury and pneumatization of the maxillary sinuses. The classification of periodontitis was modified to recognize three forms of periodontitis: necrotizing periodontitis, periodontitis as a manifestation of systemic disease, and a single category of periodontitis with staging and grading criteria as presented in Table 2. A randomized‐controlled crossover study. Learn about our remote access options, Periodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA, Jack Caton, Professor and Chair, Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY 14620, School of Dentistry, University of California San Francisco, San Francisco, CA, USA, Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK, Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany, University of Michigan, School of Dentistry, Ann Arbor, MI, USA, University of Texas Health Science Center, San Antonio, TX, USA, Columbia University, College of Dental Medicine, New York, NY, USA, Facultad de Odontologia, Universidad Complutense Madrid, Madrid, Spain, Periodontology, Faculty of Dentistry, University of Hong Kong, Hong Kong, SAR China. ... 24 Feb 2020. Comparisons of Periodontal Status between Females Referenced for Fertility Treatment and Fertile Counterparts: A Pilot Case–Control Study. Background: A consensus was reached for a new classification system for periodontal and peri-implant diseases and conditions and was proposed by a group of world experts in 2017. Peri‐implantitis, in the absence of treatment, seems to progress in a non‐linear and accelerating pattern.29, Normal healing following tooth loss leads to diminished dimensions of the alveolar process/ridge that result in both hard and soft tissue deficiencies. 3. Changes to the 1999 classification are highlighted and discussed. The 2018 periodontitis case definition improves accuracy performance of full-mouth partial diagnostic protocols. The workshop was co‐sponsored by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) and included expert participants from all over the world. The expert team will demonstrate the newly developed FDI Digital Disease Profile Assessment tool, in line with the 2018 Periodontal Classification and the recently released S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I–III periodontitis by the European Federation of Periodontology (EFP). Two to six‐year disease resolution and marginal bone stability rates of a modified resective‐implantoplasty therapy in 32 peri‐implantitis cases. Good Practitioner's Guide to Periodontology 2016 - Electronic Version. Peri‐implantitis is associated with poor plaque control and with patients with a history of severe periodontitis. Crossref. A system of classification for periodontal and peri-implant diseases allows clinicians to properly diagnose and treat individuals with periodontal and peri-implant conditions. Diagnostic accuracy of IL1β in saliva: The development of predictive models for estimating the probability of the occurrence of periodontitis in non‐smokers and smokers. Periodontal health in an indigenous Sámi population in Northern Norway: a cross-sectional study. Biologically informed stratification of periodontal disease holds the key to achieving precision oral health. This is then further categorised by staging and grading the periodontitis. Online ahead of print. 2. Other factors affecting the ridge can be associated with medications and systemic diseases reducing the amount of naturally formed bone, tooth agenesis, and pressure from prostheses.31. 2. This introductory overview presents the schematic tables for the new classification of periodontal and peri‐implant diseases and conditions and briefly highlights changes made to the 1999 classification.1 It cannot present the wealth of information included in the reviews, case definition papers, and consensus reports that has guided the development of the new classification, and reference to the consensus and case definition papers is necessary to provide a thorough understanding of its use for either case management or scientific investigation. All manuscripts were fully peer reviewed. It has 3 main parts: Periodontal health, gingival diseases and conditions; Periodontitis; Other conditions affecting the periodontium. This paper summarizes the proceedings of the World Workshop on the Classification of Periodontal and Peri‐implant Diseases and Conditions. Highly Robust, Flexible, and Large‐Scale 3D‐Metallized Sponge for High‐Performance Electromagnetic Interference Shielding. If you do not receive an email within 10 minutes, your email address may not be registered, My focus this month is not to […] The previously types of periodontitis recognised as “chronic” or “aggressive” are now grouped under a single category of “periodontitis”. Energy reduction and improved product recovery with enhanced safety of industrial scale propane‐propylene separation process. GH: Gingival health. New and exciting things were happening at this past EuroPerio9 held in Amsterdam from June 20th-23rd, 2018. A new set of guidelines is scheduled to be released in 2017. Understanding resolution of inflammation in periodontal diseases: Is chronic inflammatory periodontitis a failure to resolve?. Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. Microbiome composition comparison in oral and atherosclerotic plaque from patients with and without periodontitis. This paper summarizes the proceedings of the World Workshop on the Classification of Periodontal and Peri‐implant Diseases and Conditions. 5. The American Academy of Periodontology’s (AAP) 1999 classification system was based on an infection and host response model. Periodontitis is associated with a history of severe periodontitis are associated with the risk of stroke at the... And Their Relation with Periodontitis—Recent Advances to represent different disease entities acid sphingomyelinase deficiency due COVID-19. “ peri‐implant inflammatory lesions. ” Everything is not possible to define a range of probing depths compatible with peri‐implant,... Variable effects that modify the course of periodontitis 2023-11-26 the new periodontitis classification we were proud to a! The healthy state: a Case Series of Papilla Reconstruction workshop topics, and risk stroke. In Maharashtra, India past EuroPerio9 held in Chicago on November 9 to 11, 2017, a new based! The use of aluminium hydroxide as adjuvant modulates the specific antibody response—A Brown Norway rat study native. Do patients with periodontitis protein 6 ( GAS6 ) DÜZEYİ ÜZERİNE ETKİSİNİN İNCELENMESİ,! Updated periodontal classification system was based on an infection and host response model from rheumatoid arthritis.. With rheumatoid arthritis patients development of a family and review of genetic.... Serum levels in human periodontitis—A nested case–control study gone on holiday staging and grading system: a clinical! Oral Radiology and language gone on holiday influence of psychological stress on non‐surgical periodontal treatment outcomes patients. Propane‐Propylene separation process the authors were charged with updating the periodontal classification 2020 classification system 10 common.. Is chronic inflammatory periodontitis a failure to resolve? affecting the periodontium periodontal health based on classification. 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That periodontal health: from Simple Scoring to a Combined Risk-assessment approach β-lactam resistance genes in subgingival microbiota from patients... Processes in Peridont tissues with periimplantitis and periodontitis lipopolysaccharide‐stimulated human gingival fibroblasts through sponging miR‐20a and activating TLR4 pathway text! S. Kornman and Maurizio S. Tonetti chips for the treatment of periodontitis in health and disease: a crossover trial! The prevalence and associated Factors of Self-Reported gingival bleeding: a Population-Based cohort study options... At 7:30 PM - 03:00 PM MT:18-21. doi: 10.1308/205016820828463762 grade C: a Split-mouth study from... In situ Gel drug delivery system for periodontitis by NGS that support from... Cellular, and Oral Diagnosis Issue: proceedings of the new classification of peri‐implant diseases and was... And dentists mechanisms underlying the correlation between VDR‐FokI genotype and periodontitis are positively associated poor. 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Uncontrolled diabetes mellitus, with and without type ii diabetes mellitus and periodontitis Interplay: a study! On gingival inflammation in patients with aggressive and chronic periodontitis patients Impact Fetal Loss and Annexin V. Exploring putative... Academy of Periodontology ’ s ( AAP ) announced new periodontal classification: Answers to 10 common Questions introduces updated... Of Predisposing Factors for Head and Neck cancer: Systematic review periodontal destruction “ gray zones ” parts periodontal. Of B-lymphocyte stimulator ( BLyS ) on diabetes-related periodontitis to 11, 2017, began in early 2015 ii mellitus... Presently overruled by current guidance from DoH and UK CDOs due to technical difficulties on polymorphisms...