Nomenclature

Periodontal Disease

Topics Available:

Definitions of Stage, Grade and Index
Periodontal Disease Stages
Furcation and Mobility Indices
Periodontal Pathology
Periodontal Treatment
Flap Procedures

Return to Nomenclature Introduction

Abbeviations to be used in AVDC Case Logs are shown in (blue brackets)



Definitions of Stage, Grade and Index

Stage: The assessment of the extent of pathological lesions in the course of a disease that is likely to be progressive (e.g. stages of periodontal disease, staging of oral tumors).

Grade: The quantitative assessment of the degree of severity of a disease or abnormal condition at the time of diagnosis, irrespective of whether the disease is progressive (e.g. a grade 2 mast cell tumor based on mitotic figures)

Index: A quantitative expression of predefined diagnostic criteria whereby the presence and/or severity of pathological conditions are recorded by assessing a numerical value (e.g. gingival index, plaque index).



Return to Top


Stages of Periodontal Disease

The degree of severity of periodontal disease (PD) relates to a single tooth; a patient may have teeth that have different stages of periodontal disease.

Normal (PD0):
Clinically normal; gingival inflammation or periodontitis is not clinically evident.

Stage 1 (PD1): Gingivitis only without attachment loss; the height and architecture of the alveolar margin are normal.

Stage 2 (PD2): Early periodontitis; less than 25% of attachment loss or, at most, there is a stage 1 furcation involvement in multirooted teeth. There are early radiologic signs of periodontitis. The loss of periodontal attachment is less than 25% as measured either by probing of the clinical attachment level, or radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root.

Stage 3 (PD3): Moderate periodontitis - 25-50% of attachment loss as measured either by probing of the clinical attachment level, radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root, or there is a stage 2 furcation involvement in multirooted teeth.

Stage 4 (PD4): Advanced periodontitis; more than 50% of attachment loss as measured either by probing of the clinical attachment level, or radiographic determination of the distance of the alveolar margin from the cementoenamel junction relative to the length of the root, or there is a stage 3 furcation involvement in multirooted teeth.

Reference: Wolf HF, Rateitschak EM, Rateitschak KH et al. Color atlas of dental medicine: periodontology, 3rd ed. Stuttgart: Georg Thieme Verlag, 2005.



Return to Top


Furcation Involvement and Mobility Index


Furcation Index

Stage 1 (F1): Furcation 1 involvement exists when a periodontal probe extends less than half way under the crown in any direction of a multirooted tooth with attachment loss.

Stage 2 (F2): Furcation 2 involvement exists when a periodontal probe extends greater than half way under the crown of a multirooted tooth with attachment loss but not through and through.

Stage 3 (F3): Furcation exposure exists when a periodontal probe extends under the crown of a multirooted tooth, through and through from one side of the furcation out the other.



Tooth Mobility Index

Stage 0 (M0): Physiologic mobility up to 0.2 mm.

Stage 1 (M1): The mobility is increased in any direction other than axial over a distance of more than 0.2 mm and up to 0.5 mm.

Stage 2 (M2): The mobility is increased in any direction other than axial over a distance of more than 0.5 mm and up to 1.0 mm.

Stage 3 (M3): The mobility is increased in any direction than axial over a distance exceeding 1.0 mm or any axial movement.



Gingival and Periodontal Pathology


Gingivitis: Inflammation of gingiva

Periodontitis: Inflammation of non-gingival periodontal tissues (i.e., the periodontal ligament and alveolar bone)

Gingival recession (GR): Root surface exposure caused by apical migration of the gingival margin or loss of gingiva.

Gingival enlargement (GE): Clinical term, referring to overgrowth or thickening of gingiva in the absence of a histological diagnosis

Gingival hyperplasia (GH): Histological term, referring to an abnormal increase in the number of normal cells in a normal arrangement and resulting clinically in gingival enlargement

Abnormal tooth extrusion (ATE): Increase in clinical crown length not related to gingival recession or lack of tooth wear

Alveolar bone expansion (ABE): Thickening of alveolar bone at labial and buccal aspects of teeth


Return to Top


Periodontal Treatment

Professional oral care includes mechanical procedures performed in the oral cavity.

Professional dental cleaning (PRO) refers to scaling (supragingival and subgingival plaque and calculus removal) and polishing of the teeth with power/hand instrumentation performed by a trained veterinary health care provider under general anesthesia. See also AVDC Position Statements on Dental Health Care Providers and and on Non-Professional Dental Scaling.

Periodontal therapy refers to treatment of diseased periodontal tissues that includes professional dental cleaning as defined above and one or more of the following: root planing, gingival curettage, periodontal flaps, regenerative surgery, gingivectomy/gingivoplasty, and local administration of antiseptics/antibiotics.

Home oral hygiene refers to measures taken by pet owners that are aimed at controlling or preventing plaque and calculus accumulation.

Gingival curettage (GC): Removal of damaged or diseased tissue from the soft tissue lining of a periodontal pocket.

Root planing (RP): Removal of dental deposits from and smoothing of the root surface of a tooth; it is closed (RP/C) when performed without a flap or open (RP/O) when performed after creation of a flap.

Gingivectomy (GV): Removal of some or all gingiva surrounding a tooth

Gingivoplasty (GV): A form of gingivectomy performed to restore physiological contours of the gingiva

Guided Tissue Regeneration (GTR): Regeneration of tissue directed by the physical presence and/or chemical activities of a biomaterial; often involves placement of barriers to exclude one or more cell types during healing of tissue

Crown lengthening (CR/L): Increasing clinical crown height by means of gingivectomy/gingivoplasty, apically positioned flaps, post and core build-up, or orthodontic movement

Frenuloplasty (frenulotomy, frenulectomy) (FRE): Reconstructive surgery or excision of a frenulum

Hemisection (HS): Splitting of a tooth into two separate portionsB

Trisection (TS): Splitting of a tooth into three separate portions.

Partial tooth resection (T/XP): Removal of a crown-root segment with endodontic treatment of the remainder of the tooth

Root resection/amputation (RO/X): Removal of a root with maintenance of the entire crown and endodontic treatment of the remainder of the tooth


Return to Top

Flap Surgery


Flap (F): A sheet of tissue partially or totally detached to gain access to structures underneath or to be used in repairing defects; can be classified based on the location of the donor site (local or distant), attachment to donor site (pedicle, island or free), tissue to be transferred (e.g., mucosal, mucoperiosteal, cutaneous, myocutaneous), tissue thickness (partial-thickness or full-thickness), blood supply (random pattern or axial pattern), and direction and orientation of transfer (envelope, advancement, rotation, transposition, and hinged).

Location of Donor Site:

Local flap: Harvested from an adjacent site

Distant flap: Harvested from a remote site

Attachment to Donor Site:

Pedicle flap: Attached by tissue through which it receives its blood supply

Island flap (F/IS): Attached by a pedicle made up of only the nutrient vessels.

Free flap: Completely detached from the body; it has also been suggested that a free flap be termed a graft

Tissue to be Transferred:

Mucosal flap: Containing mucosa

Mucoperiosteal flap: Containing mucosa and underlying periosteum

Cutaneous (or skin) flap: Containing epidermis, dermis, and subcutaneous tissue

Myocutaneous flap: Containing skin and muscle

Gingival flap: Containing gingiva

Alveolar mucosa flap: Containing alveolar mucosa

Periodontal flap: Containing gingiva and alveolar mucosa

Labial flap: Containing lip mucosa

Buccal flap: Containing cheek mucosa

Sublingual flap: Containing sublingual mucosa

Palatal flap: Containing palatal mucosa

Pharyngeal flap: Containing pharyngeal mucosa

Tissue Thickness:

Partial-thickness (or split-thickness) flap: Consisting of a portion of the original tissue thickness

Full-thickness flap: Having the original tissue thickness

Blood Supply:

Random pattern flap: Randomly supplied by nonspecific arteries

Axial pattern flap: Supplied by a specific artery

Direction and Orientation of Transfer:

Envelope flap (F/EN): Retracted away from a horizontal incision; there is no vertical incision

Advancement (or sliding) flap (F/AD):
Carried to its new position by a sliding technique in a direction away from its base

Rotation flap (F/RO): A pedicle flap that is rotated into a defect on a fulcrum point

Transposition flap (F/TR): Flap that combines the features of an advancement flap and a rotation flap

Hinged flap (F/HI): Folded on its pedicle as though the pedicle was a hinge; also called a turnover or overlapping flap

Apically positioned flap (F/AP): Moved apical to its original location

Coronally positioned flap (F/CO): Moved coronal to its original location

Mesiodistally or distomesially positioned flap: Moved distal or mesial to its original location along the dental arch; also called a laterally positioned flap (F/LA)

Return to Top

Return to main Nomenclature Links page