Three Steps to Staging and Grading a Patient
Step 1:
Initial Case
Overview to
Assess Disease
Screen:
	 •	 Full mouth probing depths
	 •	 Full mouth radiographs
	 •	 Missing teeth
Mild to moderate periodontitis will typically be either Stage I or Stage II
Severe to very severe periodontitis will typically be either Stage III or Stage IV
Step 2:
Establish Stage
For mild to moderate periodontitis (typically Stage I or Stage II):
	 •	 Confirm clinical attachment loss (CAL)
	 •	Rule out non-periodontitis causes of CAL (e.g., cervical restorations or caries, root fractures,
CAL due to traumatic causes)
	 •	 Determine maximum CAL or radiographic bone loss (RBL)
	 •	 Confirm RBL patterns
For moderate to severe periodontitis (typically Stage III or Stage IV):
	 •	 Determine maximum CAL or RBL
	 •	 Confirm RBL patterns
	 •	 Assess tooth loss due to periodontitis
	 •	 Evaluate case complexity factors (e.g., severe CAL frequency, surgical challenges)
Step 3:
Establish Grade
	 •	 Calculate RBL (% of root length x 100) divided by age
	 •	 Assess risk factors (e.g., smoking, diabetes)
	 •	 Measure response to scaling and root planing and plaque control
	 •	 Assess expected rate of bone loss
	 •	 Conduct detailed risk assessment
	 •	 Account for medical and systemic inflammatory considerations
© 2018 American Academy of PeriodontologyStage descriptions drawn from Tonetti, Greenwell, Kornman. J Periodontol 2018;89 (Suppl 1): S159-S172.