Stage IV Periodontitis — ORE Part 1 MCQ

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HardPeriodontologyStage IV PeriodontitisORE Part 1

A 55-year-old patient has generalised periodontitis. Clinical and radiographic assessment shows clinical attachment loss of at least 5 mm, radiographic bone loss extending to the apical third, and loss of five teeth due to periodontitis. Which additional finding would assign the case to Stage IV rather than Stage III in the 2017 classification?

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Correct answer: C — Masticatory dysfunction requiring complex rehabilitation

Explanation lettering: D = shown as A · C = shown as B · A = shown as C · B = shown as D

A is correct. Although the severity findings in the stem meet the severity threshold for Stage III or IV, Stage IV is assigned when there is additional complexity such as masticatory dysfunction, secondary occlusal trauma with severe tooth mobility, severe ridge defects, bite collapse, drifting/flaring, or a need for complex rehabilitation. Probing depths of at least 6 mm, vertical defects of at least 3 mm, and Grade II/III furcation involvement are Stage III complexity factors and therefore do not by themselves distinguish Stage IV. Mobility of grade 2 or greater is likewise a Stage III complexity feature; Stage IV requires the greater functional or rehabilitative complexity described in option A.

Reference: Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Journal of Clinical Periodontology. 2018;45(Suppl 20):S149-S161. https://pubmed.ncbi.nlm.nih.gov/29926495/