Clinical Phenotypes of Stage IV Grade C Periodontitis in the Absence of Grade Modifiers: Case Reports

Stage IV periodontitis grade C, the most severe form of the condition, presents complex clinical and radiographic signs along with rapid progression. One of the key features of this disease is the loss of masticatory function, which requires complex treatments. The phenotype of stage IV periodontitis varies greatly depending on individual patterns. The progression of periodontitis alone can be rapid, even without any grade modifiers such as smoking or diabetes mellitus. This case report aims to present cases of periodontitis IV C with different phenotypes and without grade modifiers. The objective is to analyze variations in the clinical presentation and characteristics of stage IV, grade C periodontitis cases and their treatments.

This report consists of two cases. The first case is a 34-year-old female patient whose main complaint is that her upper front teeth are mobile and protruding. Intraoral examination showed anterior upper teeth flaring, plaque score (PS) 37%, bleeding on probing (BoP) 36%, and calculus index (CI) 0.54. Periodontal examination showed probing pocket depth (PPD) around 4–11 mm, gingival recession (GR) 1–9 mm, clinical attachment loss up to 13 mm, secondary trauma from occlusion (TFO), tooth mobility degree 1–3, and furcation involvement grade III on 36.
The second case is a 60-year-old female whose chief complaint is missing teeth. Intraoral examination showed gingival redness, anterior deep bite, PS 46%, BoP 86%, and CI 1.2. The PPD was around 2–10 mm, GR 1–5 mm, clinical attachment loss up to 11 mm, tooth mobility degree 1–3, TFO on the anterior, endo-perio lesion, and multiple missing teeth. Both cases were treated following the newest EFP clinical practice guidelines. Both cases were diagnosed with periodontitis stage IV grade C due to their severity and rapid rate of progression. These cases required multidisciplinary approaches.

Proper assessment of periodontitis severity and progression is essential to determine the right treatment plan.