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The 1989 classification raised problems in several areas³⁹:

 Considerable overlap in disease categories

 Absence of a gingival disease component

 Inappropriate emphasis on age of onset of disease and rates of progression

 Inadequate or unclear classification criteria

Therefore, the next landmark classification was the 1999 International Workshop for a Classification of Periodontal Diseases and Conditions, which addressed some of the problems in the previous classification. The major changes in the classification system for periodontal diseases included (Box 2-4)³⁹:

BOX 2-4 Summary of 1999 International Workshop for a Classification of Periodontal Diseases and Conditions³⁹

Gingival diseasesDental plaque–induced gingival diseasesGingivitis associated with dental plaque onlyGingival diseases modified by systemic factorsGingival diseases modified by medicationsGingival diseases modified by malnutritionNon-plaque-induced gingival lesionsGingival diseases of specific bacterial originGingival diseases of viral originGingival diseases of fungal originGingival lesions of genetic originGingival manifestations of systemic conditionsTraumatic lesions (factitious, iatrogenic, accidental)Foreign body reactionsNot otherwise specified (NOS)Chronic periodontitisLocalized (≤ 30% of sites involved)Generalized (> 30% of sites involved)Aggressive periodontitisLocalized (≤ 30% of sites involved)Generalized (> 30% of sites involved)Periodontitis as a manifestation of systemic diseasesAssociated with hematologic disordersAcquired neutropeniaLeukemiasOtherAssociated with genetic disordersFamilial and cyclic neutropeniaDown syndromeLeukocyte adhesion deficiency syndromesPapillon–Lefèvre syndromeChediak-Higashi syndromeHistiocytosis syndromesGlycogen storage diseaseInfantile genetic agranulocytosisCohen syndromeEhlers-Danlos syndrome (Types IV and VIII)HypophosphatasiaOtherNot otherwise specified (NOS)Necrotizing ulcerative periodontitis (NUP)Necrotizing periodontal diseasesNecrotizing ulcerative gingivitis (NUG)Necrotizing ulcerative periodontitis (NUP)Abscesses of the periodontiumGingival abscessPeriodontal abscessPericoronal abscessPeriodontitis associated with endodontic lesionsCombined periodontic-endodontic lesionsDevelopmental or acquired deformities and conditionsLocalized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitisTooth anatomical factorsDental restorations/appliancesRoot fracturesCervical root resorption and cemental tearsMucogingival deformities and conditions around teethGingival/soft tissue recessionLack of keratinized gingivaDecreased vestibular depthAberrant frenum/muscle positionGingival excessMucogingival deformities and conditions on edentulous ridgesVertical and/or horizontal ridge deficiencyLack of gingiva/keratinized tissueGingival/soft tissue enlargementAberrant frenum/muscle positionDecreased vestibular depthAbnormal colorOcclusal traumaPrimary occlusal traumaSecondary occlusal trauma

 Addition of a section on gingival diseases

 Replacement of “Adult periodontitis” with “Chronic periodontitis”

 Replacement of “Early-onset periodontitis” with “Aggressive periodontitis”

 Elimination of a separate disease category for Refractory periodontitis

 Clarification of the designation “Periodontitis as a manifestation of systemic diseases”

 Replacement of “Necrotizing ulcerative periodontitis” with “Necrotizing periodontal diseases”

 Addition of “Periodontal abscesses” category

 Addition of “Periodontic-endodontic lesions” category

 Addition of “Developmental or acquired deformities and conditions” category