Evaluating the Performance and Implementation of the 2018 Classification of Periodontal Diseases: A Systematic Review and Survey

Aim: To evaluate the performance and implementation of the 2018 Classification of Periodontal Diseases for periodontitis through systematic review and survey methodology. Materials and Methods: A two-part systematic review was conducted. Part 1 aimed, with descriptive statistics, to evaluate performance metrics of the 2018 Classification, including diagnostic accuracy, prognostic performance and examiner reliability. Part 2 used thematic analysis to elucidate facilitators and barriers to the implementation of the classification. A survey collected evidence of barriers, facilitators and local implementation. Results: Part 1 of this review included 14 individual studies of moderate risk of bias. Eight studies examined diagnostic accuracy, three studies examined prognostic efficacy and three studies examined inter-/intra-rater reliability. Part 2 included 33 individual studies with data considered at high risk of bias. The survey returned 1113 responses. The thematic analysis in Part 2 led to seven findings, five related to facilitators and two concerning barriers to the implementation. Survey results showed that 78% of respondents currently use the classification, but the most common concerns relate to its complexity. Conclusions: The 2018 Classification performs well as a classification in comparison with previous classifications. Specific identified barriers have potentially limited the comprehensive uptake of the classification.