Evaluating diagnostic precision in applying the 2017 periodontal disease framework: A Canadian study across training levels

BACKGROUND: Despite the introduction of the 2017 periodontal disease classification system to enhance diagnostic accuracy, several concerns persist regarding its implementation in clinical situations. The prevalence of diagnostic errors in periodontics remains relatively high, with limited data available on the impact of different training levels and institutional approaches on the diagnostic accuracy and competency of students and practitioners. This study aims to explore the patterns of diagnostic accuracy and perceived confidence and familiarity with utilizing the 2017 periodontal classification system across various levels of clinical complexity, different educational levels, and two Canadian institutions METHODS: This prospective cross-sectional study included 104 participants from two universities, including third- and fourth-year dental students, dental hygiene degree students, periodontics residents from five programs, and clinical instructors in periodontics and dental hygiene. Participants were asked to diagnose five de-identified clinical cases along the spectrum of periodontal health and disease. Gold standard diagnoses were established by board-certified periodontists. Diagnostic accuracy, error patterns, and factors influencing diagnostic decisions were analyzed using chi-square tests, t-tests, and a content analysis approach. RESULTS: = 4.04, p = 0.05). Common errors included underdiagnosis (32.4%), incorrect periodontal status identification (28.7%), and wrong extent classification (21.3%). Qualitatively, participants frequently described the classification system as "ambiguous" with substantial "gray zones". CONCLUSIONS: Regardless of the training level, diagnostic accuracy with the 2017 classification system remains suboptimal. Institutional variations suggest that curricular approaches may significantly impact the development of diagnostic skills and their diagnostic competency. These findings highlight the need for calibration protocols, targeted teaching and learning interventions, and technology-supported learning tools to improve diagnostic skills in periodontal education.