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Review
. 2022 Jun:49 Suppl 24:4-71.
doi: 10.1111/jcpe.13639.

Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline

David Herrera  1 , Mariano Sanz  1 , Moritz Kebschull  2   3   4 , Søren Jepsen  5 , Anton Sculean  6 , Tord Berglundh  7 , Panos N Papapanou  4 , Iain Chapple  2   3 , Maurizio S Tonetti  8 ; EFP Workshop Participants and Methodological Consultant
Collaborators, Affiliations
Review

Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline

David Herrera et al. J Clin Periodontol. 2022 Jun.

Abstract

Background: The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy.

Aim: To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss.

Materials and methods: This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders.

Results: The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III.

Conclusions: The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.

Keywords: clinical guideline; dental implant; orthodontic; periodontitis; prosthodontic; stage IV.

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References

REFERENCES

    1. Al-Harthi, S., Barbagallo, G., Psaila, A., d'Urso, U., & Nibali, L. (2021). Tooth loss and radiographic bone loss in patients without regular supportive care: A retrospective study. Journal of Periodontology, 93, 354-363. https://doi.org/10.1002/JPER.21-0415
    1. Allen, P. F., Thomason, J. M., Jepson, N. J., Nohl, F., Smith, D. G., & Ellis, J. (2006). A randomized controlled trial of implant-retained mandibular overdentures. Journal of Dental Research, 85(6), 547-551. https://doi.org/10.1177/154405910608500613
    1. Al-Zahrani, M. S., Alhassani, A. A., Melis, M., & Zawawi, K. H. (2021). Depression is related to edentulism and lack of functional dentition: An analysis of NHANES data, 2005-2016. Journal of Public Health Dentistry, 81(3), 206-213. https://doi.org/10.1111/jphd.12433
    1. Arn, M. L., Dritsas, K., Pandis, N., & Kloukos, D. (2020). The effects of fixed orthodontic retainers on periodontal health: A systematic review. American Journal of Orthodontics and Dentofacial Orthopedics, 157(2), 156-164.e117. https://doi.org/10.1016/j.ajodo.2019.10.010
    1. Awad, M. A., Locker, D., Korner-Bitensky, N., & Feine, J. S. (2000). Measuring the effect of intra-oral implant rehabilitation on health-related quality of life in a randomized controlled clinical trial. Journal of Dental Research, 79(9), 1659-1663. https://doi.org/10.1177/00220345000790090401

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