Treatment of stage IV periodontitis The EFP S3-level clinical practice guideline
Where does the need for this guideline come from? • Implementation of the new classification of periodontitis should facilitate the use of appropriate preventive and therapeutic interventions, depending on the stage and grade of the disease. The application of this S3-level clinical practice guideline will allow a homogeneous and evidence-based approach to the management of stage I–III periodontitis. What do patients need to know? • An essential prerequisite to therapy is to inform the patient of the diagnosis, including causes of the condition, risk factors, treatment alternatives and expected risks and benefits including explanations regarding consequences of refused treatment. • This discussion should be followed by agreement on a personalized care plan. • The plan might need to be modified during the treatment journey, depending on patient preferences, clinical findings and changes to overall health.
How do we interpret these infographics?
Blue colour:
Recommendations in favor of a particular strategy of treatment or specific procedure. Open recommendation in which the clinician is responsible for the final choice of a particular strategy of treatment or specific procedure based on specific patient characteristics. Uncertain recommendation for whose clarification further research is needed. Recommendations against a particular strategy of treatment or specific procedure.
Orange colour:
Red colour:
TABLE Strengh of recommendations: grading scheme (German Association of the Scientific Medical Societies (AWMF) and Standing Guidelines Commision, 2012)
Grade of recommendation grade a
Description
Syntax
We recommend We recommend not to
A
Strong recommendation
We suggest We suggest not to
B
Recommendation
O
Open recommendation May be considered a If the group felt that evidence was not clear enought to support a recommendation, statements were formulated, including the need (or not) of additional research.
Aim: This guideline aims to provide information on: · multidisciplinary therapeutic approaches in the treatment of stage IV periodontitis,
· how to minimize tooth loss associated with periodontitis, · how to improve overall systemic health and quality of life for patients in periodontitis stage IV Case Type 2.
The Case Type 2 patient is a patient with pathological tooth migration, characterized by tooth elongation, drifting and flaring, which is amenable to orthodontic correction.
Case Type 2
Orthodontic therapy in stage IV periodontitis patients
Recommended interventions
Recommended
Suggested
Recommended
Orthodontic treatment is recommended once the endpoints of periodontal therapy have been achieved (no sites with PPD = 5 mm with BOP, nor any sites with PPD ≥6 mm).
Orthodontic therapy for tilted molars
Open recommendation
Open
Orthodontic therapy for tilted molars may be considered .
Orthodontic therapy with intra-bony defects
Recommended interventions
Recommended
Suggested
Recommended
Suggested
x1 month
x6 months
It is suggested to undertake orthodontic treatment 1 to 6 months after regenerative interventions.
Orthodontic treatment is recommended after appropriate regenerative interventions in intra-bony defects.
Orthodontic therapy to mantain/improve periodontal outcomes
Recommended interventions
Recommended
Suggested
Suggested
The use of fixed rather than removable appliances is suggested .
Open recommendation
Open
Open
The use of fiberotomy adjunctive to orthodontic tooth movement may be considered .
The use of skeletal anchorage devices (implants or temporary anchorage devices—micro-screws or mini-plates) may be considered .
Supportive care after orthodontic therapy
Recommended interventions
Recommended
Suggested
Recommended
Recommended
Active OT should be interrupted and affected teeth should be maintained passively when recurrence of periodontitis is detected.
During OT periodontal check-up should be ideally performed at each orthodontic appointment .
Recommended
Recommended
Once periodontal health/stability has been reestablished, OT can be re-instituted .
After completion of OT, life-long supportive periodontal care and life-long orthodontic retention should be provided tailored to the individual needs/risk profile of the patient.
This document is a graphic adaptation of the actual clinical practice guidelines and the reader is referred for the correct explanation to the original article: “Treatment of stage IV periodontitis: The EFP S3 level clinicalpractice guideline” by Herrera and coworkers, Journal of Clinical Periodontology 2022, https://www.efp.org/education/continuing-education/clinical-guidelines/guideline-on-treatment-of-stage-iv-periodontitis/
www.efp.org
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