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SANZ et al .
TABLE 6 Timeline of the guideline development process Time point Action April 2018 Decision by European Federation of Periodontology (EFP) General Assembly to develop comprehensive treatment guidelines for periodontitis May–September 2018 EFP Workshop Committee assesses
Classification of Periodontal and Peri-Implant Diseases and Conditions (Caton et al., 2018; Chapple et al., 2018; Jepsen et al., 2018; Papapanou et al., 2018). According to this classification: • A case of clinical periodontal health is defined by the absence of inflammation [measured as presence of bleeding on probing (BOP) at less than 10% sites] and the absence of attachment and bone loss arising from previous periodontitis. • A gingivitis case is defined by the presence of gingival inflamma - tion, as assessed by BOP at ≥10% sites and absence of detectable attachment loss due to previous periodontitis. Localized gingivitis is defined as 10%–30% bleeding sites, while generalized gingivitis is defined as >30% bleeding sites • A periodontitis case is defined by the loss of periodontal tissue support, which is commonly assessed by radiographic bone loss or interproximal loss of clinical attachment measured by probing. Other meaningful descriptions of periodontitis include the number and proportions of teeth with probing pocket depth over certain thresholds (commonly >4 mm with BOP and ≥6 mm), the number of teeth lost due to periodontitis, the number of teeth with intra - bony lesions and the number of teeth with furcation lesions. • An individual case of periodontitis should be further character - ized using a matrix that describes the stage and grade of the dis - ease. Stage is largely dependent upon the severity of disease at presentation, as well as on the anticipated complexity of case management, and further includes a description of extent and distribution of the disease in the dentition. Grade provides sup- plemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; anal - ysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. The staging, which is depen - dent on the severity of the disease and the anticipated complex - ity of case management, should be the basis for the patient's treatment plan based on the scientific evidence of the different therapeutic interventions. The grade, however, since it provides supplemental information on the patient's risk factors and rate of progression, should be the basis for individual planning of care (Tables 7 and 8) (Papapanou et al., 2018; Tonetti, Greenwell, & Kornman, 2018). TABLE 5 Strength of consensus: determination scheme (German Association of the Scientific Medical Societies (AWMF) and Standing Guidelines Commission, 2012) Unanimous consensus Agreement of 100% of participants Strong consensus Agreement of > 95% of participants Consensus Agreement of 75%–95% of participants Simple majority Agreement of 50%–74% of participants No consensus Agreement of < 50% of participants
merits and disadvantages of various established methodologies and their applicability to the field EFP Workshop Committee decides on/ invites (a) topics covered by proposed guideline, (b) working groups and chairs, (c) systematic reviewers, and (d) outcomes measures Submission of PICO(S) questions by systematic reviewers to group chairs for internal alignment Decision on consensus group, invitation of stakeholders Organizing and Advisor Committee meeting. Decision on PICO(S) and information sent to reviewers Submission of Systematic reviews by reviewers, initial assessment by workshop committee Peer review and revision process, Journal of Clinical Periodontology Submission of declarations of interest by all delegates
September 2018
End of year 2018
21 January 2019
March–June 2019
June–October 2019
September 2019
• After the completion of periodontal therapy, a stable periodon - titis patient has been defined by gingival health on a reduced periodontium (bleeding on probing in <10% of the sites; shallow probing depths of 4 mm or less and no 4 mm sites with bleeding on probing). When, after the completion of periodontal treat - ment, these criteria are met but bleeding on probing is pres - ent at >10% of sites, then the patient is diagnosed as a stable periodontitis patient with gingival inflammation. Sites with per - sistent probing depths ≥4 mm which exhibit BOP are likely to be unstable and require further treatment. It should be recognized that successfully treated and stable periodontitis patients will remain at increased risk of recurrent periodontitis, and hence if gingival inflammation is present adequate measures for in - flammation control should be implemented to prevent recurrent periodontitis. Electronic circulation of reviews and guideline draft 10–13 November 2019 Workshop in La Granja with moderated formalized consensus process December 2019– January 2020 Formal stakeholder consultation, finalization of guideline method report and background text April 2020 Before workshop Publication of guideline and underlying Systematic Reviews in the Journal of Clinical Periodontology
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