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SANZ et al .
Background
and therefore, they have been evaluated within the second step of therapy.
Intervention Several different psychological interventions based on social cog - nitive theories, behavioural principles and motivational interview - ing (MI) have been applied to improve OHI adherence in patients with periodontal diseases. The available evidence has not demon - strated that these psychological interventions based on cognitive constructs and motivational interviewing principles provided by oral health professionals have improved the patient's oral hygiene performance as measured by the reduction of plaque and bleeding scores over time. Available evidence The evidence includes two RCTs on MI (199 patients) and three RCTs on psychological interventions based on social cognitive theories and feedback (1,517 patients). Risk of bias The overall body of evidence was assessed at high risk of bias (four RCTs high and one RCT low). Consistency The majority of the studies found no significant additional ben - efit implementing psychological interventions in conjunction with OHI.
5.3 | Intervention: Supragingival dental biofilm control (professional)
R1.3 | What is the efficacy of supragingival professional mechanical plaque removal (PMPR) and control of retentive factors in periodontitis therapy? Expert consensus-based recommendation (1.4) We recommend supragingival professional mechanical plaque removal (PMPR) and control of retentive factors, as part of the first step of therapy. Supporting literature Needleman, Nibali, and Di Iorio (2015); Trombelli, Franceschetti, and Farina (2015) Grade of recommendation Grade A—↑↑ Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
Background
Intervention The removal of the supragingival dental biofilm and calcified de - posits (calculus) (here identified under the term “professional mechanical plaque removal” (PMPR) is considered an essential component in the primary (Chapple et al., 2018) and secondary (Sanz et al., 2015) prevention of periodontitis as well as within the basic treatment of plaque-induced periodontal diseases (van der Weijden & Slot, 2011). Since the presence of retentive factors, ei - ther associated with the tooth anatomy or more frequently, due to inadequate restorative margins, are often associated with gingival inflammation and/or periodontal attachment loss, they should be prevented/eliminated to reduce their impact on periodontal health. Available evidence Even though these interventions were not specifically addressed in the systematic reviews prepared for this Workshop to develop guidelines for the treatment of periodontitis, indirect evidence can be found in the 2014 European Workshop on Prevention, in which the role of PMPR was addressed both in primary prevention (Needleman et al., 2015) or in supportive periodontal care (SPC) (Trombelli et al., 2015). Some additional evidence can be found to support both procedures, as part of periodontitis therapy. A split-mouth RCT, with a follow-up of 450 days in 25 subjects, concluded that the performance of supragingival debridement, before subgingival debridement, decreased subgingival treat - ment needs and maintained the periodontal stability over time (Gomes, Romagna, Rossi, Corvello, & Angst, 2014). In addition, supragingival debridement may induce beneficial changes in the subgingival microbiota (Ximénez-Fyvie et al., 2000). Moreover,
Clinical relevance and effect size The reported effect size was not considered clinically relevant.
Balance of benefit and harm Benefit and harm were not reported, and due to the fact that differ - ent health professionals were involved to provide interventions, no conclusion could be drawn. Economic considerations These studies did not assess a cost–benefit evaluation in spite of the expected additional cost related to the psychological intervention.
Patient preferences No proper information was available to assess this issue.
Applicability A psychological approach needs special training to be effectively performed.
5.2 | Intervention: Adjunctive therapies for gingival inflammation
Adjunctive therapies for gingival inflammation have been consid - ered within the adjunctive therapies to subgingival debridement,
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