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SANZ et al .
8.1 | Supportive periodontal care: preliminary considerations
Balance of benefit and harm We did not identify data about harm directly related to procedures. Regarding tooth survival a benefit of root amputation/resection, root separation or tunnelling compared to SRP or OFD cannot be currently stated. For the individual choice of procedure, however, the clinician should consider criteria beyond class of furcation in - volvement (e.g. bone loss, jaw). Economic considerations Simulations based on the German health system have indicated that tooth retention after complex periodontal therapy of teeth with furcation involvement is more cost-effective than their extraction and replacement with an implant supported fixed partial denture (Schwendicke et al., 2014). A study assessing the actual cost of reten - tion of molars in the same health system showed that cost for retain - ing periodontally compromised molars were minimal (Schwendicke et al., 2016). Patient preferences There is a strong patient preference for tooth retention (IQWiG, 2016). Applicability The guideline can be applied since it is independent of availability of materials and a segment of the dental workforce has been trained or can be trained to deliver resective treatment in the different European health systems.
R4.1 | At what intervals should supportive periodontal care visits be scheduled? Expert consensus-based recommendation (4.1) We recommend that supportive periodontal care visits should be scheduled at intervals of 3 to a maximum of 12 months and ought to be tailored according to patient's risk profile and periodontal conditions after active therapy. Supporting literature Polak et al. (2020), Ramseier et al. (2019), Sanz et al. (2015), Trombelli et al. (2020), Trombelli et al. (2015) Grade of recommendation Grade A—↑↑ Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Background
Intervention Although not addressed directly in the systematic reviews under - lying this guideline, different evidence supports the concept of defined intervals to perform SPC visit every 3–4 months are recom - mended in studies selected by Trombelli et al. (2020). • SPC every 3 months may be sufficient to control periodontitis progression after periodontal surgery (Polak et al., 2020). • In addition, the conclusions of the 2014 European Workshop on Prevention, based on the review by Trombelli et al. (2015), con - cluded that the recommended interval ranges 2–4 times per year and that it could be optimized if it is tailored according to patient's risk (Sanz et al., 2015). • A recent study (Ramseier et al., 2019), over 883 patients, re - flected on the importance of SPC and the factors involved in its success.
8 | CLINICAL RECOMMENDATIONS: SUPPORTIVE PERIODONTAL CARE
Following completion of active periodontal therapy, successfully treated periodontitis patients may fall in one of two diagnos - tic categories: periodontitis patients with a reduced but healthy periodontium or periodontitis patients with gingival inflammation (Caton et al., 2018; Chapple et al., 2018). These subjects remain at high risk for periodontitis recurrence/progression and require specifically designed supportive periodontal care (SPC), consisting on a combination of preventive and therapeutic interventions ren - dered at different intervals which should including: appraisal and on monitoring of systemic and periodontal health, reinforcement of oral hygiene instructions, patient motivation towards continu - ous risk factor control, professional mechanical plaque removal (PMPR) and localized subgingival instrumentation at residual pock - ets. The professional interventions, also frequently referred as periodontal maintenance or supportive periodontal therapy, will require a structured recall system with visits customized to the patient needs, usually requiring 45- to 60-min appointments. SPC also includes individual behaviours, since patients in SPC should be compliant with the recommended oral hygiene regimens and healthy lifestyles.
R4.2 | Is adherence to supportive periodontal care important?
Expert consensus-based recommendation (4.2) We recommend that adherence to supportive periodontal care should be strongly promoted, since it is crucial for long-term periodontal stability and potential further improvements in periodontal status. Supporting literature Costa et al. (2014), Sanz et al. (2015), Trombelli et al. (2015) Grade of recommendation Grade A—↑↑ Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
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