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SANZ et al .
Background
patient self-care in periodontal maintenance. The evidence that emerged from the search provided 16 papers reporting on 13 CCTs/RCTs, which included 17 comparisons. The differences of powered versus manual toothbrushes were evaluated in five com - parisons, an interdental device was used as an adjunct to tooth - brushing in five comparisons, and seven comparisons evaluated two different interdental devices. In total, the studies evaluated 607 patients. Risk of bias Study quality assessment identified one study at low risk of bias and 10 studies at high risk and two of an unclear risk of bias. Consistency The summary of findings table shows that the body of evidence is rather consistent.
Intervention Although not addressed directly in the systematic reviews under - lying this guideline, different evidence supports the importance of complying with SPC visit, in which PMPR is performed: • Greater rates of tooth loss and disease progression in patients with irregular compliance, versus patients with regular compli - ance (Costa et al., 2014). • The conclusions of the 2014 European Workshop on Prevention, based on the review by Trombelli et al. (2015), concluded that com - pliance with the preventive professional intervention is crucial, based also on retrospective observational studies (Sanz et al., 2015).
8.2 | Intervention: Supragingival dental biofilm control (by the patient)
Clinical relevance and effect size Variable, depending on the comparisons established.
R4.3 | Are oral hygiene instructions important? How should they be performed? Expert consensus-based recommendation (4.3) We recommend repeated individually tailored instructions in mechanical oral hygiene, including interdental cleaning, in order to control inflammation and avoid potential damage for patients in periodontal SPC. Supporting literature Slot et al. (2020) Grade of recommendation Grade A—↑↑ Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
Balance of benefit and harm The adverse events were not evaluated. There is a moderate risk of trauma due to the use of interdental cleaning devices, when not used properly. Therefore, individual instruction and adoption to the indi - vidual situation by professionals are crucial. In any case, the benefits overweigh the risks by far. Economic considerations A manual toothbrush is less expensive than a power toothbrush. Interdental brushes and oral irrigators are more expensive than dental floss, wood sticks and rubber and silicon interdental bristle cleaners.
Patient preferences No data on patient preference arrive from the current review.
Background
Applicability The guideline can be applied to patients attending a periodontal maintenance program. There is an abundance of mechanical oral hy - giene products available.
Intervention All surfaces exposed to the formation of intraoral biofilm have to be cleaned mechanically. Some of them will not be reached by tooth - brushes even under optimized conditions. Interproximal cleaning therefore is essential in order to maintain interproximal gingival health, in particular for secondary prevention. It may be achieved using different devices, primarily inter-dental brushes (IDB, which are not single-tufted brushes), rubber/elastomeric cleaning sticks, wood sticks, oral irrigators and floss. However, all devices have the potential of side effects and their use has to be monitored not only with respect to efficacy but also with respect to early signs of trauma (e.g. onset of non-carious cervical lesions). Available evidence Due to the scarcity of studies that met the inclusion criteria for each of the oral hygiene devices and the low certainty of the resultant evidence, no strong “evidence based” conclusion can be drawn concerning any specific oral hygiene device for
R4.4 | How should we choose an appropriate design of manual, powered toothbrushes and interdental cleaning devices? Expert consensus-based recommendation (4.4) We recommend taking into account patients' needs and preferences when choosing a toothbrush design, and when choosing an interdental brush design. Supporting literature Slot et al. (2020) Grade of recommendation Grade A—↑↑ Strength of consensus Strong consensus (6.9% of the group abstained due to potential CoI)
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