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agents in terms of changes in plaque and gingival indices (Escribano et al., 2016; Figuero, Herrera, et al., 2019). Additional factors have been discussed in the overall evaluation of adjunctive agents.
periodontal parameters when regularly complying with a SPC regi - men based on routine PMPR (Sanz et al., 2015).
Risk of bias The methodological quality was assessed with a specifically de - signed scale for the evaluation of non-randomized observational studies, with a quality level ranging from 3 to 7, in a 9-point scale, with 9 representing the highest quality (lowest risk of bias). Consistency Although no meta-analysis was possible, the primary outcome (tooth loss) was reported in 12 studies, showing no or low incidence. Clinical attachment level (CAL) changes were reported in 10 studies, which consistently showed limited modifications in CAL, frequently as a slight CAL loss. Clinical relevance and effect size A weighted mean yearly rate of tooth loss of 0.15 for follow-up of 5 years, and 0.09 for follow-up of 12–14 years, can be considered as relevant.
8.4 | Intervention: Supragingival dental biofilm control (professional)
R4.14 | What is the value of professional mechanical plaque removal (PMPR) as part of SPC? Expert consensus-based recommendation (4.14) We suggest performing routine professional mechanical plaque removal (PMPR) to limit the rate of tooth loss and provide periodontal stability/improvement, as part of a supportive periodontal care program. Supporting literature Trombelli et al. (2015) Grade of recommendation Grade B—↑ Strength of consensus Strong consensus (1.4% of the group abstained due to potential CoI)
Balance of benefit and harm PROMs were not reported in the included studies.
Background
Economic considerations Ethics and legal aspects are not relevant for this intervention; eco - nomic aspects have not been frequently addressed. In a study in a private practice in Norway, it was demonstrated that regular main - tenance was associated with less tooth loos than not regular mainte - nance, with follow-ups of 16–26 years; the yearly cost of maintaining a tooth was estimated in 20.2 euro (Fardal & Grytten, 2014).
Intervention Professional mechanical plaque removal (PMPR) administered on a routine basis (i.e. at specific, predetermined intervals) as an integral part of supportive periodontal care has been shown to result in low rates of tooth loss and limited attachment level changes in both the short- and long-term in patients treated for periodontitis (Heasman, McCracken, & Steen, 2002; Trombelli et al., 2015). In most of the stud - ies, PMPR in SPC was often combined with other procedures (e.g. re - inforcement of oral hygiene instruction, additional active treatment at sites showing disease recurrence), thus making it difficult to isolate in - formation on the magnitude of the mere effect of PMPR on tooth sur - vival and stability of periodontal parameters (Trombelli et al., 2015). Available evidence This issue has not been directly addressed in the systematic reviews prepared for this Workshop; however, ample evidence is available to support this statement. It has been demonstrated that professional mechanical plaque removal (PMPR), performed at defined intervals, together with the other interventions of supportive periodontal care may result in lower rates of tooth loss and attachment level changes. In a systematic review (Trombelli et al., 2015), presented at the 2014 European Workshop, a weighted mean yearly rate of tooth loss of 0.15 and 0.09 for follow-up of 5 years or 12–14 years, respectively, was reported; the correspondent figures for mean clinical attach - ment loss lower than 1 mm at follow-up ranging from 5 to 12 years. Information from this review, and also from other systematic re - views, collectively supports that patients with a history of treated periodontitis can maintain their dentition with limited variations in
Patient preferences Demonstrated with compliance in long-term studies.
Applicability Demonstrated with studies testing large groups from the general population.
R4.15 | Should alternative methods be used for professional mechanical plaque removal (PMPR) in supportive periodontal care? Evidence-based recommendation (4.15) We suggest not to replace conventional professional mechanical plaque removal (PMPR) with the use of alternative methods (Er:YAG laser treatment) in supportive periodontal care. Supporting literature Trombelli et al. (2020) Quality of evidence One RCT Grade of recommendation Grade B—↓ Strength of consensus Strong consensus (1.4% of the group abstained due to potential CoI)
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