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HERRERA ET AL .
tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I – III. Conclusions: The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.
KEYWORDS clinical guideline, dental implant, orthodontic, stage IV, periodontitis, prosthodontic
Clinical Relevance Scientific rationale for study : Patients with stage IV periodontitis share the severity and complex- ity features of stage III periodontitis but, in addition, suffer from the functional sequelae and consequences of tooth loss, frequently associated with advanced periodontitis. This clinical practice guideline (CPG) aimed to provide guidance on the necessary inter-disciplinary therapy required to rehabilitate the compromised dentition in such patients. The interventions described in this CPG should be derived following a rigorous evidence-based and patient-centred decision-making process. Principal findings : This guideline was developed using strict and validated methodologies for assuring the best available evidence on the efficacy of the interventions considered, and the most appropriate recommendations based on a structured consensus process, including a panel of experts and representatives from key stakeholder groups. Practical implications : The application of this S3 Level CPG will allow a consistent, inter- disciplinary and evidence-based approach to the management of stage IV periodontitis.
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INTRODUCTION
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of stage IV periodontitis. The distinction between periodontitis stage III and stage IV is primarily based on the common sequelae of advanced loss of periodontal tissue support, which include: (i) tooth loss, resulting in <20 remaining teeth (<10 opposing pairs); (ii) masticatory dysfunc- tion; (iii) tooth mobility grade ≥ 2; (iv) severe alveolar ridge defects; and (v) occlusal collapse (tooth drifting, flaring). These unique features of stage IV periodontitis require treatment of a higher level of complexity, but also necessitate an inter-disciplinary approach for rehabilitation of the impaired dentition (Papapanou et al., 2018; Tonetti et al., 2018; Tonetti & Sanz, 2019). Periodontitis represents a major public health problem due to its high prevalence and associated morbidity. Severe periodontitis, in particular, may lead to disability due to impaired chewing func- tion and aesthetics or edentulism, is a source of social inequality, and significantly impairs quality of life (Tonetti et al., 2017). In addi- tion, severe periodontitis has a negative impact on general health and is associated with significant dental care costs (Tonetti et al., 2017). A major difference between the treatment of periodontitis stages III and IV is the need for a stage IV patient to maintain/re-establish a functional dentition and the necessity for a rigorous supportive care
1.1
The health problem
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1.1.1 | Definition
Periodontitis is characterized by progressive destruction of the tooth- supporting apparatus (periodontium), with primary features being clin- ical attachment loss (CAL), radiographically assessed alveolar bone loss, presence of periodontal pockets and bleeding (Papapanou et al., 2018). Periodontitis is characterized further by defining the stage and grade of the disease: stage captures the severity, extent and distribution of the disease, as well as the anticipated complexity for its management; grade captures additional biological dimensions of the disease including the observed and/or anticipated progression rate, predicted treatment outcomes, and the risk that the disease or its treatment will adversely affect the general health of the patient (Papapanou et al., 2018; Tonetti et al., 2018). The management of stages I – III periodontitis has already been described in a previously published clinical practice guideline (CPG) (Sanz, Herrera, et al., 2020). The present CPG focuses on the treatment
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