13
HERRERA ET AL .
TABLE 4
(Continued)
Reference
Systematic review title
Final PICOS question (as written in manuscripts)
systemic disease risk and adverse pregnancy outcomes?
terms of systemic health and quality of life outcomes, as reported in 6 month (minimum follow-up) randomized controlled trials? #2. In patients with periodontitis (stages III or IV or equivalent) and a non-communicable disease, what is the effect of periodontal treatment in comparison with no treatment or control treatment, in terms of systemic health and quality of life outcomes, as reported in 6 months minimum follow-up randomized controlled trials? #3. In patients with periodontitis (stages III or IV or equivalent) and pregnancy, what is the effect of periodontal treatment in comparison with no treatment or control treatment, in terms of perinatal, maternal and quality of life outcomes, as reported in randomized controlled trials? What is the effect of bridges or dentures versus no treatment in fully or partially edentulous patients affected by stage IV periodontitis in terms of quality of life (as measured through psychometric testing) and systemic health (as measured through general disease's incidence and surrogate markers), as reported in randomized and non-randomized controlled clinical trials, case series, cohort studies, cross-sectional studies and case – control studies?
Gennai et al. (2021)
Impact of rehabilitation versus edentulism in systemic health and quality of life in patients affected by periodontitis. A systematic review and meta-analysis.
3.2.5 | Search strategy
overlaps between the SRs or significant thematic omissions, in order to ensure that they encompass the main interventions currently undertaken in the management of stage IV periodontitis. Since the criteria to define stage IV periodontitis were only available after 2018, in order to include, in the SRs, those studies published/conducted before 2018, the terminology “ stage IV (or equivalent) periodontitis ” has been used, when applicable.
All SRs utilized a comprehensive search strategy of at least two different databases, supplemented by a hand search of periodontology-focused journals and the reference lists of included studies. In all SRs, the electronic and manual search, as well as the data extraction, was undertaken in parallel by, at least, two differ- ent investigators.
3.2.4 | Relevance of outcomes
3.2.6 | Quality assessment of included studies
One important outcome of interest in a clinical guideline in Dentistry is tooth loss. However, a narrative review article (Loos & Needleman, 2020), commissioned during the development of the CPG for the treatment of stage I – III periodontitis (Sanz, Herrera, et al., 2020) reported that the reduction in periodontal probing pocket depth (PPD) was an important predictor of tooth loss, in the context of periodontal therapy. Therefore, PPD reduction was also used as a primary outcome in SRs not addressing periodontal regeneration, and in instances where tooth loss data were not available. When reviewing periodontal regenerative interventions, gains in clinical attachment were used as the primary outcome measure. Secondary periodontal outcomes included the proportion of residual/open pockets as critical endpoint of therapy, which have been shown to be associated with disease recurrence (Loos & Needleman, 2020). For the purposes of the present guideline, in addition to tooth survival, tooth-supported prosthesis survival and implant and implant- supported prosthesis survival were also considered. Additional out- comes related to complexity factors were also addressed in the SRs (e.g., vertical dimension or evaluation of masticatory dysfunction). Finally, patient-reported outcome measures (PROMs), quality of life indicators and economic factors were studied whenever possible.
In all SRs, the risk of bias of controlled clinical trials was assessed using the Cochrane risk-of bias tool (https://methods.cochrane.org/ bias/resources/rob-2-revised-cochrane-risk-bias-tool-randomized-trials). For observational studies, the Newcastle – Ottawa scale was used (http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp).
3.2.7 | Data synthesis
Where applicable, the available evidence was summarized by means of a meta-analysis.
3.3
| From evidence to recommendation:
Structured consensus process
The structured consensus development conference was held during the XVII European Workshop in Periodontology in La Granja de San Ildefonso Segovia, Spain, on 7 – 9 November 2021. Using the 13 SRs as background information, evidence-based recommendations were
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