16
HERRERA ET AL .
TABLE 6 Strength of consensus: Determination scheme (German Association of the Scientific Medical Societies (AWMF) & Standing Guidelines Commission, 2012)
This will include:
• Publication of the guideline and the underlying SRs as an Open Access special issue of the Journal of Clinical Periodontology . • Commentary, Adoption, or Adaptation (Schünemann et al., 2017) by national societies. • Generation of educational material for dental professionals and patients, and dissemination via the EFP member societies. • Dissemination via educational programmes at dental conferences. • Dissemination via the EFP through European stakeholders via National Society members of the EFP. • Long-term evaluation of the successful implementation of the guideline by a survey of EFP members.
Unanimous consensus
Agreement of 100% of participants
Strong consensus
Agreement of >95% of participants
Agreement of 75% – 95% of participants
Consensus
Agreement of 50% – 74% of participants
Simple majority
No consensus
Agreement of <50% of participants
3.5.2 | Declaration of interests and management of potential conflicts
All members of the guideline panel declared secondary interests using the standardized form provided by the International Committee of Medical Journal Editors (ICMJE) (International Committee of Medical Editors, 2013). Management of conflicts of interests (CoIs) was discussed in the WGs and the plenary sessions, following the principles provided by the Guidelines International Network (Schunemann et al., 2015). According to these principles, panel members with relevant, potential CoIs abstained from voting on guideline statements and recommenda- tions within the consensus process. Those abstentions were recorded in each recommendation table.
The timeline of the guideline development process is detailed in Table 7.
3.8
Validity and update process
|
The guideline is valid until 2027. However, the EFP, represented by the members of the organizing committee, will continuously assess current developments in the field. Where there are major changes of circumstances, for example, new relevant evidence, this will trigger an update of the guideline to potentially amend the recommendations. It is planned to update the current guideline regularly on demand and consistent with the format of a living guideline.
3.6
Peer review
|
4 | PERIODONTAL DIAGNOSIS AND TREATMENT SEQUENCE FOR THE
All 13 SRs underwent a multi-step peer review process. First, the draft documents were evaluated by members of the EFP Workshop Com- mittee and the methodological consultants using a custom-made appraisal tool to assess: (i) the methodological quality of the SRs using the AMSTAR 2 checklist (Shea et al., 2017); and (ii) whether all PICOS questions were addressed as planned. Detailed feedback was then provided to the SR authors. Subsequently, all 13 SRs underwent the regular editorial peer review process defined by the Journal of Clinical Periodontology . In addition, the reports of the updates of the SRs, presented in the Addendum (accessible online CPGstage4-Addendum ), were also peer-reviewed. The guideline text was drafted by the chairs of the WGs, in close cooperation with the methodological consultant, and circulated among the members of the guideline group prior to the workshop. The methodological quality was formally assessed by an external con- sultant using the AGREE framework. The guideline was subsequently peer-reviewed for its publication in the Journal of Clinical Periodontol- ogy following the standard evaluation process of the journal.
MANAGEMENT OF STAGE IV PERIODONTITIS PATIENTS
4.1
Periodontal diagnosis
|
Defining a case of periodontitis and establishing a diagnosis should be performed using the 2018 classification system, developed following the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions (Caton et al., 2018; Chapple et al., 2018; Jepsen et al., 2018; Papapanou et al., 2018; Tonetti et al., 2018). According to this classification, stage IV periodontitis is identified from the broader population of individuals with stage III periodontitis, defined by periodontal inflammation, and attachment loss reaching the middle third of the root and beyond, based on the need for com- plex rehabilitation due to the presence of one or more of the follow- ing factors: • Secondary occlusal trauma/tooth hypermobility attributable to a reduced periodontal attachment that is attributed to periodontitis. • Tooth migration, drifting and opening of diastema are associated
3.7
| Implementation and dissemination plan
For this guideline, a multi-stage dissemination and implementation strategy will be established and implemented by the EFP, supported by a communication campaign.
with severe attachment loss at the affected teeth. • Loss of five or more teeth due to periodontitis.
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