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HERRERA ET AL .
TABLE 7
Timeline of the guideline development process
• Loss of posterior support and/or flaring of anterior teeth due to periodontitis. • Loss of masticatory function (masticatory dysfunction) secondary to a combination of the above. The above signs and symptoms of functional impairment (mastica- tory dysfunction) may also be present as sequelae of multiple tooth loss due to caries or severe malocclusion in people without signifi- cant periodontal breakdown or even in people with periodontal breakdown compatible with stages I – II periodontitis, who do not meet the criteria for stage IV. Hence, differential diagnosis is important. Stage IV periodontitis not only jeopardizes the survival of indi- vidual teeth, but that of the entire dentition. In these patients, con- trol of periodontitis (through standard periodontal therapy, i.e., steps I – III plus supportive periodontal care) is not enough to stabilize the mouth, resolve masticatory dysfunction and improve quality of life. An inter-disciplinary treatment plan that may include the manage- ment of secondary occlusal trauma, orthodontic tooth movement and/or restorative dental care following successful periodontal ther- apy must therefore be implemented to adequately treat these patients.
Timepoint
Action
April 2018
Decision by European Federation of Periodontology (EFP) General Assembly to
develop comprehensive treatment guidelines for periodontitis, including periodontitis in stage IV
May – September 2018
EFP Workshop Committee assesses merits and disadvantages of various established methodologies and their applicability to the field EFP Workshop Committee decides on (i) topics covered by proposed guideline, (ii) working groups and chairs, (iii) systematic reviewers, and (iv) outcomes measures
November 2019
February 2020
EFP Workshop Committee decides the systematic reviewers
March2020
Submission of PICO(S) questions by systematic reviewers to group chairs for internal alignment Decision on PICO(S) and information sent to reviewers Decision of postponement from November 2020 until July 2021 Decision on consensus group, invitations sent to participants, invitations sent to stakeholders Submission of Systematic reviews by reviewers, initial quality assessment by workshop committee Submission to Journal of Clinical Periodontology , peer review and revision process Decision of postponement from July 2021 until November 2021, and schedule of preparatory online meetings Submission of declarations of interest by all delegates Online plenary meeting and working group meetings
April 2020
May2020
June2020
4.1.1 | Specific diagnostic pathways in patients with stage IV periodontitis
June – November 2020
The clinical assessment of a stage IV periodontitis case comprises five critical dimensions:
July2020 – March 2021
April 2021
i. Evaluation of the amount of periodontal breakdown, patient function and aesthetics A full periodontal examination/charting, combined with appropri- ate imaging, is required to assess the severity of the periodontal attachment loss and, hence, the complexity of treatment required. In stage IV periodontitis, such examinations must be complemented with an in-depth assessment of the functional and aesthetic status of the individual teeth and the overall dentition, including assessment of tooth hypermobility, assessment of tooth vitality, presence of secondary occlusal trauma, presence of sta- ble posterior vertical stops, fremitus in centric occlusion and excursive movements, subjective and objective assessments of chewing function, aesthetics and phonetics. ii. Number of teeth that have been lost due to periodontitis Attributing missing teeth to periodontitis is challenging as it requires a complex assessment based on history of tooth loss/ extraction and the symptoms associated with it (Sanz, Papapanou, et al., 2020; Ravidà et al., 2021; Uy et al., 2021). Recall bias and availability of previous records may influence the findings. Nevertheless, the use of a clinical history for the deter- mination of the probable cause of tooth loss adds useful informa- tion that can be applied for individual case diagnosis (Ravidà et al., 2021).
June2021
5 July2021
27 September 2021
Online working group meetings
18 October 2021 Online working group meetings July – October 2021
Electronic circulation of reviews, guideline draft, etc. Workshop in La Granja with moderated formalized consensus process Formal stakeholder consultation, finalization of guideline method report and background text
7 – 9November 2021 November 2021 – January 2022
26 January 2022 Online plenary meeting February 2022 Submission of guideline document to the Journal of Clinical Periodontology March – April 2022 Publication of guideline and underlying Systematic Reviews in the Journal of Clinical Periodontology April – September 2022 Processes of adaptation/adoption by National Societies
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