21
HERRERA ET AL .
4.2.2 | Additional therapeutical interventions in stage IV periodontitis
4.2.4 | Impact of therapy in stage IV periodontitis patients on systemic health and quality of life
The present guideline has specifically focused on the additional inter- ventions for stage IV periodontitis patients, including:
It is well established that, in addition to positive effects on periodontal outcomes, periodontal therapy may also impact favourably upon sys- temic health (e.g., reduce systemic inflammation and lower the levels of markers of cardio-metabolic risk) and on quality of life. Since the treatment of stage IV periodontitis includes both periodontal therapy and rehabilitation, the impact of both interventions was considered within the present guideline and recommendations are presented for both the impact of periodontal therapy (Section 12.1) and the impact of rehabilitation (dental prostheses) in fully or partially edentulous patients (Section 12.2).
• Temporary control of secondary occlusal trauma (e.g., extra- coronal splinting and/or relief of fremitus by limited selective occlusal adjustment) (Section 6). • Orthodontic therapy (Section 7). • Rehabilitation of one or multiple (small or large) tooth-delimited edentulous spaces (Section 9). • Rehabilitation of unilateral or bilateral posterior free-end edentulism (Section 9). • Tooth-supported full-arch fixed dental prostheses (Section 10). • Tooth-supported full-arch removable dental prosthesis (Section 10). • Implant-supported full-arch fixed dental prostheses (Section 10). • Implant-supported removable dental prosthesis (Section 10). Some of these interventions should be performed simultaneously or within steps 1 – 3 of periodontal therapy, including relief of pain, symptoms of tooth hypermobility, functional impairment and conservative treatment of the dentition (including abutment teeth). Restorative treatment implemented during steps 1 – 3 of periodon- tal therapy usually consists of intermediate restorations that will only be replaced with definitive ones after final evaluation of the case and achievement of the periodontal and restorative objectives. Conversely, certain other interventions will only be performed in the last step ( StepR , for rehabilitation) , following success- ful completion of steps 1 – 3 periodontal therapy, once the patient has started supportive periodontal care, and after achievement of the peri- odontal and restorative treatment objectives. StepR treatment includes:
4.2.5 | Key aspects in the treatment of periodontitis in stage IV
We highlight the following key messages :
• To effectively manage stage IV periodontitis, it is recommended that patients are informed in detail about their condition, the various treat- ment options and associated risks, including the need for periodontal therapy, the design of the rehabilitation, and the sequence of interven- tions. In addition, patients should be aware that treatment planning may be modified depending upon several factors, including treatment outcomes at re-evaluations, and adherence/compliance with interven- tions, such as supragingival biofilm control, or risk factor control. • The starting point for treatment of stage IV periodontitis initially attempts to preserve all periodontally compromised teeth that are deemed rational to treat. Early extraction of teeth with question- able (as opposed to hopeless) prognosis is strongly discouraged and is not supported by current evidence. • Whenever tooth retention is possible, it is recommended that peri- odontal treatment of stage IV periodontitis patients should follow the guideline for the treatment of periodontitis in stages I – III. In these patients, the ability to successfully complete full periodontal therapy is a pre-requisite. In addition, management of these cases may also include orthodontics, tooth splinting, tooth-supported fixed and removable dental prostheses, and/or implant-supported fixed and removable dental prostheses. • For stage IV periodontitis patients, it is recommended to frequently assess motivation and adherence to self-performed supragingival plaque control and risk factor control throughout the course of treatment and during supportive periodontal care, since this will greatly influence both the choice and the outcomes of therapy. • In stage IV periodontitis patients, it is mandatory that restorations should be designed to achieve function and aesthetics while enabling effective self-performed oral hygiene and professional tooth cleaning.
• Long-term periodontal splinting. • Orthodontic tooth movement and retention.
• Definitive restorations designed to satisfy the functional and aes- thetic demands of the patient and enable optimal self-performed oral hygiene and professional tooth cleaning during supportive periodontal care.
4.2.3 | Supportive periodontal care in stage IV periodontitis patients
As for the treatment of stage I – III periodontitis (Sanz, Herrera, et al., 2020), supportive periodontal care (Trombelli et al., 2015) is a cru- cial step to achieve periodontal stability and long-term tooth/implant retention. This guideline provides specific recommendations for sup- portive periodontal care in stage IV periodontitis patients (Section 11).
Made with FlippingBook Annual report