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HERRERA ET AL .
(Continued) Additional question raised by the WG
The first part of this CPG document (Sections 1 – 4) was prepared by the steering group with the help of the methodology consultant, it was examined by the experts participating in the consensus and Section 4 was voted upon in a plenary session to form the basis for the specific recommendations.
R5.1: Expert consensus-based statement Quality of evidence Not applicable Grade of recommendation Statement Strength of consensus Unanimous Consensus (0% of the group abstained due to potential CoI)
Strength of consensus Unanimous Consensus (0% of the group abstained due to potential CoI).
Background
Experts wished to emphasize that stage IV periodontitis can be managed beyond the scope of palliative care and that management requires appropriate periodontal therapy delivered according to the S3 guideline for management of stage I – III periodontitis (Sanz, Herrera, et al., 2020) in combination with rehabilitation of lost function. Once active treat- ment is completed, supportive periodontal care is a critical component to enable long-term success. Further, due to the complexity, case insta- bility and loss of function, option zero (no treatment) is rarely an option.
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| CLINICAL RECOMMENDATIONS:
OVERALL STRATEGY FOR THE MANAGEMENT OF STAGE IV PERIODONTITIS PATIENTS
The pathognomonic features of stage IV periodontitis, as explained in Section 4, are the functional and aesthetic complications that arise fol- lowing periodontal tissue breakdown and/or the resulting tooth loss. This process severely impacts the quality of life and puts the residual dentition at further risk of being lost if appropriate treatment is not rendered. As discussed, the disease spectrum covers a wide range of phenotypic variations characterized by a wide spectrum from subtle changes, that may be overlooked, to severe loss of function that raises the question of whether the dentition can be saved, and rehabilitation of function can translate in restoration of quality of life. The compe- tences required for appropriate diagnosis and management of these cases are frequently complex and inter-disciplinary, while the evi- dence base supporting the different choices is frequently limited. In such situation of complexity and uncertainty, the experts and stake- holders participating in the workshop agreed on a series of expert- based recommendations that provide critical guidance in the manage- ment of these cases, in order to understand the general strategical principles for therapeutic management in patients with a com- promised dentition due to stage IV periodontitis.
R5.2. How relevant is tooth retention?
Additional question raised by the WG
R5.2: Expert consensus-based recommendation We recommend tooth retention to be the first line of treatment strategy in the rehabilitation of stage IV periodontitis patients . Supporting literature (Montero et al., 2021; Tomasi et al., 2021) Quality of evidence Low Grade of recommendation GradeA — "" Strength of consensus Strong Consensus (0% of the group abstained due to potential CoI)
Background
In the long-term management of stage IV periodontitis, retention of the natural dentition with adequate therapy, whenever possible, provides a strategic advantage as it defers the time of implant-based options and shortens their required longevity. The option of tooth retention needs to be considered first and alternatives need to be justified for the spe- cific case based on case and individual tooth prognosis, technical feasi- bility, patient preference and, ideally, cost – benefit considerations.
R5.1. Can stage IV periodontitis can be successfully managed?
R5.3. How relevant is preservation of dental arch integrity
Additional question raised by the WG
R5.1: Expert consensus-based statement Stage IV periodontitis can be successfully managed with the combination of periodontal therapy , appropriate rehabilitation of function and improvement of aesthetics/quality of life , and supportive periodontal care . Supporting literature Expert opinion
Additional question raised by the WG
R5.3: Expert consensus-based recommendation In patients with stage IV periodontitis , we suggest preserving the integrity of the dental arch by avoiding extractions , if teeth can be retained . Supporting literature Expert opinion
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