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HERRERA ET AL .
(Continued) PICOS question addressed by a SR
Risk of bias For TS , study quality assessment using the Newcastle – Ottawa scale identified a low risk of bias for both studies included. For OA, study quality assessment using the Cochrane Collaboration's tool for assessing risk of bias identified unclear risk of bias, mainly related to potential centre bias. Effect sizes and their clinical relevance For TS , based on two retrospective case series ( n = 72 patients), over at least 2 years mean TL was 8.4% for TS and 10.1% for no-TS. TS may be performed as an adjunctive intervention for teeth with a pro- gressive increase in TM in order to improve the patient's chewing capabilities. For OA , based on one study ( n = 50 patients), CAL was moni- tored over a period of 2 years (Burgett et al., 1992). After 1 and 2 years, OA led to an improved CAL of approximately 0.4 mm (mean) following non-surgical periodontal therapy. Although this improvement may not be considered as clinically relevant, OA may remove jiggling forces, facilitate patients' chewing capabilities and resolve pain perception when premature contacts are removed. Consistency In the analysis of TS , only two articles exhibiting heterogenous data with a wide range of follow-up examinations (between 2 and 32.4 years) were in accordance with the inclusion criteria of the sys- tematic review. The included studies differed regarding the definition of the control group as well as operators performing splinting and periodontal examination. In addition, one study reported a high drop- out rate (Sonnenschein et al., 2017). In the analysis of OA , only three studies of heterogeneous design were in accordance with the inclusion criteria of the sys- tematic review. Of these three studies, one study was designed as an RCT focusing on randomization for OA (Burgett et al., 1992), while the two remaining studies randomized for periodontal treat- ment modalities but not for OA (Fleszar et al., 1980; Kerry et al., 1982). Balance of benefit and harm For TS , the overall evidence suggests a very weak positive relationship between benefit and harm/risks. Although TS does not improve tooth survival, a positive effect on the individual patient comfort exists. However, if TS is performed, splinting technique, material and design should enable optimal self-performed and professional oral hygiene procedures. Preliminary data exist on OHRQoL in periodontitis patients. Three months after non-surgical periodontal therapy, a positive impact on the OHIP-14 summary scores was documented, suggesting a trend towards improved patients' comfort (Sonnenschein, Ziegler, et al., 2021). There is a lack of information on PROMs and adverse events, and those need to be evaluated in future research.
R6.1: Evidence-based recommendation Strength of consensus Unanimous Consensus (0% of the group abstained due to potential CoI)
Background
Intervention
TS and OA in fully dentate patients with periodontitis.
Available evidence
Number and design of included studies For TS , the two included retrospective studies ( n = 72 patients) analysed a time follow-up time period ranging between 2 and 32.4 years. After a minimum of 2 years following non-surgical peri- odontal therapy, synthesis of data revealed a weighted mean inci- dence of 8.4% of tooth loss for TS compared with 10.1% of tooth loss for no-TS. Outcome measures comprised, beside tooth loss, PPD, changes in CAL, changes in bone level (BL), and plaque scores. Biologi- cal complications, PROMs, health-economic parameters and adverse events were not consistently reported. One additional randomized prospective study indicated a positive effect on the oral health-related quality of life 3 months after non-surgical periodontal therapy (Sonnenschein, Ziegler, et al., 2021). The time point of TS (prior or following step 2 of periodontal therapy) was addressed in a randomized trial, and the timing appeared not to influence the outcome of periodontal parameters (Sonnenschein, Ziegler, et al., 2021). Throughout periodontal therapy, TS repairs were frequently required (Sonnenschein et al., 2017; Graetz et al., 2019). In patients with periodontitis stage IV, both TS and advanced attachment loss may widely impair the patient's aesthetics. The main findings were that tooth TS does not affect tooth loss, and does not affect PPD, CAL and BL. Finally, and in preparation for step 3 of periodontal therapy, since an increase of TM following flap mobilization is anticipated, TS may be beneficial when regenerative periodontal treatment is planned (Cortellini et al., 2001). For occlusal adjustment (OA), three studies ( n = 205 patients) were included, one randomized controlled clinical trial (RCT) (Burgett et al., 1992) and two prospective studies (randomization did not include OA procedures) (Fleszar et al., 1980; Kerry et al., 1982). All studies were of prospective design. While two studies included OA as part of the ini- tial phase, one study allocated OA randomly facilitating a comparison of patients with and without OA and no-OA. The follow-up time ranged from 2 to 8 years. None of the studies reported on TL or PROMs. The main findings were that the effects of OA on TL are unclear, that OA positively affects CAL, and that OA does not affect PPD and BL.
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