25
HERRERA ET AL .
7 | CLINICAL RECOMMENDATIONS: CASE TYPE 2
For OA , the existing evidence suggests a weak positive relation- ship between benefit and harm/risks. There is no information on PROMs and adverse events, and those need to be evaluated in future research.
Case type 2: the patient with pathological tooth migration, characterized by tooth elongation, drifting and flaring, which is amenable to orthodontic correction.
Overall certainty of the evidence Very low for both TS and OA.
7.1
| Introduction: Treatment of pathological tooth
migration in stage IV periodontitis patients
From evidence to recommendation — additional considerations
As explained in Sections 1.1.1 and 4.1, stage IV periodontitis is charac- terized by similar severity and complexity as stage III periodontitis in terms of periodontal inflammation, attachment and bone loss, but these stage IV periodontitis patients have either lost five or more teeth due to periodontitis and/or are in need for complex rehabilita- tion due to one or more of the following criteria: • Bite collapse, tooth migration, drifting, flaring and spacing are asso- ciated with severe attachment loss at the affected teeth. • Loss of posterior support and/or flaring of anterior teeth conse- quent to periodontitis. • Secondary occlusal trauma/tooth hypermobility, degree ≥ 2, attribut- able to reduced periodontal attachment consequent to periodontitis. • Less than 20 remaining teeth (10 opposing pairs) • Loss of masticatory function (masticatory dysfunction) secondary to a combination of the above. Common to these patients is that the lack of appropriate treatment, not only risks the loss of affected remaining teeth, but also loss of the whole remaining dentition. In stage IV periodontitis patients, the treatment of periodontitis (through standard periodontal ther- apy, i.e., steps I – III plus supportive periodontal care) is not enough to stabilize the case, resolve the masticatory dysfunction and improve their quality of life. An inter-disciplinary treatment plan, therefore, must be implemented, which may include orthodontic and/or prosthetic rehabilitation for the stabilization and/or restora- tion of the masticatory function, patient aesthetics and quality of life. In stage IV periodontitis patients, there are specific phenotypic varia- tions/clinical scenarios based on the individual patterns of the periodontal breakdown, which result in different degrees of functional and aesthetic compromise, as well as in different treatment needs. One of the most common phenotypic variations is the clinical case defining the patient with pathological tooth migration, characterized by tooth elongation, drifting and flaring, which is amenable to orthodontic correction. This consensus report presents the evidence-based and expert-based recommendations of the present clinical practice guideline for the treatment of the described case type (type 2) of stage IV periodontitis (Figure 2). Therefore, recommendations refer to combined periodontal and orthodontic therapy in stage IV periodontitis patients where ortho- dontic therapy is indicated.
Acceptability The certainty of evidence is graded as very low based on the lack of studies, study design and lack of generalizability of data. Feasibility Both TS and OA can be performed by general dentist as well as spe- cialist as the minimum standard of care. Ethical considerations Based on the available evidence, no evaluation of ethical aspects could be performed. TS per se is a minimal-invasive, and in most cases, revers- ible therapeutic procedures that do not negatively influence tooth sur- vival. OA is a minimal-invasive but not reversible therapeutic procedure that does not negatively influence periodontal outcome variables.
Economic considerations Health-economic parameters were not evaluated in the identified studies.
Legal considerations Not applicable.
R6.2. See question for R6.1
PICOS question addressed by a SR
R6.2: Evidence-based recommendation In patients with stage IV periodontitis who do not require tooth replacement but show persistent hypermobility or increasing mobility after successful completion of periodontal therapy , long-term tooth splinting may be considered to improve patient comfort . Supporting literature (Dommisch et al., 2021; Sonnenschein, Ciardo, et al., 2021; Sonnenschein, Ziegler, et al., 2021) Quality of evidence Very low Grade of recommendation GradeO — $ Strength of consensus Unanimous Consensus (0% of the group abstained due to potential CoI)
Background
See the background text for Recommendation R6.1.
Made with FlippingBook Annual report