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HERRERA ET AL .
Available evidence
This section aims to provide recommendations for the general princi- ples of case management in patients with a compromised dentition due to stage IV periodontitis requiring rehabilitation.
Number and design of included studies The evidence for this recommendation is derived from expert opin- ion and from a retrospective cohort study with 52 patients followed at least 2 years after OT (Han et al., 2020).
R8.1. How important is it to identify the restorative needs of the individual case in stage IV periodontitis patients?
Risk of bias Not applicable.
Additional question raised by the WG
Effect sizes and their clinical relevance Han et al. (2020) reported that orthodontic fixed retainers fail more often in stage III periodontitis patients compared with stage I peri- odontitis patients. This study did not include stage IV periodontitis patients, but these findings indicate that increased periodontitis severity was associated with higher retainer failure, and hence, in stage IV periodontitis patients, the need for frequent recalls to evalu- ate the retainer's integrity should be highlighted.
R8.1: Expert consensus-based recommendation We recommend identifying the restorative needs of partially edentulous stage IV periodontitis patients based on the pattern of tooth loss , individual functional and aesthetic needs , patient comfort and
prognostic factors . The level of function and design of the rehabilitation should be compatible with case stability over time .
Supporting literature Expert opinion Quality of evidence Not applicable Grade of recommendation GradeA — "" Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Consistency, balance of benefit and harm Not applicable.
Overall certainty of the evidence Low.
Background
From evidence to recommendation — additional considerations
Stage IV periodontitis cases are characterized by high levels of pheno- typic variation. While restorative needs to achieve case stability and address patient comfort are only one dimension of what needs to be considered in treatment planning, precise identification of these needs is critical. Treatment goals need to be based on the individual patient, its unique pattern of tooth loss, tooth prognosis both in terms of peri- odontal maintainability and restorative factors. Furthermore, the treatment plan should be able to stop or mitigate greatly the occlusal and functional aspects that contribute to the instability of the case and loss of patient comfort.
Acceptability Patients usually accept and understand the need for long-term fixed passive retention and regular monitoring.
Feasibility, ethical, economic and legal considerations There are no specific considerations.
8 | CLINICAL RECOMMENDATIONS: OVERALL STRATEGY FOR THE MANAGEMENT OF CASE TYPES 3 AND 4
R8.2. Is there a need, and what is the timing of interim restorations in stage IV periodontitis patients?
In stage IV periodontitis patients, prosthetic rehabilitation requires adherence to both periodontal and reconstructive treatment princi- ples. Such principles need to be tailored to the specific needs of this patient group. Several key issues need to be addressed, including: 1. Identification of the restorative needs with an emphasis on limiting the scope of the prosthetic treatment while ensuring patient com- fort and stability. 2. Identification of the need for interim dental prostheses. 3. Timing of delivery of interim and definitive dental prostheses. 4. Need and timing of dental implant placement.
Additional question raised by the WG
R8.2: Expert consensus-based recommendation We recommend placing an interim dental prosthesis , if required , early during periodontal therapy , but only after establishing adequate oral hygiene . Supporting literature (Donos et al., 2021; Montero et al., 2021; Ramanauskaite et al., 2021; Tomasi et al., 2021) and Expert opinion Quality of evidence Very low Grade of recommendation GradeA — "" Strength of consensus Strong consensus (1.9% of the group abstained due to potential CoI)
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