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HERRERA ET AL .
Background
prosthesis and achievement of tissue health needs to be verified along with the maintainability of the abutments before insertion of the final prosthesis. Insertion of the final dental prosthesis needs to follow the achievement of the treatment goals for natural teeth and/or implants at the completion of active periodontal therapy. R8.4. Which are the general considerations when incorporating dental implants in stage IV periodontitis patients?
Once the restorative needs of the case have been identified, interim restorations may be required to provide stable posterior occlusal stops, relieve secondary occlusal trauma, replace functionally impor- tant missing teeth, or improve patient comfort. Ideally, the decision to place an interim restoration should be based on the individual response of periodontal therapy as assessed in the periodontal re- evaluation after completion of step 2 treatment. Frequently, the bene- fits to the treatment plan from interim restorations require their inser- tion as early as possible. Flexibility to move forward the interim restoration in the treatment plan, however, should not compromise the need to achieve adequate supragingival biofilm control in the con- text of step 1 treatment.
Additional question raised by the WG
R8.4: Expert consensus-based recommendation When dental implants are considered in the rehabilitation of stage IV periodontitis patients , we recommend verifying (i) absence of contraindications to surgery , (ii) hard and soft tissue dimensions and (iii) the potential need for soft-/hard-tissue augmentation . Supporting literature Expert opinion Quality of evidence Not applicable Grade of recommendation GradeA — "" Strength of consensus Consensus (3.5% of the group abstained due to potential CoI)
R8.3. Which are the general principles for the design and delivery of dental prostheses in stage IV periodontitis patients?
Additional question raised by the WG
R8.3: Expert consensus-based recommendation We recommend designing the dental prostheses to allow optimal self- performed oral hygiene measures and professional mechanical plaque removal . We recommend delivery of the definitive prosthesis after a final evaluation of the maintainability and prognosis of abutment teeth/ implants . 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 Unanimous consensus (0% of the group abstained due to potential CoI)
Background
Dental implants are frequently considered in the rehabilitation of stage IV periodontitis patients to replace missing teeth and restore function. The use of a dental implant, however, may present different levels of complex- ity and range from a simple procedure in a subject with no medical contra- indications and adequate dimensions of soft and hard tissues, to a complex procedure requiring specific medical assessments and/or challenging local hard and/or soft tissue augmentation. As the complexity of the dental implant placement increases, its clinical performance may decrease, affect- ing the cost – benefit ratio and its attractiveness with respect to alterna- tives. Such considerations are part of the strategic assessment that concur in the determination of the treatment plan for the individual case. R8.5. Which are the specific considerations when incorporating dental implants in stage IV periodontitis patients?
Background
Oral biofilm control is important for the longevity of the dentition and restorations. This is critically important in subjects with stage IV peri- odontitis who have shown high susceptibility to periodontitis. Restora- tions may render access and effectiveness of self-performed biofilm control and professional mechanical plaque removal (PMPR) more chal- lenging. While restorations are primarily designed to restore function, they should enable optimal biofilm control at the critical interface between the restoration, the tooth/root surface, the implant on one side and the soft tissues (gingiva, peri-implant or alveolar ridge mucosa) on the other. Planning and execution of these restorations should preserve the necessary access for oral hygiene aids including inter-dental brushes or dental floss, as well as instruments for PMPR (both supra- and sub- gingivally). This should be prioritized compared with avoidance of food impaction. The design should be finalized with the interim dental
PICOS question addressed by a SR
R8.5: Expert consensus-based recommendation When dental implants are considered in the rehabilitation of stage IV periodontitis patients , we recommend that information on the increased risk for peri-implantitis and implant loss should be provided . Supporting literature (Lindhe, Meyle, & Group, 2008; Carra et al., 2021) and Expert opinion Quality of evidence Low Grade of recommendation GradeA — "" Strength of consensus Consensus (23.8% of the group abstained due to potential CoI)
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