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HERRERA ET AL .
Background
Feasibility ISRP-related procedures are clinically and technically demanding.
Intervention
Ethical considerations Not applicable.
In edentulous patients in whom the insertion of a sufficient number ( ≥ 4) of bilaterally distributed and adequately sized (in terms of length and width, i.e., implant sizes providing adequate bone to implant contact to support the functional load) dental implants is not feasible, clinicians may consider an implant-supported removable prosthesis (ISRP). ISRPs can be supported/retained by a number of different attachment sys- tems. The most commonly used systems include stud, bar, magnetic and telescopic attachments. Implants may or may not be splinted.
Economic considerations Health-economic parameters were not evaluated in the identified studies. ISRPs entail costs related to surgical and prosthetic treatment.
Legal considerations Not applicable.
Available evidence
11 | LONG-TERM OUTCOMES OF TREATMENT IN STAGE IV PERIODONTITIS PATIENTS
Number and design of included studies Five studies ( n = 136 patients) with a weighted mean follow-up period of 3.3 years were included. Four studies were of prospective and one of retrospective design. All studies were observational and used conventional loading protocols. The consistently reported out- come measures included survival of ISRPs and implants. Data on tech- nical and biological complications, PROMs and health-economic parameters were not (consistently) reported. Risk of bias All studies had a high or critical risk of bias, thus raising concerns on the possibility of drawing robust conclusions. Effect sizes and their clinical relevance Prosthesis survival during the weighted mean follow-up period of 3.3 years was 100% and implant survival ranged from 96% to 100%. Consistency Due to the limited number of studies, sensitivity analyses were not feasible. Treatment strategies varied considerably across studies. Balance of benefit and harm The evidence suggests favourable outcomes in terms of prostheses and implant survival. The lack of information on complications and PROMs as well as the short follow-up should be considered. Overall certainty of the evidence The certainty of evidence is graded as very low based on study design and high risk of bias.
11.1
| Intervention: professionally administered
supportive periodontal care
The systematic review (Leow et al., 2021) assessed the role of profes- sionally administered supportive periodontal care (SPC) in preventing tooth loss, periodontitis progression (clinical attachment loss, CAL) and associated health outcomes in patients with periodontitis who had completed active periodontal treatment. The role of SPC is highly relevant to patients with all stages of periodontitis. In the systematic review (Leow et al., 2021), it was not possible to identify studies focussed on stage IV periodontitis and the findings are therefore relevant to all stages of disease. Five components or combinations thereof contribute to SPC interventions: 1. Interview : periodontal health symptoms, medical and social his- tory, risk factors including tobacco use, stress, diabetes and reported plaque control regime; 2. Assessment : plaque and calculus deposits, periodontal health sta- tus, including inflammation, PPDs and bleeding pockets; 3. Evaluation : intervention needs including risk factor management, oral hygiene and re-treatment; 4. Practical Intervention : oral hygiene coaching, instrumentation of supra- and sub-gingival plaque and calculus, treatment of sites with recurrence (finding of periodontitis at a previously healthy/stable site) or residual periodontitis (a deep periodontal pocket remains despite active therapy); 5. Planning : interval before next SPC visit. The control was no or irregular SPC, defined as greater than a frequency of 3-monthly. Specialist and non-specialist settings were considered, and protocols included adjunctive therapies. The primary outcome was tooth loss. Secondary outcomes included one site with CAL loss ≥ 2 mm, number of sites with PPDs
From evidence to recommendation — additional considerations
Acceptability PROMs were reported in two of the included studies. The tools used to assess PROMs were not validated and inconsistent across studies.
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