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Background
Overall certainty of the evidence Moderate.
Intervention
From evidence to recommendation — additional considerations
The goals of SPC are to maintain periodontal stability (BOP in <10% of sites; shallow PPDs of 4 mm or less, and no 4 mm sites with BOP) (Chapple et al., 2018), by preventing disease recurrence or progres- sion and ultimately to prevent tooth loss. Ideally, patients enter SPC with periodontal stability; however, in some situations, the strict defi- nition in the 2018 Classification of stability/health following peri- odontal treatment is not always achieved. Residual periodontal probing depths (PPDs) ≥ 4 mm with BOP are likely to be unstable and pose a risk for disease progression.
Acceptability Little is known about patient preferences in relation to SPC. How- ever, SPC has been recommended for oral healthcare for several decades. Feasibility Little is known about implementation. SPC is a routinely provided intervention in a number of healthcare systems, although the regular- ity of visits (3 – 4 times per year) may be a barrier for some patients (financial and logistical). Ethical considerations No evaluation of equity or access to SPC has been conducted. How- ever, utilization of dental services is unequally distributed, and there- fore, it is reasonable to assume the same would be the case for SPC. Identifying barriers to and facilitators of SPC, and using this informa- tion to enhance access would seem to be a priority. Economic considerations Limited evidence exists on the cost-effectiveness of SPC. SPC deliv- ered in specialist care when compared with general dental practice may result in less CAL loss and higher tooth survival rates, but at a greater financial cost (Gaunt et al., 2008). Economic modelling indi- cates SPC is cost-effective in developed economies (Pennington et al., 2011).
Available evidence
Number and design of included studies Two studies addressing disease recurrence (CAL loss ≥ 2 mm) during SPC were included, one controlled clinical trial and one prospective cohort. Risk of bias Study quality assessment using the Robins-I tool showed a “ serious ” risk of bias and “ low ” risk using the Newcastle – Ottawa scale. Effect sizes and their clinical relevance Based on one controlled clinical trial (Jenkins et al., 2000), patients with residual PPD ≥ 6 mm after active periodontal ther- apy demonstrated disease recurrence (CAL loss ≥ 2mm) in the range of 20.5% – 28.6% of sites over 12 months follow-up. In con- trast, shallower residual PPD (4.0 – 5.9 mm) showed disease recur- rence in the range of 11.6% – 11.8%. No statistically significant difference between groups was found with regard to the modal- ity of treatment during SPC (coronal scaling vs. subgingival instrumentation). The prospective cohort study (Cortellini et al., 2017) reported the highest rate of disease recurrence at sites PPD ≥ 5 mm (compared with PPD <5 mm) over a 20-year period. Regression analysis showed that residual PPD significantly correlated with disease recurrence ( p = .0024, R 2 = 0.31, root mean square error = 0.75). Consistency Studies were heterogeneous in design and reporting of outcomes. All studies describe increased disease recurrence with increasing residual PPD after active periodontal therapy. Balance of benefit and harm One study reported adverse events following subgingival instrumenta- tion of residual pockets. These were, however, not deemed to be seri- ous. An overall consideration of the benefit versus harm of achieving periodontal stability (no residual deepened PPDs), following active periodontal therapy, in order to reduce the risk of disease recurrence supports the strength of the statement.
Legal considerations Not applicable.
R11.2. Does residual probing pocket depth, following active periodontal treatment, affect disease recurrence during SPC?
PICOS question addressed by a SR
R11.2: Evidence-based statement In patients with periodontitis , the presence of residual probing pocket depths ( ≥ 5 mm) following active therapy increases the risk of disease recurrence/progression , even though the patient is enrolled in SPC . Supporting literature (Leow et al., 2021) Quality of evidence Moderate Two studies, which were a prospective cohort and a controlled clinical trial, with risk of bias designated as “ low ” and “ serious ” , respectively. Grade of recommendation Statement: unclear, additional research needed Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
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