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HERRERA ET AL .
Overall certainty of the evidence Moderate.
treatment (Machtei et al., 1993; Martin et al., 2009). Regular SPC is associated with reductions in tooth loss relative to irregular SPC (Saminsky et al., 2015). Risk factor control is an important element of the first step of therapy in the treatment of periodontitis (Ramseier et al., 2020; Sanz, Herrera, et al., 2020). It is important in an era of personalized dental medicine to determine whether frequency of SPC should be tailored according to a patient's risk profile. Patient risk pro- file can be estimated through different validated patient risk assess- ment tools, such as the Periodontal Risk Assessment tool (PRA) (Lang & Tonetti, 2003), the Periodontal Risk Calculator (PRC) and DenPlan/PreViser Patient Assessment tool (Page et al., 2003), Peri- oRisk (Trombelli et al., 2017). Patient risk profile can also be expressed through the “ Grade ” system (Tonetti et al., 2018).
From evidence to recommendation — additional considerations
Acceptability Little is known about patient preferences in relation to periodontal stability at the completion of active periodontal therapy. Dental pro- fessionals have a strong preference for PPD ≤ 4 mm without BOP after completion of periodontal therapy. Feasibility Little is known about implementation. Direct and indirect costs of reaching periodontal stability at completion of SPC may be a barrier for some patients.
Available evidence
Number and design of included studies In the systematic review (Leow et al., 2021), none of the studies that were included addressed risk factor control in SPC. No detail of factors that influenced the frequency of the recall interval was given. One 12-year prospective cohort study (Rosling et al., 2001) evaluated disease progression in normal and high susceptibility patients during 12 years of SPC, where SPC frequency was deter- mined by risk/susceptibility categorization at the end of active peri- odontal therapy.
Ethical and legal considerations Not applicable.
Economic considerations Limited evidence exits on direct/indirect costs of the treatment of dis- ease recurrence during SPC. Clearly, disparities exist between coun- tries, healthcare systems and the modality of treatment chosen to treat the recurrence.
Risk of bias Not applicable.
R11.3. Should recall intervals for SPC be guided by patients' risk status?
Effect sizes and their clinical relevance No included studies documented details on how risk factor control might have influenced recall intervals in SPC. Only one study (Rosling et al., 2001) included in the systematic review (Leow et al., 2021) investigated risk profiles in association with tooth loss, and suggested that tailoring frequency of SPC to risk profiles may prevent tooth loss in cohorts with different susceptibilities to peri- odontitis. Substantial evidence for the validity of different risk assessment tools based on individual risk factors (e.g., smoking, hyperglycaemia) and disease-associated clinical markers (such as pocket depths and BOP) to predict tooth loss has been presented (Lang & Tonetti, 2003; Page et al., 2003; Matuliene et al., 2008; Martin et al., 2009; Martin et al., 2010; Trombelli et al., 2017; Ramseier et al., 2019). Such tools may be used to inform the fre- quency of SPC recalls (Lang et al., 2015; Trombelli et al., 2020). Ini- tial evidence suggests that “ Grading ” (Tonetti et al., 2018) may be able to predict tooth loss (Ravida et al., 2020; Al-Harthi et al., 2021; Saleh et al., 2021) and may be used to set SPC frequency recalls, although more evidence is needed.
Additional question raised by the WG
R11.3: Expert consensus-based recommendation We recommend that recall intervals for supportive periodontal care (SPC) should be guided by patients' risk profile as determined by individual risk factors (e.g., smoking , hyperglycaemia) and disease-associated clinical measures (such as pocket depths and bleeding on probing) . Supporting literature (Rosling et al., 2001; Matuliene et al., 2008; Lang et al., 2015; Trombelli et al., 2015; Trombelli et al., 2017; Trombelli et al., 2020) and Expert opinion. Quality of evidence Not applicable Grade of recommendation GradeA — "" Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
Background
Intervention
Consistency Not applicable.
A patient's previous experience of periodontitis is a strong predictor of future disease activity in the absence or presence of periodontal
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