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HERRERA ET AL .
Tooth loss: two studies (one RCT and one prospective cohort) reported on tooth loss. These studies were reported qualitatively. CAL loss ≥ 2 mm: two studies reported on CAL loss ≥ 2mm (one RCT and one controlled clinical trial) and were included in the qualita- tive analysis. Pockets of ≥ 5 mm with BOP: no studies reported on the number of PPD ≥ 5 mm with bleeding on probing during SPC. Sites that need/experience re-treatment: one study (split-mouth RCT) reported on breakdown sites that required re-treatment. PROMs: one RCT reported on oral health-related quality of life utilizing the Italian translation of the Oral Health Impact Profile (OHIP) questionnaire 14. Health-economic outcomes: two RCTs provided information on total cumulative costs for operative interventions. Other PROMs: a number of studies reported on other outcomes/ adverse events. These included periodontal abscess (one RCT), masti- catory function and aesthetics (one RCT) and adverse events (one controlled clinical trial and an RCT). Risk of bias Nine studies were included. Study quality assessment using the Cochrane Risk of Bias tool 2.0 showed six studies were of, “ some con- cern ” , and one study was classified as, “ high ” . Two studies were judgedas, “ serious ” using the Robins-I tool. Effect sizes and their clinical relevance Tooth loss: one RCT (Bogren et al., 2008) on 128 patients with 3-year outcomes, compared subgingival instrumentation (SRP) alone (control) with SRP and locally delivered 8.8% doxycycline gel applications (test) in PPD ≥ 5 mm. SPC was conducted every 6 months. Twenty-five test sites were lost due to tooth extractions (3.6% of initially included sites) in the test group, while 45 sites were lost due to extractions (4.9% of those ini- tially included) in the control group. The difference between groups was not statistically significant ( p > .05). A prospective cohort (Costa et al., 2015), which included 212 patients, assessed surgical therapy ver- sus non-surgical therapy in both compliant and non-compliant patients, over 5 years of follow-up. While mean tooth loss for compliant patients was significantly less (0.3 for non-surgical and 0.8 for surgical therapy) than for non-compliant patients (2.2 and 2.8, respectively), no statisti- cally significant differences were noted overall between ST and NST. CAL loss ≥ 2 mm: one controlled clinical trial (Jenkins et al., 2000) compared coronal scaling in 17 patients (146 sites) with subgingival scaling in 14 patients (130 sites) over 12 months, and 21 sites exhibited CAL loss ≥ 2 mm from each group over the course of SPC, with no sta- tistically significant differences between groups. A 12-month multi- centre RCT (Tonetti et al., 2012) on 202 subjects compared SRP (con- trol) with SRP and 14% doxycycline gel application (test) on PPD ≥ 5 mm with BOP: 8 test and 7 control patients experienced CAL loss ≥ 2 mm with no statistically significant difference between the groups. Sites that need/experience re-treatment: one split-mouth RCT (Kaldahl et al., 1996b) reported 685 “ breakdown ” sites during the course of SPC which required re-treatment. About 5% – 12% of these breakdown sites experienced CAL loss ≥ 3 mm and were re- treated and subsequently experienced further loss of attachment.
PROMs: the Italian translation of the OHIP-14 questionnaire was used in one RCT (Cortellini et al., 2020) at baseline, 1, 5 and 10 years after regenerative treatment (other treatment groups were not rele- vant to this review). The mean OHIP-14 score 1 year after the regen- erative procedure was 6.6 (SD = 2.4), however no data were presented at 10 years. Health-economic outcomes: one RCT (Cortellini et al., 2017) reported cumulative costs over a 20-year period (with 3-monthly SPC) using an average of fees from private practices in Italy. The cumulative costs ranged from a mean of € 3090.98 (±210.66) to € 3382 (±88.95) and were dependent on the treatment carried out during the active phase of therapy. Another study (Cortellini et al., 2020) reported cumulative costs for a regenerative procedure over 10 years (excluding SPC). Other PROMs: 27 periodontal abscesses were reported in one RCT (Kaldahl et al., 1996a) with 84 months of follow-up, with most (85%) occurring in the group originally treated by coronal scaling alone and a large proportion (63%) occurring in sites with PPD ≥ 7 mm at the initial examination. Cortellini et al. (2020) assessed masticatory function and aesthetics using a 5-point Likert scale with a 10-year follow-up, and the proportion of people reporting “ some concern ” for both masticatory function and aes- thetics appeared to increase over the 9 years of SPC (graphical information available only). Adverse events were largely not described, but when judged in two studies, it was mainly judged as “ not serious ” (Jenkins et al., 2000; Tonetti et al., 2012). Both studies reported no difference between study groups in regard to adverse events.
Consistency Not applicable.
Balance of benefit and harm The best approach to treatment of recurrence of periodontitis in SPC is currently unknown. However, as demonstrated in those studies included, some clinical benefit can be achieved regardless of treat- ment modality. Additionally, no difference between treatment approaches could be determined with respect to adverse events.
Overall certainty of the evidence Low.
From evidence to recommendation — additional considerations
Acceptability Little is known about patient preferences in regard to treatment of recurrence in SPC. Determining the best approach to treatment of recurrence in conjunction with patients' views on these should undoubtedly be a research priority.
Feasibility, ethical, legal considerations Not applicable.
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