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progression, was CAL loss ≥ 2mm. “ Regular ” SPC was defined as 3-monthly, while a lack of adherence to or no SPC was described as “ irreg- ular ” . The mean proportion of patients who experienced overall CAL loss ≥ 2 mm was 24.8% (95% CI [11; 38]) with substantial heterogeneity I 2 = 63% ( p = .013). 30.2% (95% CI [ 2; 63]) of patients who attended regular SPC appointments experienced CAL loss ≥ 2 mm, compared with 21.4% (95% CI [10; 33]) of those who attended irregularly. The difference between subgroups was not statistically significant ( p = .332). Although it appears that regular SPC does not lead to significantly greater experience of CAL loss ≥ 2 mm, this should be interpreted with caution. Only a small number of studies ( n = 3) contributed to the meta-analysis and the resulting data for the regular SPC group appear imprecise (large confidence interval). Furthermore, the disparity may be explained by a single outlier where participants in that group pres- ented with an increased number of residual PPD at the start of SPC. A greater length of follow-up ( ≥ 10 years) was associated with a slight increase in CAL loss ≥ 2 mm of 26.3% (95% CI [8; 45]) compared with 22.1% (95% CI [5; 39]) for 5 – 10 years follow-up. Consistency Heterogeneity for studies included to inform on CAL loss ≥ 2mmwas substantial ( I 2 = 63%; p = .013). Balance of benefit and harm The desirable effects of long-term regular SPC (reduced prevalence of tooth loss) would undoubtedly outweigh possible undesirable effects regarding CAL. An overall consideration of the benefit versus harm of regular SPC supports regular SPC.
Economic considerations The costs and cost-effectiveness of re-treatment of recurrence are currently unknown.
11.3
| Is regular, professionally administered, SPC
associated with positive and/or negative outcomes, aside from tooth loss and/or disease recurrence?
R11.6. Are there disadvantages to regular long-term SPC (e.g., more gingival recession/clinical attachment loss)?
PICOS question addressed by a SR
R11.6: Evidence-based statement There is no evidence of clinical disadvantages to regular long-term SPC , such as gingival recession/clinical attachment loss ; however , the possibility of these side effects cannot be excluded based on the evidence reviewed . Patients should be advised of this as part of their informed consent . Supporting literature (Leow et al., 2021) Quality of evidence Three prospective cohorts with a “ low ” risk of bias. Grade of recommendation GradeO — $ Statement: unclear, additional research needed Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
Background
Intervention
Overall certainty of the evidence Low.
Periodontitis patients in long-term SPC should attend regular recall appointments in order to reduce their risk of tooth loss. At times, periodon- titis may become unstable and require re-treatment, which may take the form of a non-surgical and/or surgical approach to resolve PPDs ≥ 4mm with BOP. One common consequence of re-treatment may be CAL in the form of gingival recession, the magnitude of which is difficult to predict.
From evidence to recommendation — additional considerations
Acceptability, feasibility, ethical, economic, legal considerations See recommendation R11.1.
Available evidence
Legal considerations Not applicable.
Number and design of included studies Three prospective cohort studies contributed data to the meta- analysis for estimating the number of patients experiencing CAL loss ≥ 2 mm (86 participants) during SPC. Risk of bias All three studies were classified as having, “ low ” risk of bias using the Newcastle – Ottawa scale. Effect sizes and their clinical relevance The primary outcome of the systematic review (Leow et al., 2021) was tooth loss. The secondary outcome, to inform on disease recurrence/
R11.7. Is long-term SPC cost-effective when considering direct and indirect costs?
Additional question raised by the WG
R11.7: Expert consensus-based statement We suggest that regular long-term SPC in specialist practice may result in greater periodontal stability and tooth survival when compared with SPC in general practice .
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