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HERRERA ET AL .
• Smoking cessation (including e-cigarettes) or reducing smoking habit • Participation in regular supportive periodontal care programmes • Improving OH • Reducing bruxing and/or parafunctional habits • Periodontal therapy to eliminate gingival inflammation and achieve periodontal stability
for dental implant(s), and in patients who have received dental implant/s and currently have healthy peri-implant tissues. The purpose of ‘ primordial ’ prevention (see Section 4.2.1) in the context of the current workshop is to prevent risk factor development prior to dental implant placement. The goal is to attain and maintain optimal oral health to prevent the development of peri-implant dis- eases over time. There is no current definition of what the optimal oral and general health status of a patient should be prior to dental implant placement, or of which metrics should be included in such a definition. Therefore, no study directly addressing primordial preven- tion of peri-implant diseases was found, and any recommendations regarding primordial prevention are based upon indirect evidence and expert-based consensus. The purpose of primary prevention is to prevent disease onset following dental implant placement and loading. The goal is to achieve an optimal oral condition and to maintain dental implant health over time by controlling risk factors for the disease. The relationship between primordial, primary, secondary and ter- tiary prevention is represented in Figure 5, which documents the approach taken by the workshop to interpret the different forms of prevention in the context of peri-implant diseases. No studies were identified that provided direct evidence for pri- mary prevention. The recommendations are therefore inferred from observational and interventional studies with various working hypoth- eses that were not originally developed to test the efficacy of a pre- ventive measure on the occurrence of peri-implant diseases. Therefore, the recommendations regarding primary prevention are both evidence-based and expert-based. In the present guideline, the term SPIC is used to comprise an indi- vidually tailored follow-up programme that has been described in the available studies with the terms: (1) supportive care; (2) SPIC; (3) support- ive peri-implant therapy; (4) supportive periodontal therapy; (5) support- ive periodontal and peri-implant therapy and (6) supportive therapy.
PICOS question addressed by a systematic review
R5.1: Expert consensus-based recommendation In patients awaiting implant placement, we recommend :
1. Thorough assessment of the patient's risk profile to identify and manage modifiable risk factors/indicators for peri-implant diseases . 2. Guideline conformed treatment of gingivitis and periodontitis to a stable endpoint and adherence to a supportive care programme prior to implant placement . Supporting literature (Carra et al., 2023) and Expert opinion Quality of evidence Very low Grade of recommendation GradeA — "" Strength of consensus Unanimous consensus (0% of the group abstained due to potential CoI)
Background
This recommendation relies upon indirect evidence from studies included in the review and on expert opinion.
R5.2. Prior to and during implant placement, what are the considerations related to implant positioning to reduce the risk of incident peri-implant diseases?
Additional question addressed by the WG
5.1
| Recommendations for primordial prevention
R5.2: Expert-based recommendation We recommend that treatment planning for three-dimensional implant positioning should meet the following conditions : • adequate buccal/lingual bone thickness to allow the implant to be placed in a prosthetically guided position with good primary stability and surrounded circumferentially by bone . • adequate mesio-distal distance between an implant and adjacent tooth/implant to allow adequate space for prosthetic components and access for OH aids . • appropriate apical-coronal position of the implant platform (shoulder) to allow adequate space for prosthetic components and to avoid an excessively deep mucosal sulcus ( ‘ tunnel ’ ) . Supporting literature (Berglundh et al., 2018; Chan et al., 2019; Farina et al., 2017; Jepsen et al., 2015; Kumar et al., 2018; Schuldt Filho et al., 2014; Schwarz et al., 2018; Valles et al., 2018) Quality of evidence Low Grade of recommendation GradeA — "" Strength of consensus Strong consensus (0% of the group abstained due to potential CoI)
of peri-implant diseases
The overall objective of this section is to answer the question: in patients awaiting implant placement, does primordial prevention involving the control of lifestyle and behavioural risk factors prevent the development of peri-implant mucositis and peri-implantitis?
R5.1. In patients awaiting implant placement, do the following behaviours or interventions, prior to implant placement, reduce the incidence of peri-implant mucositis and peri-implantitis? • Educating the patient about the importance of their adherence to SPIC visits and home care • Improving glycaemic control in people with diabetes
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