Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline

Mariano Sanz, David Herrera, Moritz Kebschull, Iain Chapple, Søren Jepsen, Tord Beglundh, Anton Sculean, Maurizio S Tonetti, EFP Workshop Participants and Methodological Consultants, Anne Merete Aass, Mario Aimetti, Bahar Eren Kuru, Georgios Belibasakis, Juan Blanco, Ellen Bol-van den Hil, Nagihan Bostanci, Darko Bozic, Philippe Bouchard, Nurcan Buduneli, Francesco Cairo, Elena Calciolari, Maria Clotilde Carra, Pierpaolo Cortellini, Jan Cosyn, Francesco D'Aiuto, Bettina Dannewitz, Monique Danser, Korkud Demirel, Jan Derks, Massimo de Sanctis, Thomas Dietrich, Christof Dörfer, Henrik Dommisch, Nikos Donos, Kenneth Eaton, Peter Eickholz, Elena Figuero, William Giannobile, Moshe Goldstein, Filippo Graziani, Phophi Kamposiora, Lise-Lotte Kirkevang, Thomas Kocher, Eija Kononen, Nicklaus Lang, France Lambert, Luca Landi, Paulo Melo, Bruno Loos, Rodrigo Lopez, Pernilla Lundberg, Eli Machtei, Phoebus Madianos, Conchita Martín, Paula Matesanz, Jörg Meyle, Ana Molina, Eduardo Montero, Jose Nart, Ian Needleman, Luigi Nibali, Panos Papapanou, Andrea Pilloni, David Polak, Ioannis Polyzois, Philip Preshaw, Marc Quirynen, Christoph Ramseier, Stefan Renvert, Giovanni Salvi, Ignacio Sanz-Sánchez, Lior Shapira, Dagmar Else Slot, Andreas Stavropoulos, Xavier Struillou, Jean Suvan, Wim Teughels, Daniela Timus, Cristiano Tomasi, Leonardo Trombelli, Fridus van der Weijden, Paula Vassallo, Clemens Walter, Nicola West, Gernot Wimmer, Ina Kopp, Paul Brocklehurst, Jan Wennström, Mariano Sanz, David Herrera, Moritz Kebschull, Iain Chapple, Søren Jepsen, Tord Beglundh, Anton Sculean, Maurizio S Tonetti, EFP Workshop Participants and Methodological Consultants, Anne Merete Aass, Mario Aimetti, Bahar Eren Kuru, Georgios Belibasakis, Juan Blanco, Ellen Bol-van den Hil, Nagihan Bostanci, Darko Bozic, Philippe Bouchard, Nurcan Buduneli, Francesco Cairo, Elena Calciolari, Maria Clotilde Carra, Pierpaolo Cortellini, Jan Cosyn, Francesco D'Aiuto, Bettina Dannewitz, Monique Danser, Korkud Demirel, Jan Derks, Massimo de Sanctis, Thomas Dietrich, Christof Dörfer, Henrik Dommisch, Nikos Donos, Kenneth Eaton, Peter Eickholz, Elena Figuero, William Giannobile, Moshe Goldstein, Filippo Graziani, Phophi Kamposiora, Lise-Lotte Kirkevang, Thomas Kocher, Eija Kononen, Nicklaus Lang, France Lambert, Luca Landi, Paulo Melo, Bruno Loos, Rodrigo Lopez, Pernilla Lundberg, Eli Machtei, Phoebus Madianos, Conchita Martín, Paula Matesanz, Jörg Meyle, Ana Molina, Eduardo Montero, Jose Nart, Ian Needleman, Luigi Nibali, Panos Papapanou, Andrea Pilloni, David Polak, Ioannis Polyzois, Philip Preshaw, Marc Quirynen, Christoph Ramseier, Stefan Renvert, Giovanni Salvi, Ignacio Sanz-Sánchez, Lior Shapira, Dagmar Else Slot, Andreas Stavropoulos, Xavier Struillou, Jean Suvan, Wim Teughels, Daniela Timus, Cristiano Tomasi, Leonardo Trombelli, Fridus van der Weijden, Paula Vassallo, Clemens Walter, Nicola West, Gernot Wimmer, Ina Kopp, Paul Brocklehurst, Jan Wennström

Abstract

Background: The recently introduced 2017 World Workshop on the classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment, as it describes not only disease severity and extent but also the degree of complexity and an individual's risk. There is, therefore, a need for evidence-based clinical guidelines providing recommendations to treat periodontitis.

Aim: The objective of the current project was to develop a S3 Level Clinical Practice Guideline (CPG) for the treatment of Stage I-III periodontitis.

Material and methods: This S3 CPG was developed under the auspices of the European Federation of Periodontology (EFP), following the methodological guidance of the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The rigorous and transparent process included synthesis of relevant research in 15 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and consensus, on those recommendations, by leading experts and a broad base of stakeholders.

Results: The S3 CPG approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions. Consensus was achieved on recommendations covering different interventions, aimed at (a) behavioural changes, supragingival biofilm, gingival inflammation and risk factor control; (b) supra- and sub-gingival instrumentation, with and without adjunctive therapies; (c) different types of periodontal surgical interventions; and (d) the necessary supportive periodontal care to extend benefits over time.

Conclusion: This S3 guideline informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat periodontitis and to maintain a healthy dentition for a lifetime, according to the available evidence at the time of publication.

Keywords: clinical guideline; grade; health policy; oral health; periodontal therapy; periodontitis; stage.

Conflict of interest statement

Workshop participants filed detailed disclosure of potential conflict of interest relevant to the workshop topics, and these are kept on file. Declared potential dual commitments included having received research funding, consultant fees and speaker fee from the industries with economic interests in the interventions for prevention and therapy of Periodontitis. Those affected with potential conflict of interest abstained from vote in the specific recommendations following the required processes for S3 level clinical practice guideline. Individual potential conflict of interest forms were completed by all participants and are available on file at the European Federation of Periodontology and extracted in the Supporting Information, available online (Final Guideline‐Supporting Information_Potential conflict of interests). In addition, potential conflict of interest information of the chairs of the workshop is listed here.

Dr. Mariano Sanz (Chair) reports personal fees from Camlog implants, Colgate, Dentium Implants, Dentsply Sirona Implants, Geistlich, GSK, Klockner Implants, MIS Implants, Mozo Grau Implants, Nobel Biocare, Procter & Gamble, Straumann and Sunstar; grants from Camlog Implants, Dentaid, Dentium Implants, Dentsply Sirona Implants, Geistlich Pharma, Klockner Implants, MIS Implants, Mozo Grau Implants, Nobel Biocare, Sunstar, Straumann AG, Sweden and Martina Implants; and other support from Dentaid, outside the submitted work.

Dr. David Herrera (Chair) reports personal fees from Colgate, Dentaid, Dexcel Pharma, GSK, Johnson & Johnson, Klockner Implants, Procter & Gamble and Straumann and grants from Colgate, Dentaid, GSK, Kulzer and Zimmer‐Biomet, outside the submitted work.

Dr. Moritz Kebschull (Chair) reports personal fees from Colgate, Dexcel Pharma, Geistlich Pharma, Hu‐Friedy, NSK and Procter & Gamble and non‐financial support from Colgate, Dexcel Pharma, Geistlich Pharma, Hu‐Friedy, NSK and Procter & Gamble, outside the submitted work.

Dr. Iain Chapple (Chair) reports personal fees from Procter & Gamble and grants from GSK and Unilever, outside the submitted work. In addition, Dr. Chapple has eight patents on saliva diagnostics issued and his wife runs Oral Health Innovations that has the license for PreViser and DEPPA risk assessment software in the UK.

Dr. Sören Jepsen (Chair) reports personal fees from Colgate, Geistlich Pharma and Procter & Gamble, outside the submitted work.

Dr. Tord Berglundh (Chair) reports personal fees from Dentsply Sirona Implants and Straumann and grants from Dentsply Sirona Implants, outside the submitted work.

Dr. Anton Sculean (Chair) reports personal fees from Botiss Biomaterials, Geistlich Pharma, Oral Reconstruction Foundation, Osteology Foundation, Straumann AG, Regedent AG and Stoma and grants from Botiss Biomaterials, Geistlich Pharma, ITI Foundation, Oral Reconstruction Foundation, Osteology Foundation, Straumann AG and Regedent AG, outside the submitted work.

Dr. Maurizio Tonetti (Chair) reports personal fees from Geistlich Pharma AG, Procter & Gamble, Straumann AG, Sunstar SA anf Unilever; grants from Geistlich Pharma and Sunstar SA; and non‐financial support from Procter & Gamble, outside the submitted work.Clinical Relevance

Scientific rationale for the study: Implementation of the new classification of periodontitis should facilitate the use of the most appropriate preventive and therapeutic interventions, depending on the stage and grade of the disease. The choice of these interventions should be made following a rigorous evidence‐based decision‐making process.

Principal findings: This guideline has been developed using strict validated methodologies for assuring the best available evidence on the efficacy of the interventions considered and the most appropriate recommendations based on a structured consensus process, including a panel of experts and representatives from key stakeholders.

Practical implications: The application of this S3 Level Clinical Practice Guideline will allow a homogeneous and evidence‐based approach to the management of Stage I–III periodontitis.

© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Regenerative surgical therapy of intrabony defects and residual pockets
FIGURE 2
FIGURE 2
Periodontal surgery: molars with furcation involvement (Classes II and III) and residual pockets

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