The EFP’s S3-level clinical practice guideline on the multidisciplinary treatment of stage IV periodontitis was published on June 10 as an open-access supplement of the federation’s Journal of Clinical Periodontology.
The guideline1, the product of Perio Workshop 2021 which took place in November last year and included 13 systematic reviews, will be addressed at EuroPerio10 – as a world premiere – in a session on Thursday, June 16, featuring contributions from specialists in the various disciplines involved in treating this most advanced form of periodontitis.
The guideline complements the one on therapy for periodontitis stages I-III which was published by the EFP in 2020. Both guidelines conform to the S3 level of clinical-practice guidelines, which is the highest level.
Treatment of stage IV periodontitis poses significant challenges, including tackling tooth loss and problems with mastication, and requires collaboration between periodontists and other dental specialists such as orthodontists and prosthodontists.
“One of the main challenges in the management of periodontitis in stage IV is that periodontal treatment alone will not be enough,” said David Herrera, the scientific chair of EuroPerio10, who also chaired Perio Workshop 2021. “You need to work in close contact with other dental specialities to restore the lost function and manage the disease sequelae.”
The new guideline outlines the five components required in the clinical assessment of stage IV periodontitis:
- Evaluate the extent of breakdown of structures supporting the teeth, aesthetics, and the ability to chew and speak.
- Establish the number of teeth already lost because of periodontitis.
- Determine which remaining teeth can be saved.
- Assess all factors in the mouth that could hinder or enable retention of teeth and/or placing dental implants, such spaces without teeth and the availability of bone.
- Ascertain the patient’s overall prognosis, including the probability of disease progression or recurrence, considering the possible presence of risk factors such as smoking and diabetes.
“This detailed diagnostic process is crucial as it enables us to design a multidisciplinary treatment plan based on what is technically and biologically feasible, cost-effective, and in line with the patient’s preferences and expectations,” said Maurizio Tonetti, professor of periodontology at Shanghai Jiao Tong University School of Medicine, Shanghai, China, and one of the guideline’s co-authors.
EFP president Andreas Stavropoulos, EFP president, said that the two EFP guidelines meant that “for the first time in history we now have European recommendations for the interdisciplinary and evidence-based management of all stages of this disease.” He added that the application of the guideline was expected to improve the quality of periodontal treatment in Europe and worldwide, and that the EFP would work with national periodontology societies to translate and adapt the guideline to local contexts.
Focus on guideline at EuroPerio10
The new guideline will be in the spotlight at the EuroPerio10 session The multidisciplinary treatment of stage IV periodontitis (Hall A, Thursday, June 16, 16.30-18.00), which will feature three presentations from specialists involved in different areas of treatment:
- Spyridon Papageorgiou (Switzerland) will explain why orthodontic therapy is usually required in treating cases of stage IV periodontitis to manage the lack of posterior occlusal support and pathological tooth migration.
- Nicola Zitzmann (Switzerland) will discuss the efficacy of tooth splinting and occlusal adjustment in patients with masticatory dysfunction together with tooth migration and mobility.
- Klaus Gottfredsen (Denmark) will focus on prosthetic rehabilitation, looking at how and when to choose between different prosthetic options.
The session, chaired by Mario Aimetti (Italy) will show how a specific clinical case has been managed and there will be an interactive session where the audience can ask the speakers questions.
1. David Herrera, Mariano Sanz, Moritz Kebschull, Søren Jepsen, Anton Sculean, Tord Berglundh, Panos N. Papapanou, Iain Chapple, Maurizio S. Tonetti. Treatment of stage IV periodontitis – The EFP S3 level clinical practice guideline. J Clin Periodontol. 2022. doi:10.1111/jcpe.13639.