EFP presents new guideline on Stage IV periodontitis

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EFP presents new guideline on Stage IV periodontitis

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EFP representatives at EuroPerio10 in Copenhagen (left to right): Prof. Andreas Stavropoulos, Prof. Phoebus Madianos, Prof. David Herrera, Prof. Nicola West and Dr Bettina Dannewitz. (Image: EFP)

COPENHAGEN, Denmark: The European Federation of Periodontology (EFP) released new guidance on Stage IV periodontitis on 10 June, marking the completion of evidence-based recommendations for all stages of the disease. The new guideline was the subject of a dedicated session at EuroPerio10, and the event’s Scientific Chair Prof. David Herrera commented that successful management of Stage IV periodontitis is particularly challenging because treatment alone is insufficient.

The new guideline was addressed at EuroPerio10 in Copenhagen on 16 June by three experts involved in different areas of dental treatment. In the words of Prof. Herrera, management of periodontitis in Stage IV requires clinicians to look beyond treatment and “work in close contact with other dental specialities to restore the lost function and manage the disease sequelae”.

The session was chaired by Dr Mario Aimetti of Italy, and Dr Spyridon Papageorgiou of Switzerland explained to attendees why orthodontic therapy is usually required in treating cases of Stage IV periodontitis in order to manage the lack of posterior occlusal support and pathological tooth migration. Prof. Nicola Zitzmann of Switzerland discussed the efficacy of tooth splinting and occlusal adjustment in patients with masticatory dysfunction and tooth migration and mobility, and Prof. Klaus Gotfredsen of Denmark focused on the importance of prosthetic rehabilitation and the need to consider how and when clinicians should choose between different prosthetic options.

As discussed by the speakers, the new S3 level clinical practice guideline outlines five diagnostic pathways to clinically assess Stage IV periodontitis. These are: 1) evaluation of the extent of the breakdown of structures supporting the teeth as well as evaluation of aesthetics and the patient’s ability to chew and speak; 2) establishment of the number of teeth that the patient has already lost owing to the disease; 3) prognosis of remaining teeth; 4) assessment of all factors in the mouth that could hinder or enable retention of teeth and/or the placement of dental implants; and 5) 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.

Dr Maurizio Tonetti, professor of periodontology at Shanghai Jiao Tong University School of Medicine in China and co-author of the guideline, lauded the progress heralded by the document. He said: “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.”

The EFP said that therapy begins with the recommendations available for Stage I, Stage II and Stage III periodontitis, and that additional treatments for Stage IV disease can involve orthodontic therapy and the construction of prostheses to replace missing teeth. Prof. Herrera commented, however, that “Extracting teeth to place dental implants is not a reasonable option if teeth can be retained.”

The guideline is intended to inform clinicians, health systems, policymakers and the public about the most effective modalities for treatment according to the available evidence.

EFP President Prof. Andreas Stavropoulos pointed out 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”.

Prof. Stavropoulos said he expected the guideline to improve the quality of periodontal treatment around the world and commented that the EFP would work with national periodontology societies to translate it into appropriate languages and adapt it to local contexts.

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