Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines (2024)

Table of Contents
Abstract Key points Access options Additional access options: Similar content being viewed by others BSP implementation of the 2017 classification of periodontal diseases: a practice retrospective Factors affecting decision making at reassessment of periodontitis. Part 4: treatment options for residual periodontal pockets Periodontal care in general practice: 20 important FAQs - Part two References Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article This article is cited by Effects of enamel matrix derivative in nonsurgical periodontal therapy on pro-inflammatory profiles, microbial environment and clinical outcome: a randomized clinical trial References
  • Clinical
  • Published:
  • Moritz Kebschull1 &
  • Iain Chapple2

British Dental Journal volume229,pages 443–449 (2020)Cite this article

  • 2964 Accesses

  • 5 Citations

  • 7 Altmetric

  • Metrics details

Abstract

The 2017 international classification system for periodontal diseases characterises periodontitis patients based upon disease extent, severity and past experience, and in stage IV includes a treatment complexity component. In addition, taking into account well-established risk factors, it aims to estimate the risk for future attachment loss. This classification system draws upon current understanding of disease pathobiology and reflects the complex, multifactorial nature of the periodontitis. It also acknowledges individual patients' risk profiles.

Classification and diagnosis are distinct but linked entities, and the inclusion of established risk factors in the system helps signpost the clinician and patient towards a more personalised approach to care provision. The European Federation of Periodontology (EFP) has recently developed an S3-level clinical treatment guideline for stages I to III periodontitis, based upon a rigorous standardised process involving 15 systematic reviews of current evidence and their synthesis by a representative group of experts and stakeholders. The aim is to guide the practitioner through the complex plethora of periodontal management options and to facilitate pragmatic decision-making in full knowledge of the evidence base.

Here, we present the structured, stepwise treatment protocols developed by the EFP guideline group and highlight selected specific clinical recommendations. The adapted guidelines for the UK healthcare system will be published in early 2021.

Key points

  • Presents the key clinical recommendations of the new European Federation for Periodontology (EFP) clinical practice guideline for the treatment of periodontitis. The guidelines adopt a stepwise approach to the treatment of periodontitis that is based on the new EFP/AAP classification of periodontal diseases.

  • These guidelines were developed using the internationally leading, high-quality S3-level approach, combining state-of-the-art evidence-gathering, assessment and synthesis with the combined clinical expertise of a broadly representative pan-discipline guideline group.

  • The reader will learn about the advantages of the novel guideline approach to develop solid and unbiased clinical recommendations, and will be able to adopt a high-level, stepwise framework for the treatment of periodontitis. The national implementation of these S3-level clinical guidelines by the British Society of Periodontology & Implant dentistry will be published in early 2021.

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Change institution

Buy or subscribe

Subscribe to this journal

Receive 24 print issues and online access

We are sorry, but there is no personal subscription option available for your country.

More Information

Prices may be subject to local taxes which are calculated during checkout

Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines (1)
Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines (2)

Similar content being viewed by others

Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines (3)

BSP implementation of the 2017 classification of periodontal diseases: a practice retrospective

Article Open access 25 November 2022

Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines (4)

Factors affecting decision making at reassessment of periodontitis. Part 4: treatment options for residual periodontal pockets

Article 13 December 2019

Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines (5)

Periodontal care in general practice: 20 important FAQs - Part two

Article 22 November 2019

References

  1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1789-1858.

  2. GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1859-1922.

  3. Lindhe J, Ranney R, Lamster I et al. Consensus Report: Chronic Periodontitis. Ann Periodontol 1999; 4: 38.

  4. Lang N, Bartold P M, Cullinan M et al. Consensus Report: Aggressive Periodontitis. Ann Periodontol 1999; 4: 53.

  5. Armitage G C, Cullinan M P, Seymour G J. Comparative biology of chronic and aggressive periodontitis: introduction. Periodontol 2000 2010; 53: 7-11.

  6. Kebschull M, Guarnieri P, Demmer R T, Boulesteix A L, Pavlidis P, Papapanou P N. Molecular differences between chronic and aggressive periodontitis. J Dent Res 2013; 92: 1081-1088.

  7. Kebschull M. Editorial: Is the Current Periodontitis Classification Supported by Pathophysiological Evidence? Oral Health Prev Dent 2017; 15: 405-406.

  8. Caton J, Armitage G, Berglundh T et al. A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol 2018; DOI: 10.1002/JPER.18-0157.

  9. Tonetti M S, Greenwell H, Kornman K S. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Clin Periodontol 2018; DOI: 10.1111/jcpe.12945.

  10. Papapanou P N, Sanz M, Buduneli N et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 2018; DOI: 10.1111/jcpe.12946.

  11. Dietrich T, Ower P, Tank M et al. Periodontal diagnosis in the context of the 2017 classification system of periodontal diseases and conditions - implementation in clinical practice. Br Dent J 2019; 226: 16-22.

  12. Walter C, Ower P, Tank M et al. Periodontal diagnosis in the context of the 2017 classification system of periodontal diseases and conditions: Presentation of a middle-aged patient with localised periodontitis. Br Dent J 2019; 226: 98-100.

  13. Walter C, Chapple I L C, Ower P et al. Periodontal diagnosis in the context of the BSP implementation plan for the 2017 classification system of periodontal diseases and conditions: presentation of a patient with a history of periodontal treatment. Br Dent J 2019; 226: 265-267.

  14. Walter C, Chapple I L C, Ower P et al. Periodontal diagnosis in the context of the BSP implementation plan for the 2017 classification system of periodontal diseases and conditions: presentation of a patient with severe periodontitis following successful periodontal therapy and supportive periodontal treatment. Br Dent J 2019; 226: 411-413.

  15. Walter C, Chapple I L C, Ower P et al. Periodontal diagnosis in the context of the BSP implementation plan for the 2017 classification system of periodontal diseases and conditions: presentation of a pair of young siblings with periodontitis. Br Dent J 2019; 226: 23-26.

  16. Wadia R, Walter C, Chapple I L C et al. Periodontal diagnosis in the context of the 2017 classification system of periodontal diseases and conditions: presentation of a patient with periodontitis localised to the molar teeth. Br Dent J 2019; 226: 180-182.

  17. Balshem H, Helfand M, Schünemann H J et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011; 64: 401-406.

  18. Schünemann H J, Zhang Y, Oxman A D, Expert Evidence in Guidelines Group. Distinguishing opinion from evidence in guidelines. BMJ 2019; DOI: 10.1136/bmj.l4606.

  19. Sanz M, Herrera D, Kebschull M et al. Treatment of Stage II II PeriodontitisThe EFP S3 Level Clinical Practice Guideline. J Clin Periodontol 2020; 47 Suppl 22: 4-60.

  20. Loos B, Needleman I. Endpoints of active periodontal therapy. J Clin Periodontol 2020; 47 Suppl 22: 61-71.

  21. Teughels W, Feres M, Oud V, Martín C, Matesanz P, Herrera D. Adjunctive effect of systemic antimicrobials in periodontitis therapy. A systematic review and meta-analysis. J Clin Periodontol 2020; 47 Suppl 22: 257-281.

  22. Suvan J, Leira Y, Moreno F, Graziani F, Derks J, Tomasi C. Subgingival Instrumentation for Treatment of Periodontitis. A Systematic Review. J Clin Periodontol 2020; 47 Suppl 22: 155-175.

  23. Sanz-Sánchez I, Montero E, Citterio F, Romano F, Molina A, Aimetti M. Efficacy of access flap procedures compared to subgingival debridement in the treatment of periodontitis. A systematic review and meta-analysis. J Clin Periodontol 2020; 47 Suppl 22: 282-302.

  24. Salvi G E, Stähli A, Schmidt J C, Ramseier C A, Sculean A, Walter C. Adjunctive laser or antimicrobial photodynamic therapy to non-surgical mechanical instrumentation in patients with untreated periodontitis. A systematic review and meta-analysis. J Clin Periodontol 2020; 47 Suppl 22: 176-198.

  25. Ramseier C A, Woelber J P, Kitzmann J, Detzen L, Carra M C, Bouchard P. Impact of risk factor control interventions for smoking cessation and promotion of healthy lifestyles in patients with periodontitis: a systematic review. J Clin Periodontol 2020; 47 Suppl 22: 90-106.

  26. Polak D, Wilensky A, Antonoglou G N, Shapira L, Goldstein M, Martin C. The Efficacy of Pocket Elimination/Reduction Compared to Access Flap Surgery: A Systematic Review and Meta-analysis. J Clin Periodontol 2020; 47 Suppl 22: 303-319.

  27. Nibali L, Koidou V P, Nieri M, Barbato L, Pagliaro U, Cairo F. Regenerative surgery versus access flap for the treatment of intrabony periodontal defects. A systematic review and meta-analysis. J Clin Periodontol 2020; 47 Suppl 22: 320-351.

  28. Jepsen S, Gennai S, Hirschfeld J, Kalemaj Z, Buti J, Graziani F. Regenerative surgical treatment of furcation defects: A systematic review and Bayesian network meta-analysis of randomized clinical trials. J Clin Periodontol 2020; 47 Suppl 22: 352-374.

  29. Herrera D, Matesanz P, Martín C, Oud V, Feres M, Teughels W. Adjunctive effect of locally delivered antimicrobials in periodontitis therapy. A systematic review and meta-analysis. J Clin Periodontol 2020; 47 Suppl 22: 239-256.

  30. Figuero E, Roldán S, Serrano J, Escribano M, Martín C, Preshaw P M. Efficacy of adjunctive therapies in patients with gingival inflammation. A systematic review and meta-analysis. J Clin Periodontol 2020; 47 Suppl 22: 125-143.

  31. Donos N, Calciolari E, Brusselaers N, Goldoni M, Bostanci N, Belibasakis G. The adjunctive use of host modulators in non-surgical periodontal therapy. A systematic review of randomized, placebo-controlled clinical studies. J Clin Periodontol 2020; 47 Suppl 22: 199-238.

  32. Dommisch H, Walter C, Dannewitz B, Eickholz P. Resective surgery for the treatment of furcation involvement - a systematic review. J Clin Periodontol 2020; 47 Suppl 22: 375-391.

  33. Carra M C, Detzen L, Kitzmann J, Woelber J P, Ramseier C A, Bouchard P. Promoting behavioural changes to improve oral hygiene in patients with periodontal diseases: a systematic review. J Clin Periodontol 2020; 47 Suppl 22: 72-89.

  34. Slot D, Valkenburg C, van der Weijden F. Mechanical plaque removal of periodontal maintenance patientsA Systematic Review and Network Meta-Analysis. J Clin Periodontol 2020; 47 Suppl 22: 107-124.

  35. Trombelli L, Farina R, Pollard A et al. Efficacy of alternative or additional methods to professional mechanical plaque removal during supportive periodontal therapy. A systematic review and meta-analysis. J Clin Periodontol 2020; 47 Suppl 22: 144-154.

  36. Chapple I L C, Mealey B L, Van Dyke T E et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Clin Periodontol 2018; DOI: 10.1111/jcpe.12940.

  37. NHS England and NHS Improvement. Commissioning Standard: Dental Care for People with Diabetes. 2019. Available at https://www.england.nhs.uk/wp-content/uploads/2019/08/commissioning-standard-dental-care-for-people.pdf (accessed September 2020).

  38. Schünemann H J, Wiercioch W, Brozek J et al. GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol 2017; 81: 101-110.

Download references

Author information

Authors and Affiliations

  1. Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Trust, Birmingham, UK; Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, USA

    Moritz Kebschull

  2. Periodontal Research Group, Institute of Clinical Sciences, College of Medical & Dental Sciences, The University of Birmingham, Birmingham, UK; Birmingham Community Healthcare NHS Trust, Birmingham, UK

    Iain Chapple

Authors

  1. Moritz Kebschull

    View author publications

    You can also search for this author in PubMedGoogle Scholar

  2. Iain Chapple

    View author publications

    You can also search for this author in PubMedGoogle Scholar

Corresponding author

Correspondence to Moritz Kebschull.

Rights and permissions

About this article

Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines (6)

Cite this article

Kebschull, M., Chapple, I. Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines. Br Dent J 229, 443–449 (2020). https://doi.org/10.1038/s41415-020-2173-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41415-020-2173-7

Evidence-based, personalised and minimally invasive treatment for periodontitis patients - the new EFP S3-level clinical treatment guidelines (2024)

References

Top Articles
Tazewell, TN Single Family Homes for Sale | realtor.com®
Prescott Valley, AZ Homes For Sale - Arizona Real Estate | BEX Realty
Kingsland Waikoloa Kamaaina
Skyward Glen Ellyn
360training.com Reviews | check if site is scam or legit| Scamadviser
Customer Training: Benefits, Steps & Best Practices
Are Target, Walmart, Home Depot open on July 4th 2024? See retail store hours and details
The 50 best shopping and stores in Sarajevo
Express Advising Asu
Temu Coupons | Upto 50% Discount & Offers
Latest Posts
Tazewell TN Single Family Homes For Sale - 39 Homes | Zillow
Prescott AZ Real Estate - Prescott AZ Homes For Sale | Zillow
Article information

Author: Carmelo Roob

Last Updated:

Views: 6300

Rating: 4.4 / 5 (65 voted)

Reviews: 80% of readers found this page helpful

Author information

Name: Carmelo Roob

Birthday: 1995-01-09

Address: Apt. 915 481 Sipes Cliff, New Gonzalobury, CO 80176

Phone: +6773780339780

Job: Sales Executive

Hobby: Gaming, Jogging, Rugby, Video gaming, Handball, Ice skating, Web surfing

Introduction: My name is Carmelo Roob, I am a modern, handsome, delightful, comfortable, attractive, vast, good person who loves writing and wants to share my knowledge and understanding with you.