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; 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

doi:10.1111/jcpe.13290

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, 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 CalciolariMaria 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

College of Dental Medicine

Research output: Contribution to journal › Article › peer-review

852 Citations (Scopus)

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.

Original language	English
Pages (from-to)	4-60
Number of pages	57
Journal	Journal of Clinical Periodontology
Volume	47
Issue number	S22
DOIs	https://doi.org/10.1111/jcpe.13290
Publication status	Published - Jul 1 2020

Bibliographical note

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

Funding

(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. Iain Chapple (Chair) reports personal fees from Dentsply Sirona Implants and Straumann and grants from Dentsply Sirona Implants, outside the submitted work. Dr. Tord Berglundh The authors express their gratitude to all reviewers involved in the preparation of the systematic reviews. In addition, the organizations which accepted to participate in the guideline development process are also kindly and sincerely acknowledged: European Federation of Conservative Dentistry, European Association of Dental Public Health, European Society for Endodontology, European Prosthodontic Association, Council of European Dentists, European Dental Hygienists' Federation, European Dental Students' Association and Platform for Better Oral Health in Europe. (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. Mariano Sanz (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. David Herrera (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. Anton Sculean

Funders	Funder number
Botiss Biomaterials
Council of European Dentists
Dexcel Pharma
European Association of Dental Public Health
European Dental Hygienists' Federation
European Prosthodontic Association
European Society for Endodontology
Geistlich Pharma
Klockner Implants, Procter & Gamble and Straumann
Nobel Biocare, Procter & Gamble, Straumann and Sunstar
Oral Reconstruction Foundation
Procter & Gamble, Straumann AG
Sunstar SA
GlaxoSmithKline
Johnson and Johnson
Unilever
Osteology Foundation
European Federation of Conservative Dentistry
ITI Foundation

ASJC Scopus Subject Areas

Periodontics

Access to Document

10.1111/jcpe.13290

Cite this

Sanz, M., Herrera, D., Kebschull, M., Chapple, I., Jepsen, S., Beglundh, T., Sculean, A., Tonetti, M. S., Merete Aass, A., Aimetti, M., Kuru, B. E., Belibasakis, G., Blanco, J., Bol-van den Hil, E., Bostanci, N., Bozic, D., Bouchard, P., Buduneli, N., Cairo, F., ... Wennström, J. (2020). Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology, 47(S22), 4-60. https://doi.org/10.1111/jcpe.13290

Sanz, M, Herrera, D, Kebschull, M, Chapple, I, Jepsen, S, Beglundh, T, Sculean, A, Tonetti, MS, Merete Aass, A, Aimetti, M, Kuru, BE, Belibasakis, G, Blanco, J, Bol-van den Hil, E, Bostanci, N, Bozic, D, Bouchard, P, Buduneli, N, Cairo, F, Calciolari, E, Carra, MC, Cortellini, P, Cosyn, J, D'Aiuto, F, Dannewitz, B, Danser, M, Demirel, K, Derks, J, de Sanctis, M, Dietrich, T, Dörfer, C, Dommisch, H, Donos, N, Eaton, K, Eickholz, P, Figuero, E, Giannobile, W, Goldstein, M, Graziani, F, Kamposiora, P, Kirkevang, LL, Kocher, T, Kononen, E, Lang, N, Lambert, F, Landi, L, Melo, P, Loos, B, Lopez, R, Lundberg, P, Machtei, E, Madianos, P, Martín, C, Matesanz, P, Meyle, J, Molina, A, Montero, E, Nart, J, Needleman, I, Nibali, L, Papapanou, P, Pilloni, A, Polak, D, Polyzois, I, Preshaw, P, Quirynen, M, Ramseier, C, Renvert, S, Salvi, G, Sanz-Sánchez, I, Shapira, L, Slot, DE, Stavropoulos, A, Struillou, X, Suvan, J, Teughels, W, Timus, D, Tomasi, C, Trombelli, L, van der Weijden, F, Vassallo, P, Walter, C, West, N, Wimmer, G, Kopp, I, Brocklehurst, P & Wennström, J 2020, 'Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline', Journal of Clinical Periodontology, vol. 47, no. S22, pp. 4-60. https://doi.org/10.1111/jcpe.13290

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title = "Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline",

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.",

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

note = "Publisher Copyright: {\textcopyright} 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd",

year = "2020",

month = jul,

day = "1",

doi = "10.1111/jcpe.13290",

language = "English",

volume = "47",

pages = "4--60",

journal = "Journal of Clinical Periodontology",

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T1 - Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

AU - Sanz, Mariano

AU - Herrera, David

AU - Kebschull, Moritz

AU - Chapple, Iain

AU - Jepsen, Søren

AU - Beglundh, Tord

AU - Sculean, Anton

AU - Tonetti, Maurizio S.

AU - Merete Aass, Anne

AU - Aimetti, Mario

AU - Kuru, Bahar Eren

AU - Belibasakis, Georgios

AU - Blanco, Juan

AU - Bol-van den Hil, Ellen

AU - Bostanci, Nagihan

AU - Bozic, Darko

AU - Bouchard, Philippe

AU - Buduneli, Nurcan

AU - Cairo, Francesco

AU - Calciolari, Elena

AU - Carra, Maria Clotilde

AU - Cortellini, Pierpaolo

AU - Cosyn, Jan

AU - D'Aiuto, Francesco

AU - Dannewitz, Bettina

AU - Danser, Monique

AU - Demirel, Korkud

AU - Derks, Jan

AU - de Sanctis, Massimo

AU - Dietrich, Thomas

AU - Dörfer, Christof

AU - Dommisch, Henrik

AU - Donos, Nikos

AU - Eaton, Kenneth

AU - Eickholz, Peter

AU - Figuero, Elena

AU - Giannobile, William

AU - Goldstein, Moshe

AU - Graziani, Filippo

AU - Kamposiora, Phophi

AU - Kirkevang, Lise Lotte

AU - Kocher, Thomas

AU - Kononen, Eija

AU - Lang, Nicklaus

AU - Lambert, France

AU - Landi, Luca

AU - Melo, Paulo

AU - Loos, Bruno

AU - Lopez, Rodrigo

AU - Lundberg, Pernilla

AU - Machtei, Eli

AU - Madianos, Phoebus

AU - Martín, Conchita

AU - Matesanz, Paula

AU - Meyle, Jörg

AU - Molina, Ana

AU - Montero, Eduardo

AU - Nart, Jose

AU - Needleman, Ian

AU - Nibali, Luigi

AU - Papapanou, Panos

AU - Pilloni, Andrea

AU - Polak, David

AU - Polyzois, Ioannis

AU - Preshaw, Philip

AU - Quirynen, Marc

AU - Ramseier, Christoph

AU - Renvert, Stefan

AU - Salvi, Giovanni

AU - Sanz-Sánchez, Ignacio

AU - Shapira, Lior

AU - Slot, Dagmar Else

AU - Stavropoulos, Andreas

AU - Struillou, Xavier

AU - Suvan, Jean

AU - Teughels, Wim

AU - Timus, Daniela

AU - Tomasi, Cristiano

AU - Trombelli, Leonardo

AU - van der Weijden, Fridus

AU - Vassallo, Paula

AU - Walter, Clemens

AU - West, Nicola

AU - Wimmer, Gernot

AU - Kopp, Ina

AU - Brocklehurst, Paul

AU - Wennström, Jan

PY - 2020/7/1

Y1 - 2020/7/1

N2 - 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.

AB - 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.

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

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