Bayaborda, Madeleine Grace R.

DPE 4201 – D42C

EFP publishes first evidence-based treatment guidelines for periodon::s

The Treatment of Stage I-III PeriodonEEs – The EFP S3-level Clinical PracEce Guideline has
been recently known as an open-access supplement in which it can offer oral healthcare more
professionally and more precisely. It does provide specific intervenEons in treaEng periodonEEs.

This guideline in treaEng periodonEEs has its 3 stages in which uses a pre-established
stepwise approach. It recommends 4 step-by-step in order to achieve efficient periodontal
therapy. First is some advice on how to establish a good oral hygiene and a healthy lifestyle for us
to reduce inflammaEon which forms the foundaEon in treaEng periodonEEs which is a long-term
disease. It also involves mechanical plaque removal. Second is a detailed professional cleaning of
root surfaces below the gingival and if ever other addiEonal therapies might be needed. Third is
to have more complex treatments such as surgery for an extensive treatment if necessary. Last is
the long-term supporEve care and advice in order to prevent relapses. This includes to have
healthy lifestyles, good oral hygiene and as well as regular check-ups including scaling.

These guidelines will eventually benefit the paEents in order to get the finest treatment
as possible by applicaEon of its provisions," Mariano Sanz, who presided, said that It will be
essenEal for paEents if this clinical guidelines will be implemented and adopted accordingly.
Another statement by Iain Chapple who is another lead other of this guideline is that to have an
updated classificaEon of periodontal diseases is to discover the treatment of periodonEEs so that
to give the pracEEoners a guideline which is definitely an evidence based.

The Treatment of Stage I-III PeriodonEEs – The EFP S3-level Clinical PracEce Guideline includes 62
specific recommendaEons on different therapies in treaEng periodonEEs and each
recommendaEons contains the grade of recommendaEon thus strength of consensus through
the scheme of the German AssociaEon of the Specific Medical SocieEes and standing guidelines
commission, 2012.

In STEP 1: Guiding behavior change by moEvaEng the paEent to undertake successful

removal of supragingival dental biofilm and risk-factor control. Its recommendaEon 1.1: “What
are the adequate oral-hygiene pracEces of periodonEEs paEents in the different steps of
periodonEEs therapy?” To recommend the same protocols of oral hygiene pracEces in order to
control the inflammaEon of the gingiva must be pracEced all throughout the steps of this
periodontal therapy such as supporEve periodontal care. In the recommendaEon 1.4: “What is
the efficacy of supragingival professional mechanical plaque removal (PMPR) and control of
retenEve factors in periodonEEs therapy?” The recommendaEon of supragingival professional
mechanical plaque removal and the limit of retenEve factors must be the first step in doing the
therapy. This recommendaEon has a unanimous consensus.
 In STEP 2: Cause-related therapy, aimed at controlling (reducing/eliminaEng) the
subgingival biofilm and calculus (subgingival instrumentaEon). The RecommendaEon 2.3: “Are
treatment outcomes of subgingival instrumentaEon beaer when delivered quadrant-wise over
mulEple visits or as a full-mouth procedure within 24 hours?” They suggest that subgingival
periodontal instrumentaEon can be done through tradiEonal quadrant-wise or full-mouth
delivery within 1 day. This recommendaEon has a strong consensus. The next recommendaEon
which is the RecommendaEon 2.4: Are treatment outcomes with adjuncEve applicaEon of laser
superior to non-surgical subgingival instrumentaEon alone? Suggests that the use of lasers as an
adjunct to subgingival instrumentaEon must not be done.

In STEP 3: TreaEng areas that do not respond adequately to the second step of therapy, to
gain further access to subgingival instrumentaEon or aiming at regeneraEng or resecEng lesions
that add complexity to the management of periodonEEs (intra-bony and furcaEon lesions). It has
recommendaEons such as RecommendaEon 3.1: How effecEve are access flaps compared to
repeated subgingival instrumentaEon? In which when there is a presence of deep residual
pockets in the paEents who is already in stage III periodonEEs even though step I and II is done,
access -flap surgery must be done. If there’s a deep residual pockets wherein it measures 4-5mm,
repeaEng of subgingival instrumentaEon must be done again. In the RecommendaEon 3.3: What
is the efficacy of pocket eliminaEon/reducEon surgery in comparison with access-flap surgery?.
In cases of deep residual pocket in which measures more than 6 mm wherein the paEent has
stage III periodonEEs afer a correct second step of this guideline, do a resecEve periodontal
surgery but sEll consider that the percentage of having gingival recession might increase. In the
RecommendaEon 3.6: What is the importance of adequate self-performed oral hygiene in the
context of surgical periodontal treatment?, it contains that performing periodontal surgery which
includes the implant on paEents who do not have progress on achieving and maintaining
adequate levels of self-performed oral hygiene must not be done. This recommendaEon also has
a strong consensus.

The last step which is the STEP 4: SupporEve periodontal care, aimed at maintaining
periodontal stability in all treated periodonEEs paEents, combining prevenEve and therapeuEc
intervenEons defined in the first and second steps of therapy, depending on the gingival and
periodontal status of the paEent's denEEon. It has recommendaEon in which the
“RecommendaEon 4.1: At what intervals should supporEve periodontal care visits be
scheduled?” suggests that there must be supporEve periodontal care visits but it should have 30
to a maximum of 12 months interval and the paEent’s periodontal condiEon afer acEve therapy
must be given a consideraEon. On the other hand, RecommendaEon 4.7: What is the value of
dental flossing for interdental cleaning in periodontal maintenance paEents? Suggests that
flossing is not the first choice of periodontal paEents in maintaining and cleaning interdental.
While the RecommendaEon/statement 4.11: Should adjuncEve chemotherapeuEcs be
recommended for paEents in supporEve periodontal care? Contains that the usage of adjuncEve
anEsepEcs can be considered in supporEve periodontal care of periodonEEs paEents in order to
control the inflammaEon.