Recurrence and progression of periodontitis and methods of management in long‐term care: A systematic review and meta‐analysis

Abstract

Aim To systematically review the literature to evaluate the recurrence of disease of people in long‐term supportive periodontal care (SPC), previously treated for periodontitis, and determine the effect of different methods of managing recurrence. The review focused on stage IV periodontitis. Materials and methods An electronic search was conducted (until May 2020) for prospective clinical trials. Tooth loss was the primary outcome. Results Twenty‐four publications were retrieved to address recurrence of disease in long‐term SPC. Eight studies were included in the meta‐analyses for tooth loss, and three studies for disease progression/recurrence (clinical attachment level [CAL] loss ≥2 mm). For patients in SPC of 5–20 years, prevalence of losing more than one tooth was 9.6% (95% confidence interval [CI] 5%–14%), while experiencing more than one site of CAL loss ≥2 mm was 24.8% (95% CI 11%–38%). Six studies informed on the effect of different methods of managing recurrence, with no clear evidence of superiority between methods. No data was found specifically for stage IV periodontitis. Conclusions A small proportion of patients with stage III/IV periodontitis will experience tooth loss in long‐term SPC (tendency for greater prevalence with time). Regular SPC appears to be important for reduction of tooth loss. No superior method to manage disease recurrence was found.

Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline

“…For this guideline, a total of 13 systematic reviews (SRs) were conducted to support the guideline development process (Carra et al, 2021; Dommisch et al, 2021; Donos et al, 2021; Gennai et al, 2021; Gotfredsen et al, 2021; Kloukos et al, 2021; Leow et al, 2021; Martín et al, 2021; Montero et al, 2021; Orlandi et al, 2021; Papageorgiou et al, 2021; Ramanauskaite et al, 2021; Tomasi et al, 2021). The corresponding manuscripts are published within this special issue of the Journal of Clinical Periodontology.…”

“…The systematic review (Leow et al, 2021) assessed the role of professionally administered supportive periodontal care (SPC) in preventing tooth loss, periodontitis progression (clinical attachment loss, CAL) and associated health outcomes in patients with periodontitis who had completed active periodontal treatment.…”

“…In the systematic review (Leow et al, 2021), none of the studies that were included addressed risk factor control in SPC. No detail of factors that influenced the frequency of the recall interval was given.…”

“…A variety of qualified and trained oral healthcare professionals can carry out the components of an SPC programme. Nine prospective cohort studies included in the systematic review (Leow et al, 2021) utilized undergraduate dental students, dental hygienists and periodontists.…”

Comparison of the efficacy of periodontal prognostic systems in predicting tooth loss

“…A recent systematic review concluded that a small proportion of patients with stage III/IV periodontitis experience tooth loss during supportive periodontal care (SPC) (Leow et al, 2021). Assigning prognosis can be an effective tool for more predictable long‐term planning and management of a patient, particularly in the context of life‐long SPC as the fourth step of periodontal therapy (Sanz et al, 2020).…”