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Cited by 1,934Oral microbiology and periodontitis researchClinical practice guidelines implementationPeriodontal Regeneration and Treatments

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

Open access
Sanz, Mariano, Herrera, David, Kebschull, Moritz, Chapple, Iain, Jepsen, Søren, Berglundh, Tord, Sculean, Anton, Tonetti, Maurizio S. +1 more·2020·Journal of Clinical Periodontology
DOI 10.1111/jcpe.13290PMC PMC7891343
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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.

AI snapshot

Written from the paper’s full text.

TL;DR

This EFP S3 clinical practice guideline provides evidence-based, stepwise recommendations for treating Stage I–III periodontitis, covering behavioural and risk factor control, subgingival instrumentation with or without adjuncts, surgical therapy, and supportive periodontal care. It was developed using AWMF/GRADE methodology, 15 commissioned systematic reviews, and a structured consensus conference.

Key findings

  • The guideline recommends a stepwise approach: first step behavioural change, supragingival biofilm control and risk factor control; second step subgingival instrumentation; third step surgery for residual pockets; then supportive periodontal care.
  • Subgingival instrumentation produced a mean PPD reduction of 1.7 mm at 6/8 months, a mean proportion of closed pockets of 74%, and a mean BOP reduction of 63%; deeper sites (>6 mm) showed a greater mean PPD reduction of 2.6 mm.
  • Adjunctive host-modulating agents such as local statins, bisphosphonates, metformin, NSAIDs, omega-3 PUFAs, sub-antimicrobial dose doxycycline and probiotics were not recommended; systemic antibiotics were not recommended for routine use but may be considered for specific categories such as generalized Stage III periodontitis in young adults.
  • Regenerative surgery for intrabony defects gave a mean adjunctive benefit of 1.34 mm CAL gain and 1.20 mm pocket depth reduction versus open flap debridement; for mandibular Class II furcation involvement, regenerative treatment showed an odds ratio of 21 for furcation improvement.

Methods

  • S3 Level Clinical Practice Guideline developed under the European Federation of Periodontology, following AWMF and GRADE methodological guidance, with 15 commissioned systematic reviews using PRISMA, PICO(S) questions, and a minimum 6-month follow-up.
  • Evidence was appraised with Cochrane risk-of-bias and Newcastle–Ottawa tools; recommendations were graded A/B/0 and consensus strength recorded.
  • A structured consensus conference was held 10–13 November 2019 in La Granja de San Ildefonso, Segovia, Spain, involving delegates from 36 national periodontal societies, working groups, plenary votes, and an independent guideline methodologist.

Limitations

  • The paper states it did not consider health economic cost–benefit ratios and excluded gingivitis, Stage IV periodontitis, necrotising periodontitis, periodontitis as a manifestation of systemic diseases, and mucogingival conditions.
  • The paper states that EFP and the panel could not identify European patient organizations for periodontal diseases, so patient/citizen perspectives were not included; future updates aim to address this.
  • The text makes evident that several recommendations rely on expert consensus or limited evidence, with high/unclear risk of bias, heterogeneity, same-research-group data, off-label formulations, and applicability often reflecting efficacy rather than effectiveness.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/jcpe.13290

Cites

121 of 121 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 232 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Most identified guidelines/documents were considered not applicable due to their age, methodological approach, or inclusion criteria.

    “Most of the identified guidelines/documents were considered not applicable due to (a) their age, (b) their methodological approach, or (c) their inclusion criteria.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The majority of studies found no significant additional benefit of implementing psychological interventions in conjunction with oral hygiene instructions.

    “The majority of the studies found no significant additional benefit implementing psychological interventions in conjunction with OHI.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Carra et al., 2020

      Not checked in the free run.

  • Findingcitation

    In the systematic review by Ramseier et al. (2020), 13 relevant guidelines for interventions for tobacco smoking cessation, promotion of diabetes control, physical exercise, change of diet, carbohydrate reduction, and weight loss were identified.

    “In the systematic review (Ramseier et al., 2020), the authors have identified 13 relevant guidelines for interventions for tobacco smoking cessation, promotion of diabetes control, physical exercise (activity), change of diet, carbohydrate (dietary sugar reduction) and weight loss.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • Findingcitation

    Two studies demonstrated benefits in periodontal outcomes when comparing former smokers to smokers and oscillators.

    “Two studies demonstrated benefits in periodontal outcomes, when comparing former smokers to smokers and oscillators.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • Findingcitation

    Some improvements were observed in the intervention groups in terms of periodontal outcomes in studies of diabetes control interventions.

    “Some improvements were observed in the intervention groups, in terms of periodontal outcomes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

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  • May combine two claims. 119
  • The quote only partly states this claim. 18
  • Classified as probably not a substantial claim. 88

  • May combine two claims.

    Findingown data

    The recent German S3 guideline (Register Number 083-029) was found to be potentially relevant, scored highest in the critical appraisal using AGREE II, and was used to inform the guideline development process.

    “The recent German S3 guideline (Register Number 083‐029) was found to be potentially relevant, scored highest in the critical appraisal using AGREE II and was, therefore, used to inform the guideline development process.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Benefit and harm were not reported for psychological interventions, and no conclusion could be drawn due to different health professionals being involved.

    “Benefit and harm were not reported, and due to the fact that different health professionals were involved to provide interventions, no conclusion could be drawn.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Carra et al., 2020

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  • May combine two claims.

    Findingcitation

    The heterogeneity in study design precludes more consistent findings, but adequate consistency may be found for studies on smoking cessation and diabetes control.

    “The heterogeneity in study design precludes more consistent findings, but adequate consistency may be found for studies on smoking cessation and diabetes control.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

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  • The quote only partly states this claim.

    Findingcitation

    Periodontal interventions were not clearly defined in the studies of diabetes control interventions.

    “Periodontal interventions were not clearly defined.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In the systematic review by Ramseier et al. (2020), two studies on the impact of diabetes control interventions in periodontitis patients were identified, both 6-month RCTs performed at university settings.

    “In the systematic review (Ramseier et al., 2020), two studies on the impact of diabetes control interventions in periodontitis patients were identified, two of them 6‐month RCTs, all of them performed at university settings.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

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  • May combine two claims.

    Findingown data

    The evidence for psychological interventions includes two RCTs on motivational interviewing (199 patients) and three RCTs on psychological interventions based on social cognitive theories and feedback (1,517 patients).

    “The evidence includes two RCTs on MI (199 patients) and three RCTs on psychological interventions based on social cognitive theories and feedback (1,517 patients).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Carra et al., 2020

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    No adverse events were associated with use of omega-3 PUFAs, and they are essentially a relatively safe dietary supplement.

    “No adverse events were associated to the use of omega‐3 PUFAs, and they are essentially a relatively safe dietary supplement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Both systemic and local bisphosphonates were well-tolerated in the studies reported in the systematic review and were not associated with severe adverse reactions.

    “Both systemic and local BPs were well‐tolerated in the studies reported in the systematic review and were not associated with severe adverse reactions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    There would be a cost to using NSAIDs which would ultimately transfer to the patient.

    “There would be a cost to using NSAIDs which would ultimately transfer to the patient.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    There is an additional cost associated with the use of metformin that is borne by the patient.

    “There is an additional cost associated with the use of metformin that is borne by the patient.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    In the systematic reviews of the present European Workshop, the role of antiseptics in active periodontal therapy has not been directly addressed.

    “In the systematic reviews of the present European Workshop, the role of antiseptics in active periodontal therapy has not been directly addressed.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingnone given

    No serious adverse events were reported in NSAID studies.

    “No serious adverse events were reported.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    There is an additional cost associated with the use of bisphosphonates that is borne by the patient.

    “There is an additional cost associated with the use of bisphosphonates that is borne by the patient.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    There would be a cost to using omega-3 PUFAs which would ultimately transfer to the patient.

    “There would be a cost to using omega‐3 PUFAs which would ultimately transfer to the patient.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All metformin studies reported a benefit in PPD reduction when 1% metformin gel was used as an adjunct to subgingival instrumentation, but studies using single and multiple sites per patient were combined.

    “All studies reported a benefit in terms of PPD reduction when 1% metformin gel was used as an adjunct to subgingival instrumentation. However, studies using single and multiple sites per patients were combined.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    One RCT investigated low dose omega-3 PUFAs (6.25 mg EPA and 19.9 mg DHA) twice daily for 6 months; a second employed high dose omega-3 PUFAs (3 g) with 81 mg aspirin daily for 6 months; a third used 1 g omega-3 PUFAs twice daily for 6 months.

    “One RCT investigated low dose omega‐3 PUFAs (6.25 mg eicosapentaenoic acid ‐EPA and 19.9mg docosahexaenoic acid ‐DHA) twice daily for 6 months; a second study employed high dose omega‐3 PUFAs (3 g) in combination with 81 mg aspirin daily for 6 months; and a third study used 1 g omega‐3 PUFAs twice daily for 6 months.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    All metformin studies reported on PPD reduction at 6 months post-subgingival instrumentation, and a meta-analysis was undertaken combining the six RCTs.

    “All studies reported on PPD reduction at 6 months post‐subgingival instrumentation, and a meta‐analysis was undertaken combining the six RCTs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Systemic NSAIDs exhibited limited clinical benefits, but their heterogeneity did not permit the drawing of clinically meaningful conclusions.

    “Systemic NSAIDs exhibited limited clinical benefits, but their heterogeneity did not permit the drawing of clinically meaningful conclusions.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    Effect size estimated for all PPD categories indicates an increased effect of about 10% in PPD reduction for locally administered sustained-release chlorhexidine.

    “Effect size estimated for all PPD categories indicates an increased effect of about 10% in PPD reduction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    While the MET+AMOX combination had the most pronounced effects on clinical outcomes among different types of systemic antimicrobial therapy, the regimen was also associated with the highest frequency of side effects.

    “While the MET + AMOX combination had the most pronounced effects on the clinical outcomes among the different types of systemic antimicrobial therapy, the regimen was also associated with the highest frequency of side effects.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Teughels et al., 2020

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    Findingcitation

    The systematic review revealed statistically significantly improved PPD reduction of locally applied antibiotics as an adjunct to subgingival debridement on short-term follow-up (6-9 months) for Atridox (two studies, WMD = 0.80; 95% CI [0.08; 1.52]; p = .028), Ligosan (three studies, WMD = 0.52; 95% CI [0.28; 0.77]; p < .001) and Arestin (six studies, WMD = 0.28; 95% CI [0.20; 0.36]; p < .001).

    “Of the products available on the European market, the systematic review (Herrera et al., 2020) revealed statistically significantly improved PPD reduction of locally applied antibiotics as an adjunct to subgingival debridement on short‐term follow‐up (6–9 months) for Atridox (two studies, WMD = 0.80; 95% CI [0.08; 1.52]; p = .028), Ligosan (three studies, WMD = 0.52; 95% CI [0.28; 0.77]; p < .001)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Herrera et al., 2020

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  • May combine two claims.

    Findingcitation

    Analysis of 12-month data revealed a significant adjunctive effect for MET+AMOX (n = 7; WMD = 0.54, 95% CI [0.33; 0.74]) and MET (n = 2; WMD = 0.26, 95% CI [0.13; 0.38]).

    “Analysis of 12‐month data revealed a significant adjunctive effect for MET + AMOX (n = 7; WMD = 0.54, 95% CI [0.33; 0.74]) and MET (n = 2; WMD = 0.26, 95% CI [0.13; 0.38]).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Teughels et al., 2020

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Data on BOP and pocket closure were insufficient and no information on NNT was provided for locally applied antibiotics.

    “Data on BOP and pocket closure were insufficient. No information on NNT was provided.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    NNT was not assessed for systemic antibiotics.

    “NNT was not assessed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The meta-analysis revealed a statistically significantly improved outcome for systemically administrated antibiotics as an adjunct to subgingival debridement, but the effect was confined to a limited group of antibiotics.

    “While the results from the meta‐analysis (Teughels et al., 2020) revealed a statistically significantly improved outcome for systemically administrated antibiotics as an adjunct to subgingival debridement, the effect was confined to a limited group of antibiotics.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Teughels et al., 2020

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The cost for the product and the limited availability of products in European countries need to be considered for locally administered sustained-release chlorhexidine.

    “The cost for the product and the limited availability of products in European countries need to be considered.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Data on BOP were insufficient and no data on pocket closure or NNT were provided for locally administered sustained-release chlorhexidine.

    “Data on BOP were insufficient and no data on pocket closure or on number needed to treat (NNT) were provided.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Findingnone given

    High economic costs and limited availability of products in European countries need to be considered for locally applied antibiotics.

    “High economic costs and limited availability of products in European countries need to be considered.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    No increase in adverse effects or differences in PROMs were observed for locally applied antibiotics.

    “No increase in adverse effects or differences in PROMs were observed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    No increase in adverse effects or differences in PROMs were observed for locally administered sustained-release chlorhexidine.

    “No increase in adverse effects or differences in patient‐reported outcome measures (PROMs) were observed.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Resective periodontal surgery attained statistically significantly higher PPD reduction than access flaps at 6 months (WMD = 0.59 mm; 95% CI [0.06-1.12]) and one year (WMD = 0.47 mm; 95% CI [0.24; 0.7]).

    “Resective periodontal surgery attained statistically significantly higher PPD reduction than access flaps at 6 months (WMD = 0.59 mm; 95% CI [0.06–1.12]) and one year (WMD = 0.47 mm; 95% CI [0.24; 0.7]).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Polak et al., 2020

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    Findingcitation

    CAL gain was significantly greater in the subgingival debridement group at initially moderately deep pockets, and access flaps resulted in statistically significantly more attachment loss at sites with initial PPD ≤ 4 mm.

    “However, CAL gain was significantly greater in the subgingival debridement group at initially moderately deep pockets, and AF resulted in statistically significantly more attachment loss at sites with initial PPD ≤ 4 mm.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Sanz‐Sanchez et al., 2020

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  • May combine two claims.

    Findingnone given

    Data on PROMs, the percentage of residual pockets or the need of re-treatment were not reported in any of the studies.

    “Data on PROMs, the percentage of residual pockets or the need of re‐treatment were not reported in any of the studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    For pockets 4-6 mm, differences were statistically significant at 1 year (WMD = 0.34 mm; 95% CI [0.19; 0.48]), while pockets 7 mm or deeper showed greater difference between groups (WMD = 0.76 mm; CI [0.35; 1.17]).

    “For pockets 4–6 mm, differences were statistically significant at 1 year (WMD = 0.34 mm; 95% CI [0.19; 0.48]), while pockets 7 mm or deeper showed greater difference between the groups (WMD = 0.76 mm; CI [0.35; 1.17]).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Polak et al., 2020

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    We did not identify data about harm directly related to procedures.

    “We did not identify data about harm directly related to procedures.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Papilla preservation flaps have been shown to lead to increased CAL gain and PD reduction as well as reduced post‐surgical recession compared with OFD.

    “Papilla preservation flaps have been shown to lead to increased CAL gain and PD reduction as well as reduced post‐surgical recession compared with OFD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Results indicated that regenerative therapies had a significant benefit over OFD in terms of both primary and surrogate outcomes.

    “Results indicated that regenerative therapies had a significant benefit over OFD in terms of both primary and surrogate outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The evidence base includes two systematic reviews.

    “The evidence base includes two systematic reviews.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    No data are available about patient preference or acceptability.

    “No data are available about patient preference or acceptability.”
    Quote in the paperNot a substantial claim

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    Findingown data

    The evidence base includes 22 RCTs with 1,000 patients.

    “The evidence base includes 22 RCTs with 1,000 patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    No conclusion can be drawn.

    “No conclusion can be drawn.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    No data on patient preference arrive from the current review.

    “No data on patient preference arrive from the current review.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The summary of findings table shows that the body of evidence is rather consistent.

    “The summary of findings table shows that the body of evidence is rather consistent.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Findingnone given

    There is an abundance of mechanical oral hygiene products available.

    “There is an abundance of mechanical oral hygiene products available.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Minimal data are available.

    “Minimal data are available.”
    Quote in the paperNot a substantial claim

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    Findingcitation

    In the evidence comparing powered and manual toothbrushes for periodontal maintenance patients, no differences could be found, and the calculated clinical evidence for one study showed no clinically relevant effect size.

    “No differences could be found. The statistically established clinical evidence was calculated for one study and showed no clinically relevant effect size.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Slot et al. (2020)

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    Findingown data

    Seven comparisons evaluated two different interdental devices.

    “The differences of powered versus manual toothbrushes were evaluated in five comparisons, an interdental device was used as an adjunct to toothbrushing in five comparisons, and seven comparisons evaluated two different interdental devices.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The recommended interval could be optimized if it is tailored according to patient's risk.

    “In addition, the conclusions of the 2014 European Workshop on Prevention, based on the review by Trombelli et al. (2015), concluded that the recommended interval ranges 2–4 times per year and that it could be optimized if it is tailored according to patient's risk (Sanz et al., 2015).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Trombelli et al. (2015)

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    • cites Sanz et al., 2015

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The differences of powered versus manual toothbrushes were evaluated in five comparisons.

    “The differences of powered versus manual toothbrushes were evaluated in five comparisons, an interdental device was used as an adjunct to toothbrushing in five comparisons, and seven comparisons evaluated two different interdental devices.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In total, the studies evaluated 607 patients.

    “In total, the studies evaluated 607 patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    A manual toothbrush is less expensive than a power toothbrush.

    “A manual toothbrush is less expensive than a power toothbrush.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    The recommended interval ranges 2-4 times per year.

    “In addition, the conclusions of the 2014 European Workshop on Prevention, based on the review by Trombelli et al. (2015), concluded that the recommended interval ranges 2–4 times per year and that it could be optimized if it is tailored according to patient's risk (Sanz et al., 2015).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Trombelli et al. (2015)

      Not checked in the free run.

    • cites Sanz et al., 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    Interdental brushes and oral irrigators are more expensive than dental floss, wood sticks and rubber and silicon interdental bristle cleaners.

    “Interdental brushes and oral irrigators are more expensive than dental floss, wood sticks and rubber and silicon interdental bristle cleaners.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    An interdental device was used as an adjunct to toothbrushing in five comparisons.

    “The differences of powered versus manual toothbrushes were evaluated in five comparisons, an interdental device was used as an adjunct to toothbrushing in five comparisons, and seven comparisons evaluated two different interdental devices.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The consensus determination process followed the recommendations by the German Association of the Scientific Medical Societies (AWMF) and Standing Guidelines Commission (2012).

    “The consensus determination process followed the recommendations by the German Association of the Scientific Medical Societies (AWMF) and Standing Guidelines Commission (2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites German Association of the Scientific Medical Societies (AWMF) and Standing Guidelines Commission (2012)

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The guideline development process included synthesis of relevant research in 15 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, formulation of specific recommendations, and consensus on those recommendations by leading experts and a broad base of stakeholders.

    “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.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Working groups were directed by two chairpersons belonging to the EFP Workshop Committee, with the support of an expert in methodology in each working group.

    “These working groups were directed by two chairpersons belonging to the EFP Workshop Committee. With the support of an expert in methodology in each working group, recommendations and draft background texts were generated and subsequently presented, debated and put to a vote in the plenary of all delegates.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The methodological quality of the systematic reviews was assessed using the AMSTAR 2 checklist.

    “the methodological quality of the SRs using the AMSTAR 2 checklist (Shea et al., 2017)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Shea et al., 2017

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All 15 systematic reviews were conducted following the PRISMA framework.

    “All SRs were conducted following the “Preferred Reporting Items for Systematic Reviews and Meta‐Analyses” (PRISMA) framework (Moher, Liberati, Tetzlaff, & Altman, 2009).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    To avoid introducing bias by including possibly spurious findings of studies with very short follow-up, a minimal follow-up period of six months was requested for all reviews.

    “To avoid introducing bias by including possibly spurious findings of studies with very short follow‐up, a minimal follow‐up period of six months was requested for all reviews.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Panel members with relevant, potential conflict of interest abstained from voting on guideline statements and recommendations within the consensus process.

    “According to these principles, panel members with relevant, potential CoI abstained from voting on guideline statements and recommendations within the consensus process.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Schunemann et al., 2015

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The methodological quality of identified guideline texts was critically appraised using the AGREE II framework.

    “The methodological quality of these guideline texts was critically appraised using the AGREE II framework (https://www.agreetrust.org/agree‐ii/).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All systematic reviews utilized a comprehensive search strategy of at least two different databases, supplemented by a hand search of periodontal journals and reference lists of included studies.

    “All SRs utilized a comprehensive search strategy of at least two different databases, supplemented by a hand search of periodontal journals and the reference lists of included studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Sites with persistent probing depths ≥4 mm that exhibit bleeding on probing are likely to be unstable and require further treatment.

    “Sites with persistent probing depths ≥4 mm which exhibit BOP are likely to be unstable and require further treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    An independent guideline methodologist advised the panel and facilitated the consensus process, and had no voting rights.

    “In addition, EFP engaged an independent guideline methodologist to advise the panel and facilitate the consensus process (Prof. Dr. med. Ina Kopp). The guideline methodologist had no voting rights.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The development of this guideline and its subsequent publication were financed entirely by internal funds of the European Federation of Periodontology, without any support from industry or other organizations.

    “The development of this guideline and its subsequent publication were financed entirely by internal funds of the European Federation of Periodontology, without any support from industry or other organizations.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The quality of evidence was assessed using a recommended rating scheme.

    “The quality of evidence was assessed using a recommended rating scheme (Balshem et al., 2011; Schunemann, Zhang, Oxman, & Expert Evidence in Guidelines, 2019).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Using the 15 systematic reviews as background information, evidence-based recommendations were formally debated by the guideline panel using a structured consensus development conference, consisting of small group discussions and open plenary where proposed recommendations were presented, voted and adopted by consensus.

    “Using the 15 SRs as background information, evidence‐based recommendations were formally debated by the guideline panel using the format of a structured consensus development conference, consisting of small group discussions and open plenary were the proposed recommendations were presented, voted and adopted by consensus and Murphy et al. (1998).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    In cases where consensus could not be reached, different points of view were documented in the guideline text.

    “In case, consensus could not be reached, different points of view were documented in the guideline text.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All members of the guideline panel declared secondary interests using the standardized ICMJE form.

    “All members of the guideline panel declared secondary interests using the standardized form provided by the International Committee of Medical Journal Editors (ICMJE) (International Committee of Medical Editors).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    To ensure adequate stakeholder involvement, the EFP established a guideline panel involving dental professionals representing 36 national periodontal societies within the EFP.

    “To ensure adequate stakeholder involvement, the EFP established a guideline panel involving dental professionals representing 36 national periodontal societies within the EFP (Table 1a).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Periodontal diagnosis was followed according to the classification scheme defined in the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.

    “Periodontal diagnosis has been followed according to the classification scheme defined in the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions (Caton et al., 2018; Chapple et al., 2018; Jepsen et al., 2018; Papapanou et al., 2018).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Caton et al., 2018

      Not checked in the free run.

    • cites Chapple et al., 2018

      Not checked in the free run.

    • cites Jepsen et al., 2018

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The panel took care to avoid overlaps or significant gaps between the systematic reviews so they would cover all possible interventions currently undertaken in periodontal therapy.

    “The panel took great care to avoid overlaps or significant gaps between the SRs, so they would truly cover all possible interventions currently undertaken in periodontal therapy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The strength of consensus for the first part was strong consensus, with 0% of the group abstaining due to potential CoI.

    “Strength of consensus strong consensus (0% of the group abstained due to potential CoI).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The EFP and guideline panel were not able to identify any patient organizations regarding periodontal diseases at European level to involve.

    “EFP and the guideline panel tried to involve patient organizations but were not able to identify any regarding periodontal diseases at European level.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The guideline's methodological quality was formally assessed by an outside consultant using the AGREE framework.

    “The methodological quality was formally assessed by an outside consultant using the AGREE framework.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The S3 CPG was developed under the auspices of the European Federation of Periodontology (EFP) and followed the methodological guidance of the Association of Scientific Medical Societies in Germany (AWMF) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

    “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).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    A total of 15 systematic reviews were conducted to support the guideline development process.

    “For this guideline, a total of 15 systematic reviews (SRs) were conducted to support the guideline development process”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All 15 systematic reviews and the position paper on outcome variables commissioned for this guideline underwent a multistep peer review process.

    “All 15 systematic reviews, and the position paper on outcome variables commissioned for this guideline, underwent a multistep peer review process.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The first part of the document was prepared by the steering group with methodology consultants, examined by experts, and voted upon in the initial plenary session to form the basis for specific recommendations.

    “The first part of this document was prepared by the steering group with the help of the methodology consultants, and it was carefully examined by the experts participating in the consensus and was voted upon in the initial plenary session to form the basis for the specific recommendations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    During plenary sessions, the guideline development process and discussions and votes were overseen and facilitated by the independent guideline methodologist.

    “During these plenary sessions, the guideline development process and discussions and votes were overseen and facilitated by the independent guideline methodologist (I.K.).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    In all 15 systematic reviews, focused questions in PICO(S) format were proposed by the authors to a panel comprising working group chairs and methodological consultants for review and approval.

    “In all 15 systematic reviews, focused questions in PICO(S) format (Guyatt et al., 2011) were proposed by the authors in January 2019 to a panel comprising the working group chairs and the methodological consultants, in order to review and approve them (Table 3).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    In all systematic reviews, the electronic and manual search, as well as data extraction, was done in parallel by two different investigators.

    “In all SRs, the electronic and manual search, as well as the data extraction, was done in parallel by two different investigators.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Delegates to the guideline panel were nominated, participated in the guideline development process, and had voting rights in the consensus conference.

    “These delegates were nominated, participated in the guideline development process and had voting rights in the consensus conference.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    A split-mouth RCT with 450 days follow-up in 25 subjects concluded that supragingival debridement before subgingival debridement decreased subgingival treatment needs and maintained periodontal stability over time.

    “A split‐mouth RCT, with a follow‐up of 450 days in 25 subjects, concluded that the performance of supragingival debridement, before subgingival debridement, decreased subgingival treatment needs and maintained the periodontal stability over time (Gomes, Romagna, Rossi, Corvello, & Angst, 2014).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Gomes, Romagna, Rossi, Corvello, & Angst, 2014

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Smoking and diabetes are two proven risk factors in the etiopathogenesis of periodontitis.

    “Smoking and diabetes are two proven risk factors in the etiopathogenesis of periodontitis (Papapanou et al., 2018)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Papapanou et al., 2018

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Manual or power tooth brushing are primary means of reducing plaque and gingivitis.

    “Manual or power tooth brushing are recommended as a primary means of reducing plaque and gingivitis.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Chapple et al., 2015

      Not checked in the free run.

    • cites Van der Weijden & Slot, 2015

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    The overall body of evidence for psychological interventions was assessed at high risk of bias, with four RCTs at high risk and one RCT at low risk.

    “The overall body of evidence was assessed at high risk of bias (four RCTs high and one RCT low).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Carra et al., 2020

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Evidence for subgingival instrumentation was consistent across all 11 studies included in the pre- and post-treatment analysis and was considered strong.

    “Evidence was consistent across all 11 studies that were included in the pre‐ and post‐treatment analysis and was therefore considered strong.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Suvan et al. (2019)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    Interventions for risk factor control are heterogeneous, but the potential systemic health benefits may favour preference for them.

    “Interventions are heterogeneous, but the potential systemic health benefits may favour preference for them.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the systematic review by Ramseier et al. (2020), two studies on dietary counselling aiming at carbohydrate (free sugars) reduction in gingivitis/periodontitis patients were identified, one 4-week RCT and one 24-week prospective study.

    “In the systematic review (Ramseier et al., 2020), two studies specifically on the impact of dietary counselling aiming at carbohydrate (free sugars) reduction in gingivitis/periodontitis patients were identified, one 4‐week RCT (including also gingivitis patients) and one 24‐week prospective study.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Three of the five weight loss studies reported beneficial periodontal outcomes, and the other two reported no differences.

    “Three studies reported beneficial periodontal outcomes and, the other two, no differences.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The grading of quality of evidence and strength of recommendation may differ in justified cases.

    “The grading of the quality of evidence and the strength of a recommendation may therefore differ in justified cases.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the systematic review by Suvan et al. (2019), one RCT on 169 patients with 3-month outcomes and 11 prospective studies (n = 258) with ≥6 months follow-up were analysed for subgingival instrumentation.

    “One RCT on 169 patients with 3‐month outcomes addressed the PICOS question. Further 11 prospective studies (n = 258) with a follow‐up of ≥6 months which considered baseline measures and post‐treatment reductions in probing pocket depth (primary outcome) and bleeding on probing and percentage of closed pockets (secondary outcomes) were analysed.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Suvan et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the systematic review by Ramseier et al. (2020), two 12-week studies on physical exercise interventions in periodontitis patients were identified, one RCT and one prospective study, performed at university settings.

    “In the systematic review (Ramseier et al., 2020), two 12‐week studies on the impact of physical exercise (activity) interventions in periodontitis patients were identified, one RCT (testing education with comprehensive yogic interventions followed by yoga exercises) and one prospective study (with briefing followed by physical exercises; the control group was a dietary intervention), performed at”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some dietary counselling studies showed significant improvements in periodontal parameters, but the RCT with the longest follow-up did not identify significant benefits.

    “Some studies showed significant improvements in periodontal parameters, but the RCT with the longest follow‐up was not able to identify significant benefits (Zare Javid, Seal, Heasman, & Moynihan, 2014).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Zare Javid, Seal, Heasman, & Moynihan, 2014

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The removal of supragingival dental biofilm and calcified deposits is considered an essential component in primary and secondary prevention of periodontitis and in basic treatment of plaque-induced periodontal diseases.

    “The removal of the supragingival dental biofilm and calcified deposits (calculus) (here identified under the term “professional mechanical plaque removal” (PMPR)) is considered an essential component in the primary (Chapple et al., 2018) and secondary (Sanz et al., 2015) prevention of periodontitis as well as within the basic treatment of plaque‐induced periodontal diseases (van der Weijden & Slot”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Chapple et al., 2018

      Not checked in the free run.

    • cites Sanz et al., 2015

      Not checked in the free run.

    • cites van der Weijden & Slot, 2011

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the systematic review by Ramseier et al. (2020), five prospective studies in obese gingivitis/periodontitis patients on the impact of weight loss interventions were identified, with follow-ups of 18 months, 12 months, 24 weeks, and two studies of 12 weeks.

    “In the systematic review (Ramseier et al., 2020), five prospective studies, in obese gingivitis/periodontitis patients, on the impact of weight loss interventions were identified, with different follow‐ups (18 months, 12 months, 24 weeks and two studies of 12 weeks).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    A psychological approach needs special training to be effectively performed.

    “A psychological approach needs special training to be effectively performed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    The systemic health benefits that can be obtained from risk factor control interventions, if successful, would represent reduced cost of healthcare services in different comorbidities.

    “However, the systemic health benefits that can be obtained from these interventions, if they are successful, would represent reduced cost of healthcare services in different comorbidities.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In the systematic review by Ramseier et al. (2020), seven studies on dietary counselling in periodontitis patients were identified: three RCTs and four prospective studies, performed at hospital and university settings.

    “In the systematic review (Ramseier et al., 2020), seven studies on the impact of dietary counselling (mainly addressing lower fat intake, less free sugars and salt intake, increase in fruit and vegetable intake) in periodontitis (with or without other comorbidities) patients were identified: three RCTs (6 months, 8 weeks, 4 weeks) and four prospective studies (12 months, 24 weeks, 12 weeks, 4”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    If the group felt that evidence was not clear enough to support a recommendation, statements were formulated, including the need or not of additional research.

    “If the group felt that evidence was not clear enough to support a recommendation, Statements were formulated, including the need (or not) of additional research.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The endpoints of therapy may not be achievable in all teeth in severe Stage III periodontitis patients.

    “although these endpoints of therapy may not be achievable in all teeth in severe Stage III periodontitis patients.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationnone given

    Other relevant factors associated with healthy lifestyles may also be part of the overall strategy for reducing patient's risk factors.

    “Other relevant factors associated with healthy lifestyles (stress reduction, dietary counselling, weight loss or increased physical activities) may also be part of the overall strategy for reducing patient's risk factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The majority of delivery-protocol studies were conducted in well-controlled environments, included specifically selected populations and were undertaken in a number of different continents.

    “The majority of studies were conducted in well‐controlled environments, included specifically selected populations and were undertaken in a number of different continents.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Suvan et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is a consensus that subgingival instrumentation is efficacious in patients with systemic diseases, but the magnitude of the effect requires further study.

    “While results from studies involving populations with systemic diseases were not included in the systematic review, there is a consensus that subgingival instrumentation is efficacious in these groups (Sanz et al., 2018, 2019), but the magnitude of the effect requires further study.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sanz et al., 2018, 2019

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    The majority of laser studies were conducted in university settings, included specifically selected populations and were undertaken in a number of different countries.

    “The majority of studies were conducted in university settings, included specifically selected populations and were undertaken in a number of different countries.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Salvi et al. (2019)

      Not checked in the free run.

  • The quote only partly states this claim.

    Study design and conductown data

    The majority of laser studies displayed unclear risk of bias.

    “The majority of studies displayed unclear risk of bias.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Salvi et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    No indications of publication bias were observed for subgingival instrumentation studies, but heterogeneity was high.

    “No indications of publication bias were observed but heterogeneity was high.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Suvan et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The majority of instrument-comparison studies were conducted in well-controlled research environments, in specifically selected populations and under local anaesthetic.

    “The majority of studies were conducted in well‐controlled research environments, in specifically selected populations and under local anaesthetic.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Suvan et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The evidence for delivery protocol was considered strong and consistent, with no indications of publication bias and low heterogeneity.

    “The evidence was considered strong and consistent. No indications of publication bias were observed, and heterogeneity was low.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Suvan et al. (2019)

      Not checked in the free run.

  • The quote only partly states this claim.

    Study design and conductown data

    Study quality assessment identified all eight delivery-protocol studies at low risk of bias.

    “Study quality assessment identified all eight studies at low risk of bias.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Suvan et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The majority of subgingival instrumentation studies were conducted in well-controlled research environments and included specifically selected populations with no systemic disease.

    “The majority of studies were conducted in well‐controlled research environments and included specifically selected populations, that is those with no systemic disease.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Suvan et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The evidence for subgingival instrumentation illustrates efficacy rather than effectiveness, so generalizability to general dental practice settings is unclear.

    “The evidence presented illustrates “efficacy” rather than “effectiveness”; therefore, generalizability to general dental practice settings is unclear.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The evidence for instrument type was considered strong and consistent, with no indications of publication bias but high heterogeneity.

    “The evidence was considered strong and consistent. No indications of publication bias were observed but heterogeneity was high.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Suvan et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    All probiotic studies were conducted in two countries, and no conclusions can be drawn on the effectiveness of probiotics as adjuncts to subgingival instrumentation.

    “All studies were conducted in two countries, and no conclusions can be drawn on the effectiveness of probiotics as adjuncts to subgingival instrumentation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Although mean estimates suggested a clinically meaningful benefit from adding statin gels to subgingival instrumentation, there was a large prediction interval for PPD reduction at 6 months and high heterogeneity (I2 = 95.1%), so caution is needed when assessing statin efficacy.

    “Although the mean estimates suggested a clinically meaningful benefit from adding statin gels to subgingival instrumentation, there was a large prediction interval for PPD reduction at 6 months (−0.08 mm to 3.74 mm) and the I 2 (95.1%) indicating wide heterogeneity of data and therefore caution needs to be adopted when assessing the efficacy of statins.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    One SDD study was considered at high risk of bias and the remaining studies presented some concerns in certain domains; of the five studies in meta-analysis, three declared industrial sponsorship.

    “One study was considered to be at high risk of bias and the remaining studies presented some concerns in certain domains. Of the five studies included in meta‐analysis, three declared industrial sponsorship, one was sponsored by the academic institution, and the fifth did not declare funding.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Donos et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The same research group published all data within the statin RCTs, thereby restricting the generalizability of the results.

    “The same research group published all data within the RCTs, thereby restricting the generalizability of the results, which need to be confirmed in future larger (multicentre) RCTs by independent groups, with multilevel analyses to account for potential confounding factors (e.g. medical history, smoking history).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    All probiotic studies had an overall low risk of bias; two declared industrial sponsorship and three received probiotics from industry.

    “All studies had an overall low risk of bias. Two out of the five studies declared industrial sponsorship, and three received the probiotics from industry.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Donos et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    All aPDT studies were conducted in well-controlled university settings or specialist centres, included specifically selected populations and were undertaken in a number of different countries.

    “All studies were conducted in well controlled university settings or specialist centres, included specifically selected populations and were undertaken in a number of different countries.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Salvi et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The findings for SDD were consistent in all studies, with I2 statistic 0% for both moderate and deep pockets.

    “The findings were consistent in all studies. The I 2 statistic was 0% (95% CI [0%; 64.1%]) for both moderate and deep pockets.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Donos et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The mean estimated difference in PPD reduction between probiotics and placebo was not statistically significant and of limited clinical relevance (difference < 0.5 mm).

    “The mean estimated difference in PPD reduction between probiotics and placebo was not statistically significant and of limited clinical relevance (difference < 0.5 mm).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Statins have pleiotropic pharmacological effects including antioxidant and anti-inflammatory effects, stimulation of angiogenesis, improvements in endothelial function and positive regulation of bone formation pathways.

    “Statins are known to have pleiotropic pharmacological effects in addition to their hypolipidemic properties. These include antioxidant and anti‐inflammatory effects, the stimulation of angiogenesis, improvements in endothelial function and the positive regulation of bone formation pathways (Adam & Laufs, 2008; Mennickent, Bravo, Calvo, & Avello, 2008; Petit et al., 2019).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Adam & Laufs, 2008

      Not checked in the free run.

    • cites Mennickent, Bravo, Calvo, & Avello, 2008

      Not checked in the free run.

    • cites Petit et al., 2019

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    There was a moderate overall risk of bias in the statin studies analysed; three of 12 studies had high risk of bias in at least one domain, and one study was moderately underpowered.

    “There was a moderate overall risk of bias in the studies analysed. Three of 12 studies presented with a high risk of bias in at least one domain. One study was moderately underpowered.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Donos et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    All probiotic formulations appeared to be safe and patients did not report adverse effects.

    “All formulations appeared to be safe and patients did not report adverse effects.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Donos et al. (2019)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Study design and conductown data

    No meta-analysis of omega-3 PUFAs was performed due to the limited number of studies identified and their heterogeneity.

    “No meta‐analysis was performed due to the limited number of studies identified and their heterogeneity.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The same research group published all data on local metformin; therefore, the generalizability of the results needs to be confirmed in future larger multicentre RCTs.

    “The same research group published all data on local metformin; therefore, the generalizability of the results needs to be confirmed in future larger (multicentre) RCTs, with multi‐level analyses accounting for potential confounding factors (e.g. medical history, smoking history).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    One omega-3 study reported industry support, one was supported by a University, and one did not disclose the funding source.

    “One study reported industry support, one was supported by a University, and one did not disclose the funding source.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    SDD is mainly effective in deep sites (≥7 mm), although the clinical significance is small given that re-treatment with non-surgical root debridement might yield additional PPD reductions and local drug delivery systems may yield similar effect sizes.

    “SSD is mainly effective in deep sites (≥7 mm), although SDD is used as a systemic rather than a site‐specific treatment. The clinical significance in deep sites (0.68 mm at 6 months and 0.62 mm at 9 months) is small, given that re‐treatment with non‐surgical root debridement might yield additional PPD reductions, and local drug delivery systems may yield similar effect sizes.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In the systematic review by Donos et al. (2019), seven placebo-controlled RCTs (n = 348) on local delivery of bisphosphonate gels and two placebo-controlled RCTs (n = 90) on systemic bisphosphonates were identified.

    “Seven placebo‐controlled RCTs (n = 348), all from the same research group, on local delivery of 1% alendronate gel (six studies) and 0.5% zolendronate gel (one study) in infrabony or furcation Class II defects were identified.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Donos et al. (2019)

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Of the nine bisphosphonate studies included, two were at high risk of bias and seven presented some concerns in at least one domain; one study was underpowered.

    “Of the nine studies included, two were at high risk of bias and seven presented some concerns in at least one of the domains of the risk of bias assessment tool. One study was underpowered.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Donos et al. (2019)

      Not checked in the free run.

  • The quote only partly states this claim.

    Study design and conductown data

    One out of three omega-3 studies was considered at high risk of bias.

    “One out of three studies was considered to be at high risk of bias.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Doxycycline may lead to elevations in liver enzymes, which was evident for some patients in one RCT included in the systematic review.

    “However, it is known that doxycycline may lead to elevations in liver enzymes, which was evident for some patients in the results of one RCT included in the systematic review (Caton et al., 2000, 2001).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Caton et al., 2000, 2001

      Not checked in the free run.

  • The quote only partly states this claim.

    Study design and conductown data

    Heterogeneity in study designs precluded a meta-analysis of omega-3 PUFAs.

    “Heterogeneity in study designs precluded a meta‐analysis.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Study design and conductown data

    No meta-analysis of NSAIDs was performed due to the limited number of studies identified and their heterogeneity.

    “No meta‐analysis was performed due to the limited number of studies identified and their heterogeneity.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Study design and conductown data

    Two out of four NSAID studies were considered at high risk of bias.

    “Two out of four studies were considered at high risk of bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    While pharmaceutical companies provided metformin, the level of involvement of industry in the analysis and interpretation of the results is unclear.

    “While pharmaceutical companies provided metformin, the level of involvement of industry in the analysis and interpretation of the results is unclear.”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    High risk of bias and heterogeneity among studies for locally administered sustained-release antiseptics.

    “High risk of bias and heterogeneity among studies.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    The complete removal of subgingival biofilm and calculus at teeth with deep probing depths (≥6 mm) or complex anatomical surfaces may be difficult, and hence endpoints of therapy may not be achieved.

    “However, in periodontitis patients, the complete removal of subgingival biofilm and calculus at teeth with deep probing depths (≥6 mm) or complex anatomical surfaces (root concavities, furcations, infra bony pockets) may be difficult, and hence, the endpoints of therapy may not be achieved, and further treatment should be implemented.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    These endpoints of therapy may not be achievable in all teeth in severe Stage III periodontitis patients.

    “These endpoints of therapy may not be achievable in all teeth in severe Stage III periodontitis patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Low risk of bias and low heterogeneity among studies for systemic antibiotics.

    “Low risk of bias and low heterogeneity among studies.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Post-graduate periodontal education is specifically designed to provide competence and proficiency towards the resolution of such complex problems.

    “Post‐graduate periodontal education, on the other hand, is specifically designed to provide competence and proficiency towards the resolution of such complex problems (Sanz, van der Velden, van Steenberghe, & Baehni, 2006; Van der Velden & Sanz, 2010).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Sanz, van der Velden, van Steenberghe, & Baehni, 2006

      Not checked in the free run.

    • cites Van der Velden & Sanz, 2010

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Dental curricula include knowledge and familiarity with the approach but are not designed to provide competence to conduct such treatment.

    “Dental curricula include knowledge and familiarity with the approach but are not designed to provide competence to conduct such treatment: Additional specific training is required and is available through continuing professional development and periodontal learned societies in most countries.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    High risk of bias and scarcity of quantitative data (only 4 RCTs) for resective surgery.

    “High risk of bias, scarcity of quantitative data (only 4 RCTs).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Religious issues may be present for segments of the population since some of the regenerative materials are of porcine or bovine origin.

    “Religious issues may be present for segments of the population since some of the regenerative materials are of porcine or bovine origin.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Twenty-two RCTs (1,182 teeth in 1,000 patients)-four studies at low risk of bias-there is consistency of direction of benefit but high heterogeneity for superiority of regeneration over open flap debridement.

    “Twenty‐two RCTs (1,182 teeth in 1,000 patients)—four studies at low risk of bias—there is consistency of direction of benefit but high heterogeneity for superiority of regeneration over open flap debridement.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Premisereasoning

    The perception that regenerative treatment of deep intrabony defects results in better outcomes than access flap is commonly held in the research and clinical community.

    “The perception that regenerative treatment of deep intrabony defects results in better outcomes than access flap is commonly held in the research and clinical community.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Six papers failed to disclose support.

    “Bearing in mind that six papers failed to disclose support and seven papers reported industry funding for the research.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    The guideline can be applied since it is independent of availability of materials and a segment of the dental workforce has been trained or can be trained to deliver surgical furcation treatment in the different European health systems.

    “The guideline can be applied since it is independent of availability of materials and a segment of the dental workforce has been trained or can be trained to deliver surgical furcation treatment in the different European health systems.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The quality of the evidence for the statement was assessed according to GRADE and considered to be high.

    “The quality of the evidence for the statement was assessed according to GRADE and considered to be high.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The level of self-performed oral hygiene is clinically assessed using a plaque control record.

    “The level of self‐performed oral hygiene is clinically assessed using a plaque control record [for an example, see (O'Leary, Drake, & Naylor, 1972)].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites O'Leary, Drake, & Naylor, 1972

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Study quality assessment identified five studies at low risk of bias and 15 studies at unclear risk of bias.

    “Study quality assessment identified five studies at low risk of bias and 15 studies at unclear risk of bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Seven papers reported industry funding for the research.

    “Bearing in mind that six papers failed to disclose support and seven papers reported industry funding for the research.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Study quality assessment identified four studies at low risk of bias and 15 studies at unclear risk of bias.

    “Study quality assessment identified four studies at low risk of bias and 15 studies at unclear risk of bias.”
    • Also stated in: § Intervention: Management of intrabony defects · plain
      “Study quality assessment identified four studies at low risk of bias and 15 studies at unclear risk of bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    There is a mix of researcher and industry‐initiated studies.

    “There is a mix of researcher and industry‐initiated studies.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The quality of the evidence for the statement was assessed according to GRADE and considered to be high/moderate.

    “The quality of the evidence for the statement was assessed according to GRADE and considered to be high/moderate.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The quality of the evidence for the statement was assessed according to GRADE and considered to be moderate.

    “The quality of the evidence for the statement was assessed according to GRADE and considered to be moderate.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The guideline can be applied to patients attending a periodontal maintenance program.

    “The guideline can be applied to patients attending a periodontal maintenance program.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning

    Regenerative surgery has additional costs, which appear to be justified by the added benefits (furcation improvements).

    “Regenerative surgery has additional costs, which appear to be justified by the added benefits (furcation improvements).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The benefits overweigh the risks by far.

    “In any case, the benefits overweigh the risks by far.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Study quality assessment identified one study at low risk of bias and 10 studies at high risk and two of an unclear risk of bias.

    “Study quality assessment identified one study at low risk of bias and 10 studies at high risk and two of an unclear risk of bias.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    All the studies reported FDA‐ or CE‐approved devices.

    “All the studies reported FDA‐ or CE‐approved devices.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    The adjunctive use of some agents has been proposed in subjects who are not able to effectively remove supragingival biofilms by mechanical procedures alone, but there is no direct evidence to support this statement.

    “The adjunctive use of some agents has been proposed in those subjects who are not able to effectively remove supragingival biofilms by the sole use of mechanical procedures, but there is no direct evidence to support this statement.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Figuero, Roldan, et al., 2019

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the systematic review, four long-term studies (1.5-3 years) were identified, and no significant impact was observed for gingival indices.

    “In the systematic review (Figuero, Roldan, et al., 2019), four long‐term studies (1.5–3 years) were identified, and no significant impact was observed for gingival indices.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Figuero, Roldan, et al., 2019

      Not checked in the free run.

  • The quote only partly states this claim.

    Study design and conductown data

    All studies comparing powered and manual toothbrushes were at high risk of bias.

    “Study quality assessment showed that all studies at high risk of bias.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Slot et al. (2020)

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The great majority of studies on adjunctive antiseptics were industry-funded, and there was a high risk of bias both within and across studies.

    “The great majority of these studies were industry‐funded, and there was a high risk of bias both within and across studies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Figuero, Roldan, et al., 2019

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mouth rinse delivery offers a better distribution around the mouth and better pharmacokinetic properties.

    “Mouth rinse delivery offers a better distribution around the mouth (Serrano et al., 2015) and better pharmacokinetic properties (Cummins & Creeth, 1992).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Serrano et al., 2015

      Not checked in the free run.

    • cites Cummins & Creeth, 1992

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some evidence suggests that adjunctive use of mouth rinses may provide better outcomes than dentifrices, but the evidence is conflictive and significant differences were only observed for the secondary outcome.

    “Some evidence suggests that the adjunctive use of mouth rinses may provide better outcomes than that of dentifrices. However, the evidence is conflictive and significant differences were only observed for the secondary outcome (Figuero, Roldan, et al., 2019).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Figuero, Roldan, et al., 2019

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The evidence on adjunctive antiseptics was highly consistent across studies, with 72 comparisons included in the primary analysis.

    “Highly consistent across studies, 72 comparisons were included in the primary analysis.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Figuero, Roldan, et al., 2019

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    At least 31 studies assessed adverse events and PROMs, and staining was the only relevant finding.

    “At least 31 studies assessed adverse events and PROMs and staining was the only relevant finding.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Figuero, Roldan, et al., 2019

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There is little evidence available on gingivitis patients that rubber/elastomeric cleaning sticks are effective in reducing inflammation with no difference to interdental brushes.

    “Rubber/elastomeric cleaning sticks are a relatively newly developed instruments with an increasing market share, and there only little evidence available on gingivitis patients that these devices are effective in reducing inflammation with no difference to interdental brushes (Abouassi et al., 2014; Hennequin‐Hoenderdos, van der Sluijs, van der Weijden, & Slot, 2018).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Abouassi et al., 2014

      Not checked in the free run.

    • cites Hennequin‐Hoenderdos et al., 2018

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Most studies assessing the adjunctive benefits of antiseptic formulations have been performed in general populations, with statistically significant benefits in plaque and gingival indices.

    “Most studies assessing the adjunctive benefits of antiseptic formulations have been performed in general populations, with statistically significant benefits in plaque and gingival indices (Serrano, Escribano, Roldan, Martin, & Herrera, 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Serrano et al., 2015

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    No conclusions could be made for non-antiseptic agents because only one study was identified.

    “No conclusions could be made for other, non‐antiseptic, agents, since only one study was identified.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Figuero, Roldan, et al., 2019

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).

    Study design and conductcitation

    The risk of bias of studies on other interdental cleaning devices was high.

    “High.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Slot et al. (2020)

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Recommending adjunctive antiseptics to mechanical supragingival biofilm control in a specific patient group instead of the general population is plausible, but there is no supporting evidence to defend it.

    “Recommending adjunctive antiseptics, to mechanical supragingival biofilm control, in a specific patient group, instead in the general population, is plausible, but there is no supporting evidence to defend it.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In treated periodontitis patients, the impact of antiseptic agents on gingival indices was statistically significant (p < .001) with an additional reduction of S‐WMD −1.564 (95% CI [−2.197; −0.931]) and significant heterogeneity (p < .001).

    “In treated periodontitis patients, analysed in 13 studies with 16 comparisons, including 1,125 test and 838 control patients, the impact was statistically significant (p < .001) and the additional reduction, expressed as S‐WMD, was −1.564 (95% CI [−2.197; −0.931]), with significant heterogeneity (p < .001).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Figuero, Roldan, et al., 2019

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    For antiseptic agents, the impact on changes in gingival indices was statistically significant (p < .001) with an additional reduction of S‐WMD −1.3 (95% CI [−1.489; −1.047]) and significant heterogeneity (p < .001).

    “For antiseptic agents, the impact in the primary outcome, changes in gingival indices (analysed in 52 studies with 72 comparisons, including 5,376 test and 3,693 control patients), was statistically significant (p < .001) and the additional reduction, expressed as standardized weighted mean difference (S‐WMD), was −1.3 (95% CI [−1.489; −1.047]), with significant heterogeneity (p < .001).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Figuero, Roldan, et al., 2019

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Controlling smoking and diabetes would be critical for treatment response and for long-term stability.

    “Controlling these risk factors therefore would be critical for treatment response and for long‐term stability.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In the systematic review, 13 relevant guidelines for interventions for smoking cessation, diabetes control, physical exercise, change of diet, carbohydrate reduction and weight loss were identified, and 25 clinical studies were found that assess the impact of some of these interventions in gingivitis/periodontitis patients, but only some included patients in supportive periodontal care.

    “In the systematic review (Ramseier et al., 2020), the authors have identified 13 relevant guidelines for interventions for smoking cessation, diabetes control, physical exercise (activity), change of diet, carbohydrate (dietary sugar reduction) and weight loss. In addition, 25 clinical studies were found that assess the impact of (some of) these interventions in gingivitis/periodontitis patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the systematic review, none of the identified studies on diabetes control interventions was performed in patients in supportive periodontal care, and indirect evidence suggests that diabetes control interventions ought to be implemented in supportive periodontal care patients.

    “In the systematic review (Ramseier et al., 2020), none of the identified studies was performed in patients in supportive periodontal care. Indirect evidence (see section on active periodontal therapy) suggests that diabetes control interventions ought to be implemented in supportive periodontal care patients.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Although no meta-analysis was possible, the primary outcome (tooth loss) was reported in 12 studies, showing no or low incidence, and CAL changes were reported in 10 studies, consistently showing limited modifications, frequently as a slight CAL loss.

    “Although no meta‐analysis was possible, the primary outcome (tooth loss) was reported in 12 studies, showing no or low incidence. Clinical attachment level (CAL) changes were reported in 10 studies, which consistently showed limited modifications in CAL, frequently as a slight CAL loss.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Trombelli et al., 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The methodological quality of non-randomized observational studies on PMPR was assessed with a specifically designed scale, with quality levels ranging from 3 to 7 on a 9-point scale.

    “The methodological quality was assessed with a specifically designed scale for the evaluation of non‐randomized observational studies, with a quality level ranging from 3 to 7, in a 9‐point scale, with 9 representing the highest quality (lowest risk of bias).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In previously published network meta-analyses, chlorhexidine and triclosan and copolymer were the most effective agents for plaque reduction, but no clear differences were observed for gingival index control.

    “In a previously published network meta‐analyses, chlorhexidine and triclosan and copolymer were the most effective agents for plaque reduction, but no clear differences were observed for gingival index control (Escribano et al., 2016; Figuero, Herrera, et al., 2019).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Escribano et al., 2016

      Not checked in the free run.

    • cites Figuero, Herrera, et al., 2019

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Smoking and diabetes are two of the main risk factors for periodontitis, and they are currently included in the grading of periodontitis.

    “Smoking and diabetes are two of the main risk factors for periodontitis, and they are currently included in the grading of periodontitis (Papapanou et al., 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Papapanou et al., 2018

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a systematic review, a weighted mean yearly rate of tooth loss of 0.15 for 5-year follow-up and 0.09 for 12-14-year follow-up was reported, with mean clinical attachment loss lower than 1 mm at follow-up ranging from 5 to 12 years.

    “In a systematic review (Trombelli et al., 2015), presented at the 2014 European Workshop, a weighted mean yearly rate of tooth loss of 0.15 and 0.09 for follow‐up of 5 years or 12–14 years, respectively, was reported; the correspondent figures for mean clinical attachment loss lower than 1 mm at follow‐up ranging from 5 to 12 years.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Trombelli et al., 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Study design and conductnone given

    This guideline has been developed using strict validated methodologies for assuring the best available evidence on the efficacy of the interventions considered and the most appropriate recommendations based on a structured consensus process, including a panel of experts and representatives from key stakeholders.

    “This guideline has been developed using strict validated methodologies for assuring the best available evidence on the efficacy of the interventions considered and the most appropriate recommendations based on a structured consensus process, including a panel of experts and representatives from key stakeholders.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Premisecitation

    In the systematic review, none of the identified studies on physical exercise, dietary counselling or weight loss was performed in patients in supportive periodontal care.

    “In the systematic review (Ramseier et al., 2020), none of the identified studies was performed in patients in supportive periodontal care.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ramseier et al., 2020

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    In the systematic review, two RCTs were identified, one testing sub-antimicrobial dose doxycycline and another evaluating photodynamic therapy, and no statistically significant differences were observed in any study, although CAL gain was more relevant with adjunctive PDT (1.54 mm) compared with conventional PMPR alone (0.96 mm).

    “In the systematic review (Trombelli et al., 2020), two RCTs were identified, one testing sub‐antimicrobial dose (20 mg b.i.d.) of doxycycline (Reinhardt et al., 2007), another evaluating photodynamic therapy (PDT) with a 0.01% methylene blue as photosensitizer and a diode laser (wavelength of 660 nm) (Carvalho et al., 2015). No statistically significant differences were observed in any study,”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Trombelli et al., 2020

      Not checked in the free run.

    • cites Reinhardt et al., 2007

      Not checked in the free run.

    • cites Carvalho et al., 2015

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A previous systematic review including 11 RCTs found better results for PDT, but only after 3 months, with 0.13 mm of additional impact in PPD reduction, and no increase in adverse events were reported.

    “For the adjunctive use of PDT, a previous systematic review (Xue et al., 2017), which included 11 RCTs, found better results for PDT, but only after 3 months, with 0.13 mm of additional impact in PPD reduction. No increase in adverse events were reported.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Xue et al., 2017

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the systematic review, only one RCT was identified assessing Er:YAG laser as an alternative method to conventional PMPR, and no statistically significant differences were found.

    “In the systematic review (Trombelli et al., 2020), only one RCT was identified, assessing Er:YAG laser as an alternative method to conventional PMPR. No statistically significant differences were found (Krohn‐Dale, Boe, Enersen, & Leknes, 2012).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Trombelli et al., 2020

      Not checked in the free run.

    • cites Krohn‐Dale et al., 2012

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a study in a private practice in Norway, regular maintenance was associated with less tooth loss than not regular maintenance, with follow-ups of 16-26 years, and the yearly cost of maintaining a tooth was estimated at 20.2 euro.

    “In a study in a private practice in Norway, it was demonstrated that regular maintenance was associated with less tooth loos than not regular maintenance, with follow‐ups of 16–26 years; the yearly cost of maintaining a tooth was estimated in 20.2 euro (Fardal & Grytten, 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fardal & Grytten, 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Those affected with potential conflict of interest abstained from vote in the specific recommendations following the required processes for S3 level clinical practice guideline.

    “Those affected with potential conflict of interest abstained from vote in the specific recommendations following the required processes for S3 level clinical practice guideline.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Individual potential conflict of interest forms were completed by all participants and are available on file at the European Federation of Periodontology and extracted in the Supporting Information.

    “Individual potential conflict of interest forms were completed by all participants and are available on file at the European Federation of Periodontology and extracted in the Supporting Information, available online (Final Guideline‐Supporting Information_Potential conflict of interests).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Workshop participants filed detailed disclosure of potential conflict of interest relevant to the workshop topics, and these are kept on file.

    “Workshop participants filed detailed disclosure of potential conflict of interest relevant to the workshop topics, and these are kept on file.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The application of this S3 Level Clinical Practice Guideline will allow a homogeneous and evidence‐based approach to the management of Stage I-III periodontitis.

    “The application of this S3 Level Clinical Practice Guideline will allow a homogeneous and evidence‐based approach to the management of Stage I–III periodontitis.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Implementation of the new classification of periodontitis should facilitate the use of the most appropriate preventive and therapeutic interventions, depending on the stage and grade of the disease.
196 of 196

  • The paper relies on this without support.

    Periodontitis is preventable and treatable in the majority of cases.

    “If untreated, it may lead to tooth loss, although it is preventable and treatable in the majority of cases.”

  • The paper relies on this without support.

    Untreated or inadequately treated periodontitis leads to the loss of tooth-supporting tissues and teeth.

    “Untreated or inadequately treated periodontitis leads to the loss of tooth‐supporting tissues and teeth.”

  • The paper relies on this without support.

    There is a need for evidence-based clinical guidelines providing recommendations to treat periodontitis.

    “There is, therefore, a need for evidence‐based clinical guidelines providing recommendations to treat periodontitis.”

  • The paper relies on this without support.

    The first step of therapy is insufficient to treat a periodontitis patient.

    “Although this first step of therapy is insufficient to treat a periodontitis patient, it represents the foundation for optimal treatment response and long‐term stable outcomes.”

  • The paper relies on this without support.

    The first step of therapy represents the foundation for optimal treatment response and long-term stable outcomes.

    “Although this first step of therapy is insufficient to treat a periodontitis patient, it represents the foundation for optimal treatment response and long‐term stable outcomes.”

  • The paper relies on this without support.

    Full-mouth treatment protocols have systemic implications (e.g., acute systemic inflammatory response).

    “Clinicians should be aware that there is evidence of systemic implications (e.g. acute systemic inflammatory response) with full‐mouth protocols.”

  • The paper relies on this without support.

    Weight loss interventions may improve both the treatment and long-term outcome of chronic non-communicable diseases.

    “Available evidence suggests that weight loss interventions may improve both the treatment and long‐term outcome of chronic non‐communicable diseases.”

  • The paper relies on this without support.

    There is an additional cost associated with the use of statins that is borne by the patient.

    “There is an additional cost associated with the use of statins that is borne by the patient.”

  • The paper relies on this without support.

    SDD is not approved or available in some European countries.

    “SDD is not approved or available in some European countries.”

  • The paper relies on this without support.

    The statin formulations included in the systematic review are off-label and an approved formulation with appropriate good manufacturing practice quality control and patient safety validation is not available.

    “The statin formulations included in the systematic review are “off‐label” and an approved formulation with appropriate good manufacturing practice quality control (Good Manufacturing Practice, GMP) and patient's safety validation is not available.”

  • The paper relies on this without support.

    Periodontitis is an inflammatory disease in which altered immune-inflammatory responses to a dysbiotic biofilm drives connective tissue destruction and bone loss.

    “Periodontitis is an inflammatory disease in which altered immune‐inflammatory responses to a dysbiotic biofilm drives connective tissue destruction and bone loss.”

  • The paper relies on this without support.

    Long-term use of systemic NSAIDs carries a well-known risk of unwanted side effects.

    “Long‐term use of systemic NSAIDs carries a well‐known risk of unwanted side effects, which raises concerns over their use as adjuncts to subgingival instrumentation.”

  • The paper relies on this without support.

    The metformin formulation included in the systematic review is off-label and an approved formulation with appropriate quality control (GMP) and patient safety validation is not available.

    “The metformin formulation included in the systematic review is “off‐label” and an approved formulation with appropriate quality control (GMP) and patient safety validation is not available.”

  • The paper relies on this without support.

    Systemic antibiotic regimens have shown long lasting impact on the faecal microbiome, including an increase in genes associated with antimicrobial resistance.

    “Systemic antibiotic regimens have shown long lasting impact on the faecal microbiome, including an increase in genes associated with antimicrobial resistance.”

  • The paper relies on this without support.

    Optimal management of Stage III and Stage IV periodontitis remains limited in most health systems with significant inequalities in availability and access to advanced/specialist periodontal care.

    “Optimal management of Stage III and Stage IV periodontitis remains limited in most health systems with significant inequalities in availability and access to advanced/specialist periodontal care.”

  • The paper relies on this without support.

    Multiple RCTs on surgical periodontal intervention have shown a dose-dependent effect of plaque control on healing outcomes.

    “Multiple RCTs on surgical periodontal intervention have shown a dose‐dependent effect of plaque control on healing outcomes.”

  • The paper relies on this without support.

    Plaque scores smaller than 20%–25% have been consistently associated with better surgical outcomes.

    “Plaque scores smaller than 20%–25% have been consistently associated with better surgical outcomes (see Step 1 and SPC clinical recommendations for detailed discussions on how to facilitate achieving stringent levels of self‐performed oral hygiene).”

  • The paper relies on this without support.

    BP gel formulations are off-label and an approved formulation with appropriate quality control (GMP) and patient safety validation is not available.

    “It is important to note that BP gel formulations are “off‐label” and an approved formulation with appropriate quality control (GMP) and patient safety validation is not available.”

  • The paper relies on this without support.

    Only few classes of regenerative materials are registered in Europe.

    “It is important to emphasise that only few classes of regenerative materials are registered in Europe.”

  • The paper relies on this without support.

    Regenerative surgery is more expensive than access flap surgery but cheaper than tooth replacement necessary as a consequence of tooth loss.

    “Regenerative surgery is more expensive than access flap surgery but cheaper than tooth replacement necessary as a consequence of tooth loss.”

  • The paper relies on this without support.

    The use of regenerative materials for medical reasons is generally acceptable and has been approved by religious leaders.

    “While the use for medical reasons is generally acceptable and has been approved by religious leaders, the sensitivity of individual subjects may pose a barrier.”

  • The authors state this as an assumption.

    The perception is that regenerative therapies to promote tooth retention are preferred over tooth extraction (and replacement) or open flap debridement.

    “The perception is that regenerative therapies to promote tooth retention are preferred over tooth extraction (and replacement) or open flap debridement.”

  • The paper relies on this without support.

    There is a moderate risk of trauma due to the use of interdental brushes or flossing when not used properly.

    “There is a moderate risk of trauma due to the use of interdental brushes, when not used properly.”
    “There is a moderate risk of trauma due to the use of interdental brushes or flossing, when not used properly.”

  • The paper relies on this without support.

    Patients with open interdental spaces prefer the use of interdental brushes over the use of dental floss.

    “There is clinical evidence supporting that patients with open interdental spaces prefer the use of interdental brushes over the use of dental floss.”

  • The paper relies on this without support.

    No adverse effects of other interdental cleaning devices have been reported up to now.

    “Up to now no adverse effects have been reported.”

  • The paper relies on this without support.

    Rubber/elastomeric cleaning sticks and oral irrigators are highly accepted by patients.

    “Rubber/elastomeric cleaning sticks are highly accepted by patients as are oral irrigators.”

  • The paper relies on this without support.

    Both dentifrices and mouth rinses are widely accepted by the population.

    “Both dentifrices and mouth rinses are widely accepted by the population.”

  • The paper relies on this without support.

    Implementation of the new classification of periodontitis should facilitate the use of the most appropriate preventive and therapeutic interventions, depending on the stage and grade of the disease.

    “Implementation of the new classification of periodontitis should facilitate the use of the most appropriate preventive and therapeutic interventions, depending on the stage and grade of the disease.”
28 of 28

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Non-surgical periodontal therapy (NSPT) primarily consists of subgingival scaling and root surface debridement to eliminate calculus and supra/subgingival biofilm, and is the gold-standard treatment for Stages I-III periodontitis.

    “Non-surgical periodontal therapy (NSPT) primarily consists of subgingival scaling and root surface debridement to eliminate calculus and supra/subgingival biofilm [26], which is the gold-standard treatment for Stages I–III periodontitis [25].”

    From Effect of non-surgical periodontal therapy on risk markers of cardiovascular disease: a systematic review and meta-analysis (2024) · cites this paper as [25]

    The guideline’s ‘Sequence for the treatment of periodontitis stages I, II and III’ recommends subgingival instrumentation for all periodontitis patients, and recommendation R2.1 strongly recommends it to treat periodontitis (page numbers unavailable). But the guideline describes it as one step in an incremental treatment pathway, with further treatment when needed; it does not designate non-surgical therapy the ‘gold-standard treatment’ for all three stages. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conflicting treatment thresholds for a bleeding 4 mm pocket

    Minor

    One passage permits a 4 mm pocket with bleeding under its stated endpoint, while another identifies a bleeding pocket of 4 mm or greater as needing third-step treatment.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. German Association of the Scientific Medical Societies (AWMF), 2012, AWMF Guidance manual and rules for guideline development
  2. International Committee of Medical Editors, ICMJE Form for disclosure of potential conflicts of interest
  3. IQWiG, 2016, Präferenzmessung bei Parodontopathien

Cited by

Sorted by citations

Related

Authors
Sanz, M., Herrera, D., Kebschull, M., Chapple, I., Jepsen, S., Berglundh, T., Sculean, A., Tonetti, M. S., & Consultants, E. W. P. A. M.
Affiliations
  • Universidad Complutense de Madrid (ES)
  • Birmingham Community Healthcare NHS Trust (GB)
  • University Hospital Bonn (DE)
  • University of Gothenburg (SE)
  • University of Bern (CH)
  • Shanghai Jiao Tong University (CN)
Corresponding author
Sanz, Mariano
ORCID
Venue
Journal of Clinical Periodontology
Publisher
Wiley
Published
2020-07
Volume
47
Issue
S22
Pages
4-60
ISSN
  • 0303-6979 (ISSN-L)
  • 1600-051X
DOI
10.1111/jcpe.13290
PMC
PMC7891343
OpenAlex
W3021393259
Semantic Scholar
eb797f69e6c9b73882b7f08d87fdf5c082ce8f8e
Cited by
1,934
References
121
Citations by year
2026: 424 · 2025: 506 · 2024: 326 · 2023: 283 · 2022: 208 · 2021: 154 · 2020: 29 · 2013: 1 · 2012: 1
FWCI
172.13
Type
journal article
Language
en
Update notices
correction (2020-12-28)
Open access
Licence
Locations
  • Journal Of Clinical Periodontology (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, other-oa)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion)
  • Discovery Research Portal (University of Dundee) (submittedVersion, cc-by-nc-nd)
  • UCL Discovery (University College London) (submittedVersion)
  • Lirias (KU Leuven) (submittedVersion)
  • ORBi (University of Liège) (submittedVersion, other-oa)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
  • Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by-nc)
  • Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, cc-by-nc)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Funders
  • European Federation of Conservative Dentistry
  • Geistlich Pharma
Topics
  • Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Medicine › Urology › Periodontal Regeneration and Treatments
Keywords
periodontitis, periodontitis treatment, stepwise treatment, supragingival plaque, gingivitis, risk factor control, subgingival instrumentation, adjunctive therapy, periodontal surgery, supportive periodontal care
MeSH terms
Germany, Gingivitis, Humans, Periodontics, Periodontitis, Health Behavior

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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