UK Implementation of 'Treatment of Stage IV Periodontitis: The EFP S3-Level Clinical Practice Guideline’ – Rehabilitation of Severe Periodontitis Patients

Objectives
To adapt the supranational European Federation for Periodontology (EFP) S3-Level Clinical Practice Guideline for treatment of very severe periodontitis (stage IV) to a UK healthcare environment, considering views of a broad range of stakeholders, and patients.

Sources
This UK version is based on the supranational EFP guideline published in the Journal of Clinical Periodontology. The source guideline was developed using the S3-level methodology, combining assessment of formal evidence from 13 systematic reviews with a moderated consensus process of a representative group of dental discipline stakeholders, accounting for health equality, environmental factors and clinical effectiveness. This guideline encompasses 47 clinical recommendations for the treatment of stage IV periodontitis, based on a step-wise process mapped to the 2018 periodontal and peri-implant diseases and conditions classification and UK classification implementation.

Methodology
The UK version was developed from the source guideline using a formal process called the GRADE ADOLOPMENT framework. The adoption allows (unmodified acceptance) adaptation (acceptance with modifications) and the de novo development of clinical recommendations. Using this framework and following the S3-process, the underlying evidence was updated and a representative guideline group of 101 delegates from 19 stakeholder organisations was assembled into three working groups. Following the formal S3-process, all clinical recommendations were formally assessed for their applicability to the UK and adoloped accordingly.

Results and Conclusion
Using the ADOLOPMENT protocol, a UK version of the EFP S3-level Stage IV clinical practice guideline was developed. This guideline delivers evidence- and consensus-based clinical recommendations of direct relevance to the UK dental community.

Clinical Significance.
The aim of this S3-level guideline is to combine the evaluation of formal evidence, grading and synthesis with clinical expertise of a broad range of stakeholders. Herein, the second major international S3-level guideline in dentistry, the EFP guideline, was implemented for direct clinical applicability in the UK healthcare systems.