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Recent guidelines have been developed by the European Federation of Periodontology (EFP) and adoloped by the British Society of Periodontology to provide evidence-based guidance for clinicians in the UK to deliver periodontal therapy. To ensure the guidelines are as robust as possible the process of development is carefully structured. This article explores the background behind S3-level guidance for the treatment of periodontitis. CPD/Clinical Relevance: Understanding the process behind guideline formulation allows clinicians to apply them appropriately and confidently within their clinical practice. [ABSTRACT FROM AUTHOR]

Background: The ESE previously published quality guidelines for endodontic treatment in 2006; however, there have been significant changes since not only in clinical endodontics but also in consensus and guideline development processes. In the development of the inaugural S3‐level clinical practice guidelines (CPG), a comprehensive systematic and methodologically robust guideline consultation process was followed in order to produce evidence‐based recommendations for the management of patients presenting with pulpal and apical disease. Aim: To develop an S3‐level CPG for the treatment of pulpal and apical disease, focusing on diagnosis and the implementation of the treatment approaches required to manage patients presenting with pulpitis and apical periodontitis (AP) with the ultimate goal of preventing tooth loss. Methods: This S3‐level CPG was developed by the ESE, with the assistance of independent methodological guidance provided by the Association of Scientific Medical Societies in Germany and utilizing the GRADE process. A robust, rigorous and transparent process included the analysis of relevant comparative research in 14 specifically commissioned systematic reviews, prior to evaluation of the quality and strength of evidence, the formulation of specific evidence and expert‐based recommendations in a structured consensus process with leading endodontic experts and a broad base of external stakeholders. Results: The S3‐level CPG for the treatment of pulpal and apical disease describes in a series of clinical recommendations the effectiveness of diagnosing pulpitis and AP, prior to investigating the effectiveness of endodontic treatments in managing those diseases. Therapeutic strategies include the effectiveness of deep caries management in cases with, and without, spontaneous pain and pulp exposure, vital versus nonvital teeth, the effectiveness of root canal instrumentation, irrigation, dressing, root canal filling materials and adjunct intracanal procedures in the management of AP. Prior to treatment planning, the critical importance of history and case evaluation, aseptic techniques, appropriate training and re‐evaluations during and after treatment is stressed. Conclusion: The first S3‐level CPG in endodontics informs clinical practice, health systems, policymakers, other stakeholders and patients on the available and most effective treatments to manage patients with pulpitis and AP in order to preserve teeth over a patient's lifetime, according to the best comparative evidence currently available. [ABSTRACT FROM AUTHOR]

Background: The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy. Aim: To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss. Materials and Methods: This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders. Results: The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III. Conclusions: The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication. [ABSTRACT FROM AUTHOR]

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Members of the interleukin (IL)-12 family constitute subunits of IL-12, -23, and -27. These ILs represent pivotal mediators in the regulation of cell-mediated immune responses and in animal models of human inflammatory bowel disease. Recent work has suggested that intestinal endothelial cells might serve as a second fine of defense in bacterial sensing of invading pathogens. The purpose of this study was to examine the production of IL-12 family members in intestinal endothelial cells (HIMEC). HIMEC were stimulated with proinflammatory agents (TNF-[alpha], IFN-[gamma], IL-[beta]) and microbial antigens [LPS, lipoteichoic acid, peptidoglycan, CpG-DNA, flagellin, poly(I:C)]. Expression of IL-12 family members and of Toll-like receptor (TLR)3 in HIMEC was assessed by real-time RT-PCR, immunostaining, flow cytometry, and immunoblot analysis. HIMEC display an induction of Epstein-Barr virus-induced gene 3 (EBI3), IL-12p35, and IL-23p19, whereas no expression of IL-12p40 and IL-27p28 was detectable. The strongest induction was induced by proinflammatory factors known to utilize the NF-[kappa]B pathway, and expression of EBI3 and IL-23p19 was diminished by an NF-[kappa]B inhibitor. HIMEC display regulated expression of TLR3. Adhesion and transmigration assays showed proinflammatory responses after HIMEC stimulation. HIMEC are capable of producing IL-12 family members as a response to microbial stimuli. The TLR3 agonist, poly(I:C), was shown to enhance leukocyte adhesion in vitro in HIMEC. Our data suggest that the intestinal microvasculature is responsive to ligands of TLR3 expressed on intestinal endothelial cells, thereby adding to the regulation of adaptive immunity and leukocyte recruitment. Epstein-Barr virus-induced gene 3; inflammatory bowel disease; Toll-like receptor 3

The objective of this study was to quantitatively determine ridge contour changes after different alveolar ridge preservation techniques. An initial total of 40 patients provided a final total of 35 single-gap extraction sites. After tooth removal, the socket was subjected to one of four treatment modalities: placement of a deproteinized bovine bone mineral (DBBM; Endobon) covered with a soft tissue punch from the palate (Tx1); placement of DBBM without soft tissue punch (Tx2); placement of an adsorbable collagen membrane (Osseoguard) covering the DBBM (Tx3); and no additional treatment (control). Silicone impressions were obtained before and 6 months after tooth extraction for quantitative-volumetric evaluation on stone cast models. Bone quality and need for further bone augmentation were also noted. Tx1 and Tx3 resulted in significantly less bucco-oral tissue loss when compared to Tx2 and the control group. Premolar teeth and teeth extracted for traumatic reasons revealed significantly less tissue loss. Using barrier membranes or soft tissue punches in addition to placement of DBBM seems to be advantageous to limit bucco-oral tissue atrophy. The clinical benefit, however, is still questionable. [ABSTRACT FROM AUTHOR]