# Next-Generation S3-Level Clinical Practice Guidelines in Periodontology: Methodology, Current Evidence, and Future Directions

## TL;DR

This paper reviews current periodontology guidelines and suggests improvements to address gaps in complex cases and new technologies.

## Contribution

Proposes a roadmap for next-generation S3-level periodontal guidelines integrating emerging technologies and patient-centered care.

## Key findings

- Current S3 guidelines lack coverage of stage IV periodontitis and peri-implant diseases.
- Emerging areas like AI and biomarkers are not systematically included in existing guidelines.
- Future guidelines should prioritize precision diagnostics and real-world implementation strategies.

## Abstract

Background: S3-level clinical practice guidelines represent the highest standard of evidence-based healthcare, integrating systematic reviews, formal evidence grading, and structured expert consensus. In periodontology, current S3-level guidelines provide robust recommendations for the management of stage I–III periodontitis. However, increasing clinical complexity, emerging diagnostic technologies, and the need for patient-centred and implementation-oriented care highlight important gaps that warrant further methodological refinement. Objective: This review aims to critically appraise the conceptual foundations, strengths, and limitations of existing S3-level periodontal guidelines and to propose a structured roadmap for the development of next-generation S3 guidance. Methods: A narrative and methodological review was conducted focusing on key European S3-level guidelines in periodontology and endodontics, with emphasis on guideline methodology, evidence grading, outcome prioritization, and consensus processes. Results: Current S3-level periodontal guidelines demonstrate strong methodological rigor but show limited coverage of stage IV periodontitis, peri-implant diseases, and endo–perio lesions. In addition, emerging domains such as biomarker-based diagnostics, artificial intelligence-assisted decision support, and implementation science are not yet systematically integrated. Conclusions: Future S3-level periodontal guidelines should incorporate clinical complexity, patient-reported outcomes, precision diagnostics, digital technologies, and real-world implementation strategies to enhance personalization, transparency, and clinical impact.