13 - Diagnosis, Prognosis, and Treatment Planning Flashcards
What are the critical PDs?
Lindhe
Exam after active therapy, finding the balance between LOA or CAL gain
SRP - 2.9mm
MWF - 4.2mm
Poor plaque, the critical PD is higher
What do we know about furcation arrows?
In a skull study, advanced bony defects increased the incidence of visible furcation arrows. There was no difference between degree 1/control while degree 3 furcations had a furcation arrow >50% of the time. Not useful for buccal furcations (HARDEKOPF).
The analysis of furcation arrows is (DEAS) Sensitivity 39% Specificity 92% PPV 81% NPV 75%
What can be said about retaining or treating hopeless teeth?
When retaining hopeless teeth, without periodontal treatment the retained tooth leads to greater bone loss on the adjacent tooth than if the tooth was extracted (MACHTEI). With periodontal treatment (OFD), there was no detrimental effect on adjacent teeth but the extracted sites did have better bone gain (1.5% vs 11.5%) (MACHTEI). In another study, retained and treated periodontally hopeless teeth do not affect the adjacent periodontium over 8 years (WOJCIK). For extraction of hopeless teeth, the periodontal status of the adjacent teeth can be improved beyond what can be achieved by scaling and root planing alone (GRASSI)
What can be said about pathologic migration?
The prevalence of pathologic migration has been seen as 33% (GREENSTEIN) or 30-56% (BRUNSVOLD). Tooth position determined by the forces of the tongue/cheek/lips together with the forces of the periodontal tissues are the most important factors. Treatment includes spontaneous realignment following treatment of inflammation as well as periodontal/orthodontic/prosthodontic therapy.
What increases the probability of pathologic migration?
Martinez-Canut
Bone loss, 3-8x PTM
Describe the McGuire prognosis system
Based on TOOTH SURVIVAL. 5 years after NST/surgery/maintenance, the good prognosis was the only group with consistently correct projections. Fair/poor generally improved while questionable improved or were lost. Decreased likelihood of improvement is associated with high initial PD, more severe furcation invasion, mobility, malposition, and smoking. After 16 years, factors associated with tooth loss are teeth with greater than average initial PD and bone loss, higher degree of FI and mobility, unsatisfactory C/R ratio, parafunctional habits, fair to poor oral hygiene, and smoking.
Describe the Kwok & Caton system
Proposed plan with periodontal treatment and maintenance based on the probability of disease progression or the stability of periodontal supporting tissues. Factors affecting classification are maintenance compliance, DM, smoking, deep PD, plaque retentive features, TFO, parafunctional habits, and mobility.
Local factors are PD, root form/number, plaque retentive factors/calculus, furcation invasion, mobility, severity of CAL, trauma from occlusion, and parafunctional habits
Subject level factors are smoking, DM, neutrophil dysfunction, LAD, compliance with maintenance, systemic disease, dental history, glycemic control
Explain some prognosticating studies.
When prognosticating molars, one retrospective study found that with NST/OFD/root resection after 18 years the risk of molar loss was associated with FI-3, bone loss >50%, mobility, maxillary molars, and increasing PD (GRAETZ). In a SR MA with periodontal treatment, tooth loss was affected by degree of furcation invasion (1 8%, 2 18%, 3 30%). Therefore, even degree 3 molars had 70% survive over 15 years. (NIBALI). In teeth without treatment in a SHIP study, molars extractions were associated with greater initial PD/CAL, more severe furcation invasion, and irregular periodontal therapy (NIBALI). Molars with grade 1 furcation invasion have same prognosis as no furcation invasion (ROSS & THOMPSON or SALVI)
Talk about when we see radiographic lesions.
Radiographically, lesions will be seen when there is perforation of the cortex, erosion from the inner surface of the cortex, and extensive erosion or destruction/erosion from the outer surface. Extensive bone destruction, especially of the cancellous bone, may be present even when there is no radiographic evidence. (BENDER & SELTZER)
What are the #’s associated with radiographic calculus?
Sensitivity 43%
Specificity 92%
PPV 92%
NPV 46%
Buchanon
Is linear estimation of a root surface good?
When looking at a radiograph on an implant, linear estimation of supported root surface area overestimates supported ratios and makes remaining tooth support seem better than it actually is (CHEN 2004)
How should we handle third molar extractions and second molars?
Un-erupted 3rd molars can have a negative effect on adjacent teeth such as root resorption of 2M (24%) and is related to <75% bony support, apical position of the 3M on the 2M, and increased age (NEMCOVSKY).
After extraction, a deep residual PD on the 2M is associated with a mesio-angular impaction, pre-extraction crestal radiolucency, and inadequate post-extraction local plaque control (KAN)
At the time of 3M extraction, SRP on 2M-distal after extraction of erupted 3M ensures healing of the periodontal lesion and aids in plaque control and maintenance to improve clinical parameters (FERREIRA, LEUNG)
Will treated vertical defects affect adjacent bone heights?
When there is a vertical defect that is treated with OFD and maintenance, progressive bone resorption is localized to the deep-side of an early angular defect. Therefore, the deep side of a proximal angular defect does not pose a threat to the adjacent shallow side (HEINS)
As well, a radiographic crestal lamina dura in angular or horizontal defects is associated with clinical periodontal stability up to 24 months (RAMS)
