L6 - risks Flashcards
problem solving requires?
requires a DIAGNOSIS and a PROGNOSIS and a calculation of risk –> leads us to a silution
impact of prognosis
understanding gives us a way to EVALUATE TREATEMTN ALTERNATIVES
we dont selct treamtnet that we know will lead to a bad outcome
prognosis determine which procedure has best probability to be successful
components of ‘cost’ with decisions in tx
financial time, discomfort, and biologic
providers prognosis can be broken down into
understanding therapeutic prognosis
understanding therapeutic potentials
knowledge of the literature
experience
operators skills
diagnosis definition
the process of identifying and understanding the nature of a PROBLEM or disease
prognosis defintition
a prediction of the course and outcome
estimate for recovery from a condition or for success of a therapy
risk definition
exposure to loss / the potential of gaining or losing something of value
intentional interaction with uncertainty/ adverse outcome
prognosis gives what to the patient
gives them a measure of the possible outcome for a treatment helping them to decide how they wish to proceed
*always a financial, time, discomfort, and biologic cost when treatment decisions are made
patient variables that ‘mess with prognosis’
perception of patient
look at their individual teeth
establish overall picture and a sense of outcomes with the patient
risk factors examples
heredity
systemic disease or condition (CA,DM)
diet
behavior
stress or environment (anxiety, smoking)
trauma or functional conditions (bruxism)
providers skills and nowledge
perception
list of options for periodontal therapy
maintenance
scaling and root planing
pocket reduction /elimination
furcation therapy
one defects and regeneration of lost bone
crown lengthening procedures
which factors usually outnumber
patient factos > factors associated with dentistry in terms of success of therapy / prgonosis / risk factors
scaling and root planing elieved to be preventative?
No - according to the insurance codes
definition of prophylaxis D1110 CDT-4
a PROPHYLAXIS refers to scaling and polishing of the teeth in order to PREVENT oral diseases
for adult patients in a HEALTHY ORAL STATE as well as ANY CONDITION OTHER THAN ACTUAL PERIODONTAL DISEASE WITH BONE LOSS
patient has D4910 means what?
they had previous diagnosis of peridontal disease and this is a perio MAINTENANCE program now
POST THERAPEUTIC PROCEUDRE
“following periodontal therapy”
“SITE SPECIFIC SCALING AND ROOT PLANING WHERE INDICATED, AND POLISHIN THE TEETH”
D1110?
intended to CONTROL LOCAL IRRITATIONAL FACTORS
– considered maintenance and is for the removal of plaque, calculus, and stains from a tooth structure in permanent and transitional dentition WITH NO SIGNS AND SYMPTOMS OF PERIO DISEASE
code for prophylaxis
D1110
code for perio maintenance
D4910
code for scaling and root planing
D4341
root planing involves? / describe
scaling the tooths ROOT
removal of deposits on root surfaces / detoxifying the root surface
risks / consequences of SRP
appearance changes
crown margin exposure
exposed root surfaces
pain / sensitivity
does D04910 work?
if prognosis was good in beginning – tx does help / tx was successful but if INITIAL PROGNOSIS WAS LESS THAN GOOD – then success rate droped to 40%
risk associated with perio therapy
risk = clinical SIGNS OF DISEASE ACTIVITY PERSITING following thorough mechanical therapy , such as increased pocket depths, loss of attachment and bleeding on probing
pocket reduction / elimniaton/ surgical approach ?
removal of deposits on root surfaces / detoxify root surface and reshape the bone to aid in self healing – usually involves making a flap and recontouring
– IMPOSSIBLE TO PREDICT SURVIVAL OF PERIO COMPROMISED TOOH
prognosis of perio compormised?
impossible to predict if prognosis is less than good – and those used as removable partial denture abutments had an increased risk of tooth loss
furcation therapy treatment choices
- maintenance
- regeneration
- resection
prognosis of maintenance on furcation invlovlemt
IMPOSSIBLE – presence of furcation involvment renders complete plaque and calculus removal IMPOSSIBLE
regeneration furcation defects in decreasing predictability
- maxillary or mandibular BUCCAL class II
- maxillary mesial or distal class II (harder to access)
- maxillary or mandibular class III
failure in posterior roots most likely one?
DB root
regenerating infraabony defects and listt in decreasing predictability
three wall — two wall — one wall (nothing to hold graft material into place)
can i resort to CLP to save a restorative situation of inadequate toth structure?
need to do RISK ANALYSIS
look at amount of tooth structure that is NOT furcated
success / mean survival of primary endo tx and implant tx
primary endo – 86% and implant 90.9%
risk does not end at the RTC procedure?
TRUE – need foundatinoal restorations too
- like cores
- cores and prefab posts
- cast post and cores
T/F may remove more tooth structure with pre-fab post and core?
true
ferrule needs to be
1.5 to 2mm 360 around the tooth
ferrule does what
reduces the potential for
- root fracture
- post fracture
- post dislodgment
- failure of cement seal of artificial crown
if post length isnt correct you create?
leverage –
implicatino if post is 1/4 length of crown
force on crown is multiplied by factor of 4
(if crown is double the length of the post – the force of the crown is doubled in the root)
if the ratio is 1:1 the force is equal
explain anterior teeth and their need / not need for post /core
anterior teeth with excessive loss of coronal tooth structure usually NEED A POST b/c the pulp chamber and single canal are generally NOT ADEQUATE TO RETAIN A CORE , anterior teeth are subject to LATERAL FORCES during function
failures of fiber reinforced usually seen where?
in ther periapical area
and also debonding of the posts mainly by failure in cementation or during removal of temporary restorations
primary concern with fiber posts
whether they ALLOW MOVEMENT of the core during function or parafunction
main relevant factor in longevity of post and core
REMAINING DENTIN AFTER PREP / FERRULE – not necessarily the type of post and core
costs (6 categories)
- biologic
- therapeutic
- like options (implant vs 3 unit bridge) - esthetic
- financial
- temporal
- psychological
what should you consider when look into crown lengthen to restore a tooth?
crown lengthen procedure will remove bone that could be kept to support an implant and the ridge and not compromise the canine
treatment choices are bases on? ** impacted by?
PROGNOSIS and RISK ASSESSMENT
which are impacted by - therapeutic $ and biologic cost -pain / degree of discomfort - time - self image
