Perio Prognosis Flashcards
What is prognosis?
The prediction of probable course, duration, and outcome of a disease based on general knowledge of pathogenesis and presence of risk factors.
When is prognosis established?
After diagnosis and before treatment
What factors are taken into account for prognosis to be made?
It is based on disease information
Practitioners experience
Prediction of course and outcome of the disease
What factors determine the prognosis?
Overall clinical factors:
Age
Disease severity
Plaque control
Patient compliance
What determines individual teeth prognosis?
Local factors: Plaque and calculus and subgingival restorations
Anatomical factors: Short tapered roots, cervical enamel projections, enamel pearls, root concavities, developmental grooves, root proximity, and furcation involvement.
Tooth mobility
What factors determine the prognosis of prosthetic and restorative structures?
Abutment selection (Resting surfaces adjacent to restoration)
Caries
Nonvital teeth
Root resorption
What tooth related factors determine the prognosis of the tooth?
Probing depths
Attachment loss
Crown:root ratio
Tooth position
What factors should be taken into account during the intiial assessment?
Patient expectation
Treatment expectation (Long term prognosis and goals of treatment)
Aesthetics (Price of smile and aesthetics demand)
Finances (Patient’s financial status)
Compliance (Maintenance and long term stability)
How is the severity of periodontal disease assessed?
Pocket depth
Tooth mobility (Tooth survival influenced negatively by mobility)
Periodontal abscess (Repeated means hopeless prognosis)
Bone loss (severity of the disease %)
Bone defect (Angular vs horizontal bone loss)
How is furcation loss assessed for tooth preservation?
Horizontal involvement (class I, II, and III)
Interproximal bone loss (Vertical involvement and regenerative potential)
Root anomalies (Enamel projections, pearls, and grooves)
Root resection (Associated to finances but cheaper to fix than using implants)
What are the aetiological factors that need to be considered when assessing prognosis?
Presence of calculus (explain association to disease)
Surgery bone dimensions (thin or thick bone relation and susceptibility to recession)
Periodontal treatment (Stop progression of bone loss, response, and SPT)
Root proximity (At least 0.8mm of residual bone)
Root canal therapy (Long term survival and restorative options)
What are the restorative factors that need to be assessed when assessing prognosis?
Faulty restorations (condition of the tooth)
Caries extension (tooth restorability)
Crown:root ratio (remaining amount of tooth support)
Post core and crown (Long survival of teeth if less restorative needs. More needs, more chances of failure)
What other determinants can affect prognosis?
Smoking (major risk factor for perio)
Systemic conditions (Controlled or not diabetes, HIV, anaemia, Leukemia, etc)
Use of bisphosphonates (IV or oral)
Clinicians skills (ability and experience in treating disease)
How can overall prognosis be assessed?
Evaluate social and medical history
Complete perio examination
Opinion of periodontal health should be made
Distribution and severity of disease assessed
Local factors amount vs disease
Attachment loss vs age
Plaque control and compliance
What are the levels of prognosis?
Excellent
Good prognosis
Fair prognosis
Poor prognosis
Questionable prognosis
Hopeless prognosis
