Periodontal Prognosis: To Extract or not?? Flashcards
What kind of teeth have questionable prognosis?
Teeth that have 50 - 70% bone loss
Grade 2 furcation involvement
What kind of teeth have hopeless prognosis?
> or = 70% bone loss
Grade 3 furcation involvement
How accurate are we at determining the prognosis of periodontally compromised teeth?
According to Mcguire 1991 and 1996 the good prognosis category is the only group which was consistently correct.
If a category shift is made it most frequently changes to a better prognosis.
Overall accuracy at 8 years nearly 35%
The traditional approach for assigning prognoses is ineffective for teeth with an initial prognosis of less than good.
Are we too hasty to make a decision to extract?
Splieth 2002 showed that the majority of teeth were extracted at an attachment level of 50 - 70%.
The threshold for periodontal extractions seems to be too low and so there is a call for an improvement in knowledge of periodontal diagnosis and treatment.
How should periodontally compromised single root teeth or periodontally compromised teeth without furcation involvement be managed?
Always start with non-surgical periodontal debridement + OH. Regardless of the level of periodontitis. (The most conservative treatment)
Periodontal surgery: Open flap debridement and periodontal regeneration.
endo-perio: RCT -> Debridement -> reassess after 3 months -> remedicate -> after 3 months check and remedicate if no healing -> After 3 months check and extract if no healing.
What is a combined endo perio lesion? How can we determine prognosis?
Concurrent endodontic and periodontic diseases with communication
Concurrent diseases that communicate have the worst prognosis
However, prognosis cannot be easily determined until after initial endodontic and periodontal treatment have been provided
How are endo-perio lesions with communication treated?
Commence endo treatment first
Intra-canal medication
Non-surgical root planing and OHI
3 months review - Favourable response: Assess perio healing.
Unfavourable response: Root canal system re-medicated + perio surgery then wait 3 months and if favourable finish RCT. If unfavourable re medicate if still not favourable after 3 months extract.
How should periodontally compromised multi root teeth with furcation involvement be managed?
Non-surgical debridement.
Open flap debridement + Perio regeneration (Guided tissue regeneration (membrane used) regenerate the bone at the furcation)
Tunneling (exaggerate the furcation so that patient can clean it more easily)
In endo-perio lesions involving combined endo-perio lesions; Root resection is indicated.
What is the purpose of management methods of multi-rooted teeth with furcation involvement?
Creating a cleansable anatomy:
Close furcation (regeneration)
Exaggerate the furcation (Tunneling)
Eliminate the furcation (Root resection)
What factors affect success of periodontal treatment in periodontally compromised teeth?
Non-smokers
Medically fit and well
Good plaque control
Good compliance to supportive periodontal therapy
when are teeth extracted?
Unrestorable teeth
Concurrent endo-perio disease with communication + grade III mobility
Inaccessible or non-functional third molars
Why is saving a tooth with questionable prognosis a better idea than an implant?
Implants are not without complications: Mechanical complications and biologic complications
Implants are more expensive than tooth-retaining periodontal treatments. Retreatment for peri-implantitis is also very expensive. (regardless of degree of furcation involvement)
Survival rate of teeth following perio treatment is identical to implants
What complications could arise from using implants?
Biologic:
Peri-implant mucositis
Peri-implantitis
Why are peri-implant complications important to consider when choosing between extracting and not extracting a periodontally compromised tooth?
Peri-implant diseases are very common (Peri-implant mucositis 19 - 65% and peri-implantitis 1 - 47%)
More aggressive than periodontitis
Too complicated to manage peri-implant diseases
When should implants be used ideally?
If teeth are already missing.
Teeth that are present and indicated for extraction.
