Prognosis Flashcards
What is Prognosis?
a forecast of probable outcomes of disease based on the esperience of a large number of other patients with similar disease progression
What are the most relevant tooth-related factors for loss of molars?
Class III furcations, advanced bone loss (>60%), endodontic treatment. However 63% of molars with class III furcation involvement were still present after 10 years, mean survival of 11.8 years.
In Miller et al study smoking was the most important prognostic factor, more than PPD, mobility, age, or furcation involvement
What amount of tooth loss is expected if no compliance with maintenance?
0.36 teeth lost per year with no treatment
0.22 teeth lost per year with treatment but no maintenance
0.11 teeth lost per year with treatment and maintenance
McGuire and Nunn classification of prognosis
80% accuracy over 5-8 years in assessing tooth loss, however if you eliminate teeth with a good prognosis it is less than 50% accurate.
How much time is indicated by short and long term prognosis?
short term is fewer than 5 years, long term is greater than 5 years
Kwok and Caton prognostic classification
based on the probability of disease progression. There are 4 categories:
Hopeless - tooth must be extracted
Unfavorable - periodontal status of the tooth is influenced by factors that cannot be controlled
Questionable - the periodontal status of the tooth is influenced by factors that may or may not be controlled
Favorable - the periodontal status of the tooth can be stabilized with comprehensive treatment and periodontal maintenance.
The factors involved are general patient compliance, smoking, diabetes, and other systemic conditions. Further localized factors include deep PPD and CAL, Anatomical features (furcation, enamel pearl, open contacts, crowding, root proximity overhanging restorations), trauma from occlusion, root fractures, mobility
Is there harm in not extracting hopeless teeth in a periodontitis patient?
DeVore found treated patients hopeless teeth had no change in prognosis
Machtei et al found patients without periodontal treatment, hopeless teeth had a negative effect on periodontal management.
What is the prognosis of a tooth with a root fracture
if tooth fracture occurred coronal to the gingival margin and does not extend to parts of the tooth surrounded by periodontal tissues it does not initiate gingivitis or periodontitis
a 10 year survival of apical root fracture is 89%, mid-root fracture 78%, cervical mid-root fractures 67%, and cervical fractures 33%
Compare the prognosis of implant therapy and endodontic therapy
endo cheaper
if endo is questionable then ext may be a better option.
mandible and anterior maxilla is a better implant location than post maxilla
Tooth strength - questionable teeth should be ext
occlusion - endo may be questionable in bruxers
periodontal condition - must be assessed
Overall health - smoking and systemic conditions
Time needed for treatment - implant takes longer
Potential esthetic result - tooth may retain esthetics better
Does tooth/root position affect the prognosis of the patient?
misalignment, crossbite, and crowding of anterior teeth is associated with gingivitis, attachment loss, increased plaque retention and PPD
interradicular distance of <0.8mm is a significant local risk factor for alveolar bone loss in mandibular anterior teeth.
When or when not to extract the tooth
extract the tooth
The tooth with an existing crown will need RCT, Crown lengthening, a post and a new crown
Inadequate amount of tooth above the crest
high chance of decay in the mouth
periodontal surgery will cause esthetic concerns
Grade III furcations
Save the tooth
intact arch
no endodontic needs
restorations are functional
adequate amount of tooth structure above the crest
low decay rate
little periodontal disease
not esthetic tooth
Pt emotional about keeping the tooth
