prognosis

Question 1

what factors are involved in individual tooth prognosis

Answer 1

1. percentage of bone loss
2. PD
3. furcation
4. mobility
5. crown to root ratio
6. root morphology
7. developmental/acquired deformities
8. pulpal involvement
9. caries
10. tooth positions and occlusal relationship
11. strategic value
12. provider’s knowledge and skills

Question 2

what factors are involved in overall prognosis

Answer 2

1. age
2. systemic conditions (diabetes)
3. behavioral conditions (smoking)
4. individual tooth prognosis
5. rate of disease progression
6. compliance
7. economic considerations
8. provider’s knowledge and skills
9. etiologic factors

Question 3

Kwok and Caton prognosis system

Answer 3

 Favourable: can be stabilized with maintenance
 Questionable: tooth is influenced by local/systemic factors that may or may not be controlled
 Unfavourable: cannot be controlled
 Hopeless: must be extracted

Question 4

How accurate is the system for estimating tooth retention

Answer 4

o 5-8 year prediction accuracy of 80%, but if you take out the “good” category, it drops to 50% so it is ineffective for teeth with initial prognosis of less than good
o Kwok and Caton – prognosis should be dynamic and re-evaluated throughout treatment and maintenance

Question 5

How effective are implants in a patient with history of perio

Answer 5

-History of perio disease is most determinant risk factor for development of peri-implantitis
-Karoussis: 10 year incidence 29% (versus 6% in non perio pts)
-Roccuzzo: More bone loss and PD in severely perio compromised group
-Costa: 5 years of people with peri-mucositis. History of perio were 9 times more likely to develop peri-implantitis

Question 6

Diabetes is a risk factor for peri-implantitis?

Answer 6

Monje 2017
-Systematic review: risk is 50% higher in DM than non DM pts (RR 1.46) and those with hyperglycemia were 3.39 fold higher risk for peri implantitis

Question 7

What is the average CAL and tooth loss per year?

Answer 7

Needleman et al 2018
-Mean attachment loss was 0.1 mm/year
- mean annual tooth loss was 0.2 teeth/year

Question 8

What is the average CAL and tooth loss per year for non-compliant pts?

Answer 8

-Becker
-0.11 teeth/year for those treated + maintained
-0.22 teeth/year – treated + not maintained
-0.36 teeth/year – no treatment

Question 9

Which teeth are most frequently lost for perio reasons?

Answer 9

Hirschfeld and Wasserman (1978)
Maxillary 2nd molars are most likely, mandibular canines are least likely

Question 10

What prognostic factors have the highest risk of tooth loss

Answer 10

-Ong 1998:
-initial attachment loss, bone height, and smoking
-main reason for tooth loss was 1) mobility 2) furcation involvement
-Agudio et al 2023
age, gender, molar teeth, pocket depth, bone loss, and the presence of a root canal treatment and a crown are prognostic factors associated with tooth loss
Miller - smoking (HR=3.38), probing depth (HR=1.33), and mobility (1.45) were the most significant prognostic factors.