prognosis

Question 1

what are some basic questions you need to ask yourself for determining prognosis?

Answer 1

Can I achieve long term periodontal stability?
Can the tooth be treated ?
Is my intended treatment likely to succeed – long term?
Thinking of P.D/Bridge?Are the remaining teeth and abutments able to support the added burden of the prosthesis?
The answers depend a lot on your prognosis.

Question 2

what is prognosis?

Answer 2

IS THE PREDICTION OF THE COURSE OR OUTCOME OF A DISEASE
AND
THE PREDICTION OF IT’S RESPONSE TO TREATMENT.

Question 3

what may an incorrect prognosis do?

Answer 3

An incorrect prognosis may result in wasted time and money, embarrassment , complaints, dissatisfaction.

Although prognosis is dependent on a proper diagnosis of the condition, it is also dependent on other LOCAL, SYSTEMIC and BEHAVIORAL factors!

Question 4

what types of prognosis can you have in terms of the mouth and teeth?

Answer 4

OVERALL PROGNOSIS(as in the case of generalized periodontal disease, partials)
           or
PROGNOSIS OF INDIVIDUAL TEETH (e.g.; localized periodontitis, abutments,a carious tooth)

Question 5

when is prognosis determined and what are the categories of it?

Answer 5

PROGNOSIS MUST BE DETERMINED AFTER YOUR DIAGNOSIS AND BEFORE PLANNING TREATMENT

PROGNOSIS Can be either GOOD, FAIR, POOR, GUARDED/questionable OR HOPELESS.

Question 6

how do you define the different categories for prognosis?

Answer 6

Good or Fair : Good chance of improvement of the condition with therapy.
Poor: Maybe there is a chance of improvement.
Guarded: Unlikely.
Hopeless: No chance! Only solution is to extract.

Good & Hopeless: easy to establish. Fair, poor, guarded : DIFFICULT! Depends on a bunch of factors!!

Question 7

what factors do you need to make a FAIR PROGNOSIS?

Answer 7

FAIR PROGNOSIS: (these are just a few of the factors you need to consider BEFORE making a ‘ fair’ prognosis

• • early/mild bone loss. * PD: 4-5mm
• No mobility.
• NO Furcal defects.
• Patient is well motivated.
• Cooperative.
• NO systemic or behavioral risk factors.

Question 8

what factors do you need to make a poor prognosis?

Answer 8

POOR PROGNOSIS: ( a few factors to consider)

• Moderate bone loss.
• PD: >6mm
• Mobile tooth.(type 1)
• Furcation 1 and 2.
• Able to maintain good PC.
• Doubtful patient cooperation.
• Presence of one or more systemic or behavioral risk factors.

Question 9

what factors do you need to consider to make a guarded prognosis?

Answer 9

GUARDED Prognosis:* Moderate to advanced bone loss.
PD> 6mm
* Furcation 2 and 3.
* Mobile tooth.(type 2)
* Difficult to maintain good PC.
* Doubtful patient cooperation, not motivated.
* Presence of one or more systemic or behavioral risk factors.

Question 10

what are factors determining prognosis?

Answer 10

AGE OF PATIENT/ RATE OF DISEASE PROGRESSION. (comparing a 25 yr. old with a 65 yr. old, both having similar extent of periodontal disease, the 25 yr. old will have a poorer prognosis.) [disease is progressing more rapidly]

LOCAL FACTORS.(next slides)

SYSTEMIC / GENERAL FACTORS.

Question 11

what are some local factors having to do with plaque and microorganisms as well of mobility calculus and loss of attachment and presence of deep pockets?

Answer 11

Plaque Control and the type of MO that are within the deep pockets.

Porphyromonas (P) gingivalis

Tannerella (T) forsythia

Aggregatibacter actinomycetemcomitans
   (AA) [all are associated with advanced chronic or aggressive periodontitis].

Extent of MOBILITY

Extent of CAL/LA

PRESENCE OF DEEP POCKETS
Probing depths >5 mm are difficult to maintain as healthy and tend to have more residual plaque and calculus.

Deep pockets are also associated with virulent periodontal pathogens.

Question 12

what are local factors having to do with things around the teeth and bone and roots?

Answer 12

OCCLUSAL TRAUMA

FOOD IMPACTION SITES

PLUNGER CUSPS

% OF REMAINING BONE

ROOT ANATOMY

SHAPE [ conical  VS square or ovoid ]
NUMBER of roots (more the merrier)
LENGTH (the longer, the better)
ROOT PROXIMITY (closer they are, the difficult to clean)

ROOT Fractures
A vertical fracture in the root has a poorer prognosis than a horizontal fracture.

Question 13

what are local factors having to do with decay, roots, and teeth?

Answer 13

Extensive –

Caries
Idiopathic Root Resorption
Developmental defects
e.g.; palato-gingival groove (incisor), Root Concavities (these complicate perio Tx.)

TOOTH ALIGNMENT.

% OF REMAINING BONE.

REMAINING TEETH. If only a few natural teeth remain, these will have to bear the brunt of occlusal forces which could result in a breakdown of the periodontium and hence will have a poorer prognosis.
MGI.
Idiopathic: overhangs

TYPE OF FURCAL DEFECT.

TYPE OF BONY DEFECT.
3 walled VS 1 walled (explain this in March)

TEETH ADJACENT TO EDENTULOUS AREAS.
(Abutments have more functional demands).

Question 14

what are systemic/behavioral/genetic factors?

Answer 14

Medical status/condition (e.g.: diabetes, arthritis in the wrist/fingers/stroke)

Impaired Host defense.

Genetics.

Medications that may cause dry mouth or gingival enlargement, excessive bleeding.

SMOKING.
STRESS.
Drug abuse.
Alcohol abuse.
Skill of the dentist!
Dexterity of patient.
Economic means.

The prognosis is also HIGHLY DEPENDENT UPON THE PATIENT’S MOTIVATION, COMPLIANCE AND COOPERATION.

Patient must desire to retain natural teeth and be available & motivated to undergo long term MT.

Question 15

what is prognosis determined by?

Answer 15

THE NUMBER OF RISK FACTORS (local, behavioral, systemic) THAT CAN BE REDUCED OR ELIMINATED.

THE GREATER THE REDUCTION – THE BETTER THE PROGNOSIS