Prognosis Flashcards
Prognosis definition
likely outcome of an illness with or without treatment-a forecast of the probable course and final outcome of the disease
Essential elements of prognosis (2)
timing of the projection, individual tooth versus overall dentition
Timing of the projection (3 prognosis)
initial, short, long (define)
- initial prognosis-before
- short term prognosis: less than 5 yrs
- long term pronosis (>5yrs)
Prognosis comes from the latin term _____
foreknowledge
Most traditional systems are based on tooth mortality
data based on when a tooth is lost– not truly relevant since?
teeth don’t just fall out
Prognosis factors
characteristics that may predict the outcome once the disease is present but DO NOT actually cause it (i.e. accessibility of a furcation)
How we define survival
as long as it is still in the oral cavity
Success as defined with perio prognosis (3 things)
sucess is defined as stable, functional, and comfortable
If a tooth has what 3 qualities it should likely been retained?
Stable, functional, comfortable-hence it is a success
overall prognosis determined via?
communication between pt and professionals
T/F; periodontal disease progresses uniformly throughout the dentition
False; it does not
Local factors that affect individual prognosis (prognostic factors-6 things)
Deep probing depth Molars Post. proximal sites Palatal grooves/CEP/EP Overhanging restorations Food impaction sites
Worse: vertical or horizontal bone loss?
horizontal bone loss-can treat and reverse vertical bone loss better
greater prognosis, vertical or horizontal bone loss?
horizontal has a LOWER prognosis
2 levels of evaluation when considering a comprehensive approach
patient level and individual tooth level
Patient level includes (3)
biological risk, environmental risk, financial and behavioral
20yr old with 20% bone loss vs 60yr old with 20% bone loss; worse prognosis?
20yr old
Evaluation of individual teeth; how many criteria and additional factors?
4 main criteria and 2 additional factors
the 4 main criteria and 2 additional factors for the evaluation of individual teeth
PERO
- Periodontal condition and alveolar bone support
- Endodontic condition
- Restorability, remaining sound tooth structure
- Occlusal place and tooth position including… anatomical irregularities and Iatrogenic compromising factors
**WORTH KNOWING
teeth most likely to be lost due to furcation
max second molars-molars in general tho
All of these studies are based on what study type? (hint-when/how where they done)
retrospective private practice analysis-I am sure this does not matter though
Hirschfeld and Wasserman 1978
Patients?
outcome being measured?
prognostic categories?
Cons of this study?
600 w/ 75% severe
Tooth loss
Favorable or questionable (not very precise!)
Hirschfeld and Wasserman 1978 called a tooth questionable if
furcation, deep pockets, extensive bone loss, or mobility of 2 or 2.5-
This seems too specific to care about tho
Hirschfeld and Wasserman 1978: Higher % of teeth with a “?” prognosis were lost in Well- maintained group – means it had high predictive value, but only for this group…
what is the problem here?
Classification is too simple I guess? who knows
**I WOULD KNOW THIS
Becker, Berg and Becker 1984
did a study on two groups… what were they? How did they classify their prognoses?
Those who were attending for maintenance and no maintenance with 3 prognostic categories (good, questionable, hopeless)
Becker, Berg and Becker 1984
Like Hirschfeld, this system predicted _____ correctly in pts but did not predict well in ______ maintained patients
well- maintained
poorly
**point is predicting teeth with a good prognosis that are well maintained is not hard
For each study, what types of prognosis were easy (made accurately) and which were more difficult
Good and poor were easy to make, fair,poor, and questionabe were hard! (as were non maintained)
the purpose of this lecture
We suck at prognosis and you should just not take teeth out and they will survive, or they might not, but who really gives a shit anyways according to this guy
McGuire and Nunn
patients, # of classes of prognoses? What was different about this? What are the classes of classification?
Patient group is TREATED-ALL Prognoses were developed AFTER Therapy
5 classes- which are Good, fair, poor, questionable, and hopeless. We use this at MUSoD!!!
**KNOW ALL OF THIS
Worse according to the literature… poor or questionable?
Questionable, but he was really worked up about this
What do lost teeth mean in studies?
Apparently not much because they do not fall out of peoples head’s someone must use judgement and pull them out
Prognoses for ___ rooted teeth were more reliable than for ___ rooted teeth
Single
Multi
**KNOW THIS
In these studies, how was the prognosis of good prognosis teeth
Long-term prognosis was reasonably predictable in teeth listed as having a good prognosis post perio tx
Seven factors probably should carry more weight when determining an individual tooth prognosis
according to McGuire… Thus at MUSoD thus probably should know :(
Increased PD
Severe FURCATION involvement
Greater MOBILITY
Unsatisfactory CROWN/Root ratio
Malposed teeth
Smoking
Teeth used as fixed ABUTMENTS
in McGuire
When “Good” prognosis was excluded, the predictive value dropped to ____%
50%
In the presence of furcation, teeth were ____ as likely to be lost
twice
**KNOW THIS
Without hemisection or amputation, Hirschfeld reported loss of nearly ___ of the teeth originally diagnosed as furcation involvement
1/3
dumb
Other reports showed with non-surgical maintenance, ___% of molar teeth can be maintained over 5-24 yrs
85%-this is very inconsistent….
Smoking on prognosis….
always worsens it…duh
Consider 4 aspects of Prognosis….
Periodontal
Endodontic
Implant
Prosthetic
End results of each
Good prognosis –
Questionable prognosis –
Hopeless prognosis –
maintained
retreated
extracted
Stable situation (BoP, CAL, PD) DEFINE
no BoP, no further CAL, residual PD ≦5 mm
**KNOW THIS
Further disease activity classified as (PD etc.)
residual PD ≧6 mm and additional CAL
Mobility and furcation involvement together
can be deadly
After successful periodontal treatment, teeth with reduced periodontal support are capable of serving as foundations for single crowns or as abutments for FDPs, however, which are most likely to be lost?
maxillary molars and resected mandibular molars with retained mesial roots are the teeth most likely to be lost
teeth most likely to be lost as abutments
maxillary molars and resected mandibular molars with retained mesial roots
Positive for the IL-1 genotype means what
RISK
From a restorative perspective, the amount of remaining _______ is critical for the strategic value of an abutment
coronal tooth substance
**KNOW THIS
Are most failures due to endo or pros? What %s
60% pros and 32% endo he says (seems bias-about everything)
Patient group of McGuire and Nunn
Only treated patients (prognosis was guessed after)
Study we use at school for perio prognosis and year it was done-no this is not a joke
McGuire and Nunn-1996
Kwok and Caton year and what did they use
2007-used patient level factors such as compliance and local factors such as periodontal disease
-this one is probably the least important study
Becker, Berg, Becker
Year?
Prognosis Classifications?
1984- used 3: good, questionable, hopless
Hirschfield and Wasserman
Year?
Prognosis used?
1978
only used favorable and questionable-which was TOO SIMPLE
