Prognosis Flashcards by Austin Mahlik

Prognosis definition

likely outcome of an illness with or without treatment-a forecast of the probable course and final outcome of the disease

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Essential elements of prognosis (2)

timing of the projection, individual tooth versus overall dentition

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Timing of the projection (3 prognosis)

initial, short, long (define)

initial prognosis-before
short term prognosis: less than 5 yrs
long term pronosis (>5yrs)

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Prognosis comes from the latin term _____

foreknowledge

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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

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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)

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How we define survival

as long as it is still in the oral cavity

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Success as defined with perio prognosis (3 things)

sucess is defined as stable, functional, and comfortable

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If a tooth has what 3 qualities it should likely been retained?

Stable, functional, comfortable-hence it is a success

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overall prognosis determined via?

communication between pt and professionals

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T/F; periodontal disease progresses uniformly throughout the dentition

False; it does not

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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

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Worse: vertical or horizontal bone loss?

horizontal bone loss-can treat and reverse vertical bone loss better

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greater prognosis, vertical or horizontal bone loss?

horizontal has a LOWER prognosis

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2 levels of evaluation when considering a comprehensive approach

patient level and individual tooth level

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Patient level includes (3)

biological risk, environmental risk, financial and behavioral

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20yr old with 20% bone loss vs 60yr old with 20% bone loss; worse prognosis?

20yr old

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Evaluation of individual teeth; how many criteria and additional factors?

4 main criteria and 2 additional factors

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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

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teeth most likely to be lost due to furcation

max second molars-molars in general tho

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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

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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 :(

People find more coke, meth, synthetics, alcohol ---------------------------- 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