Prognosis, Re-eval, and Maintenance Flashcards
A prediction of the course, duration and
outcome of a disease based on a general
knowledge of the risk factors for the disease
‣ It is established after the diagnosis is made and
before the treatment plan is established.
Prognosis
an evaluation of the course of the
disease without treatment.
Diagnostic Prognosis:
an evaluation of the course of
the disease with treatment.
Therapeutic Prognosis:
T/F: The GOAL is to Deliver a predictable and long term stable comprehensive tx plan
True
_______: the anticipated result of the
periodontal therapy with anticipated prosthetic treatment
Prosthetic Prognosis:
In the studies, what combination of tx and maintenance showed the least number of teeth lost per year?
Tx and regular maintenance
(KWOK AND CATON (2007) Prognosis)
: The periodontal status of the tooth can be stabilized with comprehensive periodontal
treatment and periodontal maintenance. Future loss of the periodontal supporting tissues is
unlikely if these conditions are met
Favorable
(KWOK AND CATON (2007) Prognosis)
: The periodontal status of the tooth is influenced by local and/or systemic factors
that may or may not be able to be controlled. The periodontium can be stabilized with
comprehensive periodontal treatment and periodontal maintenance if these factors are
controlled; otherwise, future periodontal breakdown may occur
Questionable
(KWOK AND CATON (2007) Prognosis)
: The periodontal status of the tooth is influenced by local and/or systemic factors that
cannot be controlled. Periodontal breakdown is likely to occur even with comprehensive
periodontal treatment and maintenance
Unfavorable
(KWOK AND CATON (2007) Prognosis)
: The tooth must be extracted
Hopeless
(PROGNOSIS (MCGUIRE ’96))
One or more of the following: ‣ Etiologic factors can be controlled ‣ Adequate periodontal support ‣ Tooth or teeth can be adequately maintained by the professional and patient ‣ Controlled systemic factors
GOOD:
(PROGNOSIS (MCGUIRE ’96))
: One or more of the following:
• Up to 25% attachment loss measured clinically and radiographically
• Grade I furcation allows access for maintenance
• Tooth or teeth can be maintained with proper professional and
home care
• Limited systemic factors
FAIR
(PROGNOSIS (MCGUIRE ’96))
\: One or more of the following: • Up to 50% loss has occurred • Grade II furcation with difficult access to the depth and position of the furcation • Greater than Miller class 1 mobility • Poor crown-to- root ratio • Lack of patient compliance • Presence of systemic factors
POOR
(PROGNOSIS (MCGUIRE ’96))
One or more of the following:
• Greater than 50% attachment loss
• Grade II or III furcation involvement not accessible for maintenance
• Endodontically involved tooth that must be resolved before
periodontal treatment
• Tooth or teeth not easily maintained by professional and/ or patient
QUESTIONABLE:
(PROGNOSIS (MCGUIRE ’96))
‣ One or more of the following:
‣ Inadequate attachment to support the tooth
‣ Grade III furcation involvement
‣ Miller class III mobility
‣ Tooth or teeth cannot be maintained by the professional and/ or the patient
HOPELESS:
What is the most important determinant of prognosis for individual teeth/
Amount of attachment loss
when present extend into furcation areas of ~20-30% of mandibular and maxillary molars. This clinical photo illustrates the most common location of CEPs (buccal surface of second maxillary molar)
CERVICAL-ENAMEL PROJECTIONS
What teeth commonly hace CEPs?
Max 2nd molars
Where do enamel pearls typically occur?
Max 2nd and 3rd molars
The palatogingival groove is found on what teeth typically?
Max laterals
Amount of bone loss is about 3.6 times higher
than normal in teeth that have more or less root proximity?
Teeth having roots closer together have more rapid bone loss
Are max or mand molars most often loss to perio disease?
Max molars
73% OF MANDIBULAR MOLARS
cementum extending from the mesial to the distal of a furcation opening
-Hinders professional cleaning
-More rapid bone loss
Furcation ridge
DOES A SUCCESSFUL ENDODONTIC TX EFFECT PERIO PROGNOSIS?
Does not
Re-evaluation of periodontal case should occur about __
weeks after completion of SRP.
‣ Allows time for healing of epithelium and CT
‣ Allows patient sufficient time to practice and improve OH
‣ Gingival inflammation is usually reduced or eliminated
within 3-4 weeks after removal of calculus and local irritants
4-6 weeks
Healing after STP: Formation of __________
‣ this attachment epithelium appears 1-2 weeks after therapy
‣ Gradual reductions in inflammatory cell population, crevicular fluid
flow, and repair of connective tissue will result in less
inflammation, redness and swelling
LONG JUNCTIONAL EPITHELIUM
Does healing after SRP tx involve hypersensitivity?
Yes for a few weeks; should go away
Ideally: No pockets =/> ___ mm and none >___ mm with BOP
> or =5; none >4 mm with BOP
if the pt has a loss of attachment of __ mm or greater at re-
evaluation, should be referred
5 mm or more
Treatment of advanced perio disease by a periodontist
usually successful if ___ to ____ mm pockets
5mm to 8 mm
Does a pt need to have a good plaque score to be referred to a periodontist?
Yes ideally less than 20%
includes all the procedures performed at selected
intervals to assist the periodontal patient in maintaining oral
health.
• These usually consist of examination, an evaluation of oral
hygiene and nutrition, scaling, root curettage, and polishing
of teeth.
SPT or perio maintenance
In a study where SPT wasn’t performed, what happened to attachment loss over 2 years without maintenance?
1.2-1.9mm of attachment loss
How often should SPT be delivered to a high risk patient?
Every 3 months
(how often should pt be seen)
Patients displaying a low- risk profile for
periodontitis recurrence yield all risk factors in
the low-risk category or, at most, one risk
factor in the moderate risk category.
Once a year for SPT
(How often should pt be seen)
Patients presenting with at least two risk
factors in the moderate-risk category and at
most one risk factor in the high-risk category
were classified as displaying a moderate-risk
profile.
Twice a year
(How often should pt be seen?)
Patients showing at least two risk factors in the
high- risk category are defined to belong to a
high-risk profile for disease recurrence.
Every 3-4 months
Maintenance is usually every __ months initially - WHY?
—-> Clinical Studies show it is the right regiment to keep
the clinical parameters stable.
3
