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Periodontics I > Prognosis Re-evaluation and Maintenance > Flashcards

Prognosis Re-evaluation and Maintenance Flashcards

1
Q

what is prognosis

A

a prediction of the course, duration and outcome of a disease based on a general knowledge of the risk factors for the disease

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2
Q

what are the steps in delivering a predictable and long term stable comprehensive treatment plan

A
  • comprehensive exam -> dx -> prognosis -> tx plan
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3
Q

what is a diagnostic prognosis

A

an evaluation of the course of the disease without treatmentw

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4
Q

what is a therapeutic diagnosis

A

an evaluation of the course of the disease with treatment

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5
Q

what is the prosthetic prognosis

A

the anticipated result of the periodontal therapy with anticipated prosthetic treatment

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6
Q

what are the two main factors to consider in prognosis assignment

A
  • individual tooth prognosis
  • overall prognosis
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7
Q

what are the factors that make up the individual tooth prognosis

A
  • percentage of bone loss
  • deepest probing depth
  • horizontal or vertical bone loss
  • anatomical factors- furcation involvement, root form, mobility
  • crown to root ratio
  • caries or pulpal involvement
  • tooth malposition
  • fixed or removable abutment
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8
Q

what are the factors in overall prognosis

A
  • age
  • medical status
  • smoker and/or diabetic
  • family history of periodontal disease
  • oral hygiene
  • compliance
  • maintenance interval
  • parafunctional habits with/without guard
  • individual tooth prognosis
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9
Q

what do we examine in the individual tooth prognosis

A
  • amount or percentage of attachment loss
  • bony defect topography
  • pocket depth
  • rate of attachment loss
  • systemic/enivronmental factors
  • patients compliance and OH control
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10
Q

what is the most important determinant in the individual tooth prognosis

A

amount or percentage of attachment loss

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11
Q

what are the anatomical factors considered in individual tooth prognosis

A
  • excessive occlusal forces
  • overhang or defective subgingival restorations
  • cervical enamel projections/enamel pearls
  • developmental/palatogingival grooves
  • root concavities
  • root forms and lengths
  • furcation and intermediate bifurcation ridges
  • accessory canals
  • root proximity
  • tooth proximity
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12
Q

what are the 3 grades of CEPs

A
  • grade I: the enamel projection extends from the CEJ of the tooth toward the furcation entrance
  • grade II: the enamel projection approaches the entrance to the furcation
  • grade III: the enamel projection extends horizontally into the furcation
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13
Q

when present, CEPs extends into furcation areas of _____ of molars

A

20-30%

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14
Q

the most common location for CEPs is:

A

the buccal surface of 2nd mandibular molars

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15
Q

enamel pearls are found in _____ especially ______

A

molar furcation areas, maxillary 2nd and 3rd molars

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16
Q

what is the incidence of enamel pearls

A

1.1-1.9%

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17
Q

what is the incidence of the palatogingival groove

A

4-6% of maxillary lateral incisors

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18
Q

when looking at the furcal aspects of maxillary first molar teeth, root concavities were found in:

A
  • 94% of mesiobuccal roots
  • 31% of distobuccal roots
  • 17% of palatal roots
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19
Q

radiographs ____ the root concavity defects

A

underestimate

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20
Q

what is the furcation root trunk length in maxillary molars

A
  • mesial 3mm
  • buccal 4mm
  • distal 5mm
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21
Q

what is the furcation root trunk length of mandibular molars

A
  • buccal 3mm
  • lingual 4mm
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22
Q

what is the furcation root trunk length of maxillary 1st premolars

A
  • mesial 7-8mm
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23
Q

what teeth are less prone to having mobility

A

long- divergent and multi rooted teeth

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24
Q

the longer the root trunk the ____ likely it is to become periodontally involved

A

less

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25
Q

when it is involved the more apical the furcation the more _____ it is to access and treat

A

difficult

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26
Q

with furcation involvement are maxillary molars or mandibular molars lost more

A

maxillary molars

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27
Q

what are furcation ridges

A
  • cementum extending from the mesial to the distal of a furcation opening
  • impede plaque control
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28
Q

what is the incidence of accessory canals in molars

A
  • 28.4% of molars have accessory canals in the furcation
  • 29.4% in mandibular molars
  • 27.4% in maxillary molars
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29
Q

the distance between roots of adjacnet teeth on radiographs is:

A

less than or equal to 1mm

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30
Q

the distance of _____ is a significant local risk factor for alveolar bone loss in mandibular anterior teeth

A

less than 0.8mm

31
Q

the amount of bone loss when teeth are less than .8mm apart is ____ higher than normal

A

3.6 times

32
Q

what are the 3 levels of root proximity

A
  • class I: about 0.3mm. no bone just PDL between teeth
  • class II: 0.3-0.5mm, just cortical bone present
  • class III: 0.5mm. some cancellous bone in the area
33
Q

what is the ideal tooth position

A

within the alveolus envelope and has full bone support

34
Q

describe pathologic tooth migration

A
  • when the balance among the factors that maintain physiologic tooth position is disturbed by periodontal disease
  • occurs most frequently in the anterior region
35
Q

what are the classification systems

A
  • McGuire and Nunn - 1996
  • Kwok and Caton (2007)
36
Q

describe the McGuire and Nunn system

A

-system is based on tooth loss
- the coefficients from this model were able to predict accurately the 5 year and 8 year prognosis 81% of the time
- when the teeth with a good prognosis were excluded the predictvie accuracy dropped approximately 50%

37
Q

what are the classes in the Mcquire system

A
  • good
  • fair
    -poor
  • questionable
  • hopeless
38
Q

describe the Kwok and Caton system

A
  • system is based on periodontal stability
  • periodontal prognostication is dynamic and should be re evaluated throughout treatment and maintenance
39
Q

does endo treatment affect periodontal prognosis

A
  • early inflammatory changes in the pulp exert very little effect on the periodontium
  • even a pulp that is significantly inflamed may have little or no effect on the surrounding periodontal tissues
40
Q

the initial pulpal inflammatory response is an attempt to:

A

prevent the spread of infection to the apical tissues

41
Q

what is the re-evaluation used to determine

A

the effectiveness of SRP and to review the proficiency of plaque control

42
Q

what are the objectives of treatment

A
  • arrest the disease
  • regenerate lost periodontium
  • maintain periodontal health
  • reduce critical mass of plaque
  • allow host to control the bacteria
43
Q

what is the expectation of healing after SRP

A
  • formation of a long junctional epithelium
  • appears 1-2 weeks after therapy
  • clinical presentation with less inflammation, redness, and swelling
  • gradual reductions in inflammatory cell population, crevicular fluid flow and repair of connective tissue
  • transient root hypersensitivity and recession of the gingival margins can be seen during healing
44
Q

the decrease in the probing depths consists of two components:

A

clinical attachment gain and recession

45
Q

when is re evaluation done

A

4-6 weeks after completion of SRP

46
Q

why wait 4-6 weeks to do re-eval

A
  • allows time for healing of epithelium and CT
  • allows pt 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
  • the time to remotivate the pt and go over further instructions if the pt has not improved OH
  • the time to decide whether the patient needs to be referred for advanced periodontal tx
47
Q

why NOT wait longer than 4-6 weeks for re-eval

A
  • initial improvement of clinical attachment was found at 3 weeks following SRP and no additional gain of clinical attachment occurred in the succeeding 3 months
  • longer than 2 months, pathogenic bacteria have already repopulated periodontal pockets
48
Q

what clinical parameters do you evaluate and compare to baseline

A

-OH and patients compliance
- resolution of the inflammation (BOP, plaque control)
- progression of attachment loss
- mucogingival defects and gingival recession
- resolution of occlusal trauma
- hypersensitivity
- furcation, mobility

49
Q

what are the criteria for success in re-eval

A
  • no pockets greater than 5mm and non greater than 4mm with BOP
50
Q

the decision to refer to periodontist is based on the following:

A
  • PD greater than 5mm is proposed as the current guideline
  • grade C progression
  • early referral of advanced cases is crticial to provide the best outcome
  • PD of 5-8mm- usually successful
  • PD greater than 9mm- limited success
51
Q

supportive periodontal treatment includes:

A

all the procedures performed at selected intervals to assist the periodontal patient in maintaining oral health

52
Q

supportive periodontal treatment usually consists of:

A
  • examination
  • evaluation of OH
  • evaluation of nutrition
  • scaling
  • root currettage
  • polishing of teethw
53
Q

what is another name for maintenance

A

supportive periodontal treatment

54
Q

what are the 3 types of maintenance

A
  • periodontal maintenance
  • preventative maintenance
  • recall maintenance
55
Q

what is the checklist for SPT appointment

A
  • review and update medical and dental hx
  • clinical exam: extra oral exam, intra oral exam, dental exam, periodontal exam
  • radiographic exam
  • assessment of disease status or changes by comparing clinical and radiographic information with baseline
  • assessment of OH
  • treatment
56
Q

what is involved in treatment in the checklist for SPT appointment

A
  • removal of subgingival and supragingival plaque and calculus
  • behavioral modification: OH re-instruction, adherence to maintenance intervals, control of risk factors
  • selective scaling or root planing
  • occlusal adjustment
  • use of local antimicrobial agents or irrigation procedures
  • root desensitization
  • return to phase II active therapy if needed
57
Q

if you dont have maintenance, the treatment will _____

A

fail

58
Q

for patients with a history of periodontal disease, periodontal maintenance should be provided on a regular and recurrent basis, generally at intervals of _____

A

2-6 months

59
Q

patients without additional attachment loss can have maintenance visits every:

A

6 months

60
Q

most studies support maintenance visits at least _____ for patients with a history of periodontal disease

A

once every 3 months

61
Q

the shorter the recall interval for maintenance visits following periodontal surgery, the _____ the surgical outcomes

A

better

62
Q

what places patients in low risk category

A
  • BOP less than 10%
  • 4 pockets greater than 5mm
  • 4 missing teeth
  • less than 0.5 loss of periodontal support
  • no systemic conditions
  • non or former smoker
63
Q

what places patient in moderate risk category

A
  • BOP 10%-25%
  • 4-8 pockets greater than 5mm
  • 5-8 missing teeth
  • 0.5-1.0 loss of periodontal support
  • no systemic conditions
  • less than 20 cigarettes per day
64
Q

what places patients in the high risk category

A
  • BOP greater than 25%
  • greater than 8 pockets greater than 5mm
  • more than 8 missing teeth
  • greater than 1.0 loss of periodontal support
    -diabetes
  • more than one pack of cigs per day
65
Q

patients with low risk profile or at most one risk factor in the moderate category how often are intervals

A

once a year at least

66
Q

patients with at least two risk factors in moderate category and at most one factor in high risk how often SPT

A

twice a year

67
Q

patients with at least 2 risk factors in high risk category how often SPT

A

3-4 months

68
Q

what are the clinical parameters at SPT appointment

A
  • clinical exam
  • periodontal exam
  • treatment
  • planning future SPT intervals according to individual periodontal risk assessment
69
Q

what do you do if probing depths are stable and no bleeding at SPT

A
  • routine tx
  • review OHI
  • same recall interval
70
Q

what do you do if probing depths are stable but there is bleeding at SPT

A
  • re-scale and root plane bleeding sites
  • consider local delivery of antimicrobials
  • review OHI
  • consider shortening recall interval
71
Q

maintenance is usually at ______ initially

A

every 3 months

72
Q

if referred to a periodontist and treatment then:

A

determine what maintenance schedule is needed

73
Q

what is perio maintenance versus compromised perio maintenance

A

in compromised perio maintenance the disease process is still active, but the pateints oral hygiene is not adequate enough to proceed to surgical therapy
- this is a temporary solution until OH has improved

74
Q
A

Periodontics I (13 decks)

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