PROGNOSIS, RE-EVALUATION, AND MAINTENANCE Flashcards
1
Q
What is a 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
2
Q
What does a prognosis allow for?
A
Deliver a predictable and long term stable comprehensive treatment plan
3
Q
What is a diagnostic prognosis?
A
an evaluation of the course of the disease without treatment
4
Q
What is a therapeutic prognosis?
A
an evaluation of the course of the disease with treatment
5
Q
What is a prosthetic prognosis?
A
the anticipated result of the periodontal therapy with anticipated prosthetic treatment
6
Q
What are the factors to consider for individual tooth prognosis?
Modified and affected by overall prognosis
A
- Percentage of bone loss
- Deepest probing depth
- Horizontal or vertical bone loss
- Anatomical factors (Furcation involvement, root form, etc.)
- Crown-to-root ratio
- Mobility
- Caries or pulpal involvement
- Tooth malposition
- Fixed or removable abutment
7
Q
What are the factors to consider for overall prognosis?
Concerned with the dentition as a whole
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
8
Q
What is included in an individual tooth prognosis?
Modified and affected by overall prognosis
A
- Amount or percentage of attachment loss
—the most important determinant-influences mobility and crown/root ratio - Bony defect topography
- Pocket depth
—need to relate this to attachment loss - Rate of attachment loss
- Systemic/environmental factors
—smoking, diabetes, stress, genetics, medications inducing gingival enlargements, systemic disease affecting periodontitis, etc. - Patient’s compliance and oral hygiene control
9
Q
What are the anatomical factors included in inidividual tooth prognosis?
A
- Excessive occlusal forces
- Overhangs or defective subgingival restorations
- Cervical enamel projections (CEP’s)/Enamel pearls
- Developmental/Palatogingival grooves
- Root concavities
- Root forms and lengths
- Furcations and intermediate bifurcation ridges
- Accessary canals
- Root proximity
- Tooth mobility
- Overhang
- Defective subgingival margins
10
Q
What are the grades of cervical enamel projections (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. (Not enter yet)
- Grade III: The enamel projection extends horizontally into the furcation.
11
Q
What is the most common location for cervical enamel projections (CEPs)?
A
buccal surface of 2nd mandibular molars
12
Q
Where are enamel pearls most common?
A
- In the molar furcation areas, especially maxillary 2nd and 3rd molars.
- Incidence of 1.1-9.7%
13
Q
A palatogingival groove is found in _____% of maxillary lateral incisors
A
4-6%
14
Q
What is the percentage of maxillary first molar roots that have root concavities?
A
94% of mesiobuccal roots
31% of distobuccal roots
17% of palatal roots
15
Q
What is the furcation rooth trunk length for a maxillary molar?
important
A
Mesial 3mm
Buccal 4mm
Distal 5mm
16
Q
What is the furcation rooth trunk length for a mandibular molar?
A
Buccal 3mm
Lingual 4mm
17
Q
What is the furcation rooth trunk length for a maxillary premolar?
A
Mesial 7-8mm
18
Q
The longer the root trunk, the ______ likely it is to become periodontally involved
A
less
19
Q
When a furcation is periodontally involved, the more apical the furcation, the more __________ it is to access and treat.
A
difficult
20
Q
Long, divergent and multi-rooted teeth are ______ prone to having mobility
A
less
21
Q
What teeth are lost more often due to furcation involvement: max molars or mand molars?
A
maxillary molars
22
Q
What is important to know about the furcation ridge?
A
- 73% of mandibular 1st molars
- 67.9% of mandibular 1st molars
- Cementum extending from the mesial to the distal of a furcation opening
- Impede plaque control
23
Q
______% of molars have accessory canals in the furcation
A
28.4%
24
Q
The distance between the roots of adjacent teeth on radiographs is…
A
<1.0mm
25
The distance of ______mm is a significant local risk factor for alveolar bone loss in mandibular anterior teeth.
<0.8 mm
## Footnote
The amount of bone loss is about 3.6 times higher than normal.
26
What are the different levels of root proximity?
- 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
27
The ideal tooth position is within the...
alveolus envelope and has full bone support
28
What are the features of pathologic tooth migration?
* When the balance among the factors that maintain physiologic tooth position is disturbed by periodontal disease
* Occurs most frequently in the anterior region
29
What classification system does UMKC use for perio?
Kwok and Caton (2007)
30
McGuire and Nunn 1996 classification system is based on...
| important
tooth loss
31
What are the features of McGuire and Nunn 1996 classification system?
▪ System is based on tooth loss
▪ The coefficients from this model were able to predict accurately the 5-year and 8-year prognoses 81% of the time.
▪ When the teeth with a “good” prognosis were excluded, the predictive accuracy dropped approximately 50%.
32
What are the classifications for McGuire and Nunn 1996?
33
Kwok and Caton 2007 classification system is based on...
| important
periodontal stability
34
What are the classifications for Kwok and Caton 2007?
35
Does endo treatment affect periodontal prognosis?
basically it doesn't
* 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.
* It is believed that this initial pulpal inflammatory response is an attempt to prevent the spread of infection to the apical tissues
36
What is re-evaluation?
- The evaluation or assessment of treatment
- It is used to determine the effectiveness of scaling and root planing (SRP) or scaling in the presence of gingival inflammation and to review the proficiency of plaque control
37
What are the objectives of treatment?
* Arrest the disease
* Regenerate lost periodontium
* Maintain periodontal health
--- Reduce “critical mass” of plaque
--- Allow host to control the bacteria
38
What is the expectation for healing after an SRP for the patient?
* Formation of a long junctional epithelium
--- It 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
--- It is important to warn patients about these possibilities
39
What is the expectation for healing after an SRP clinically?
The decrease in the probing depths consists of two components: clinical attachment gain and recession
40
When should you re-evaluation for an SRP?
Done 4-6 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
▪ The time to re-motivate the patient and go over further instructions if the patient has not improved OH
▪ The time to decide whether the patient needs to be referred for advanced periodontal treatment
41
Why should you not wait longer than 4-6 weeks to re-eval after an SRP?
* 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
42
What do you need to evaluate in terms of clinical parameters and compare to the baseline?
* OH and patient’s compliance
* Resolution of the inflammation (BOP, Plaque control)
* Progression of attachment loss
* Mucogingival defects and gingival recession (progressing or the same?)
* Resolution of occlusal trauma
* Hypersensitivity
* Furcation, mobility
43
What is the criteria for success after an SRP?
No pockets >5mm and none > 4mm with BOP
44
Residual PD >___mm represent an incomplete treatment and require further therapy
6mm
45
When should you decide to refer to the periodontist?
* PD >5mm is proposed as the current guideline
* Grade C progression
* Early referral of advanced cases is critical to provide the best outcome
--- PD of 5-8mm: treatment by a periodontist is usually successful
--- PD > 9mm: Limited success
46
What is supportive periodontal treatment (SPT)?
SPT includes all the procedures performed at selected intervals to assist the periodontal patient in maintaining oral health.
These procedures usually consist of:
* Examination
* Evaluation of oral hygiene
* Evaluation of nutrition
* Scaling
* Root curettage
* Polishing of teeth
## Footnote
▪ Periodontal Maintenance
▪ Preventive Maintenance
▪ Recall Maintenance
47
What is the checklist for an SPT appointment?
1. Review and update medical and dental
history
2. Clinical examination (to be compared to
previous data)
▪ Extra-oral examination
▪ Intra-oral examination
▪ Dental examination
▪ Periodontal examination
--- Probing depths
--- Attachment levels
--- Bleeding on probing
--- Plaque score
--- Calculus
--- Evaluation of furcations
--- Note any exudate present
--- Gingival recession
--- Mobility
3. Radiographic examination
4. Assessment of disease status or changes by comparing clinical and radiographic information with baseline
5. Assessment of oral hygiene
6.Treatment
48
You must _______ the patient in order to record a plaque score.
| important (it had its own slide)
disclose
49
What kind of treatment is involved in a SPT appointment?
▪ Removal of subgingival and supragingival plaque and calculus
▪ Behavioral modification
--- Oral hygiene re-instruction
--- Adherence to suggested maintenance intervals
--- Counseling on control of risk factors
▪ Selective scaling or root planing, if indicated
▪ Occlusal adjustment, if indicated
▪ Use of local antimicrobial agents or irrigation procedures, as needed
▪ Root desensitization, if indicated
▪ Return to Phase II active therapy, if indicated
50
Why is communication important for an SPT appointment?
- Informing the patient of current status and need for additional treatment if indicated
- Consultation with other health care practitioners who may be providing additional therapy
51
In the absence of SPT how does the treatment work?
All treatment approaches are equally ineffective in preventing recurrence of destructive periodontitis in the absence of SPT.
52
Most studies support maintenance visits at least once every __________ for patients with a history of periodontal disease
3 months
53
Remember, patients with a history of periodontal disease are a ____________; therefore, they are prone to recurrence of active disease
“susceptible host”
54
What are the different risk categories for periodontal disease?
55
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. What recall strategy?
an SPT interval of at least once a year was recommended
56
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. What recall strategy?
SPT twice a year
57
Patients showing at least two risk factors in the high-risk category are defined to belong to a high-risk profile for disease recurrence. What recall strategy?
SPT at intervals of 3-4 months
58
What are the clinical parameters at a SPT appointment?
* Clinical examination (to be compared with previous data)
--- Periodontal examination
* Treatment
* Planning future SPT intervals according to individual Periodontal Risk Assessment
59
What should you do if the probing depths are stable with no bleeding?
Routine treatment
Review OHI
Same recall interval
60
What should you do if the probing depths are stable with **bleeding**?
- Re-scale and root plane bleeding sites (if needed/etiological factors still present)
- Consider local delivery of antimicrobials
- Review OHI
- Consider shortening recall interval
61
Maintenance is usually every ___ months initially
3
## Footnote
Clinical studies support this regimen to keep the clinical parameters stable
62
63
If referred to a periodontist and treated, then determine what _______________ is needed
maintenance schedule
## Footnote
Alternating between the referring dentist and the periodontist is an option
64
Perio Maintenance versus Compromised Perio Maintenance
Compromised perio maintenance (a UMKC term) differs from perio maintenance in that the disease process is still active, but the patient’s oral hygiene is not adequate enough to proceed to surgical therapy. This is a temporary solution until oral hygiene has improved.
