function would help immensely, but 95% of people don’t even read the materials I Introduction. lor the younger patient, the prognosis is not as good because of the shorter time frame in which the periodontal destruction has occurred. 3.3 Treatment planning: periodontal problems in children and young adults. Because of the greater height of bone in relation to other surfaces, the center of rotation of the tooth will be nearer the crown d ig. Patients who have been treated for periodontitis should be staged frequently to monitor them. Periodontal disease is a disease, or more likely a number of diseases of the periodontal tissues that results in attachment loss and destruction of alveolar bone. It follows that the prognosis in these cases is dependent on patient compliance relative to both their medical and dental status. dentition is shorter. Determining the Periodontal Prognosis Trying to determine the prognosis starts with the assumption that after treatment the patient will at the least use the Sonicare Diamond Clean tooth brush and clean in between their teeth twice daily and present for supportive care every 3 months. image, Click the Image to generate a new one.). The American Academy of Periodontology defines periodontitis (periodontal disease) as “Inflammation of the periodontal tissues resulting in clinical attachment loss, alveolar bone loss, and periodontal pocketing.” 1 The disease is the leading cause of tooth loss in the United States. However, it should be emphasized that smoking cessation can affect the treatment outcome and therefore the prognosis.1,4 Patients with slight to moderate periodontitis who stop smoking can often be upgraded to a good prognosis, whereas those with severe periodontitis who stop smoking may be upgraded to a lair prognosis. (iooiI prognosis: One or more ol the following: adequate remaining bone support, adequate possibilities to control etiologic factors and establish a maintainable dentition, adequate patient cooperation, no systemic/ environmental factors or it systemic lactnrs are present, they are well controlled. Tig. Similarly, in patients with other systemic disorders that could affect disease progression, prognosis improves with correction of the systemic problem. treatment. (February, 2014), researchers followed patients for 25years and looked at their This process includes an The prognosis for patients with gingival and periodontal disease is dependent on the patient's attitude, desire to retain the natural teeth, and ability to maintain good oral hygiene. Determination of periodontal prognosis is an integral part of periodontal practice and it influences treatment planning directly whether to treat, retain or remove periodontally involved teeth.1,2 The prognosis of whole dentitions or individual teeth is “dynamic” and may require alteration of projections as health status or dental initiatives (e.g., oral hygiene) change. Similarly, patients diagnosed with diabetes must be informed ol the impact ol diabetic control on the development and progression of periodontitis. CONCLUSIONS: PLMs must be considered when determining the prognosis of a tooth with periodontal disease. The prognosis is questionable when surgical periodontal treatment is required but cannot be provided because of the patient's health (see < hapter W). 3. Incapacitating conditions that limit the patient's performance ol oral procedures (e.g., Parkinson's disease) also adversely affec t the prognosis. Incapacitating conditions that limit the patient's performance ol oral procedures (e.g., Parkinson's disease) also adversely affec t the prognosis. It has been demonstrated that knowledge of the patient's II -1 genotype and smoking status can aid the clinician in assigning a prognosis/1 (ienetic factors also appear to influence serum Ig(i2 antibody titers and the expression of 1-c-yKII receptors on the neutrophil, both of which may be significant in aggressive periodontitis.1, Other genetic disorders such as leukocyte adhesion deficiency type I can influence neutrophil function, creating an additional risk factor for aggressive periodontitis. They are determined by clinical and radiographic evaluation (see Chapters 30 and 31). determining prognosis is the periodontal status of the tooth, usually the attachment loss (8). *n»xnos is • C!H APÏÏ.K t.* 479, variable in this relationship (see t hapter S) Therefore patients at risk for diabetes should be identified as early as possible and informed ol the relationship between periodontitis and diabetes. The determination of the level ot clinical attachment reveals the approximate extent of root surface that is devoid ol periodontal ligament; the radiographic examination shows the amount ot root surface still invested in bone. or. Systemic Disease/Condition. Section 3: Periodontal Treatment Planning. Epidemiologic evidence suggests that smoking may be the most important environmental risk factor impacting the development and progression ot periodontal disease (see Chapter 5). Studies have demonstrated that a patient's history ot previous periodontal disease may he indicative of their susceptibility lor future periodontal breakdown (see Chapter 5). class II mobility, and there are usually significant occlusal problems at this point. In dealing with a tooth with a questionable prognosis, the chances of successful treatment should be weighed against any benefits that would accrue to the adjacent teeth it the tooth under consideration were extracted. Without these, treatment cannot succeed. In a recent article in the Journal of Periodontology, The AAP describes periodontal maintenance as the treatment provided to individuals after the completion of initial (nonsurgical) periodontal therapy with the intention of preventing further disease progression and maintaining the health of the periodontium.8,9 The purpose of a rigorous maintenance schedule is to allow time for tissues to heal after initial therapy, followed by appropriate support to preserve the treatment outcomes without relapse to a diseased state.10 A typical periodontal maintenance appointm… This results in a more favorable distribution of forces to the periodontium and less tooth mobility.44. Smoking. Methods . The presence of apical disease as a result of endodontic involvement also worsen the prognosis. restore these teeth with clear and written expectations about longevity, costs, benefits, For two patients with comparable levels of remaining connective tissue attachment and alveolar bone, the prognosis is generally better in the older of the two. Without these, treatment cannot succeed. Name some common factors in making an overall prognosis for the periodontal patient. patient will at the least use the Sonicare Diamond Clean tooth brush and clean in The presence of complex pockets encompassing multiple root surfaces is a poor prognostic factor than the presence of simple pockets. recommend they be restored except for caries control during the first year after To determine whether you have periodontitis and how severe it is, your dentist may: 1. Review your medical history to identify any factors that could be contributing to your symptoms, such as smoking or taking certain medications that cause dry mouth. when there is so little bone loss that tooth support is not in jeopardy (Tig. 3.1 Treatment planning - gingivitis and periodontitis. Periodontal prognosis refers to the expected longevity of teeth with or without periodontal therapy. The charts below provide an overview. 4. In general, a tooth with deep pockets and little attachment and bone loss has a better prognosis than one with shallow pockets and severe attachment and bone loss. Newer "automated" oral hygiene devices such as electric toothbrushes may be helpful for these patients and … How to use this system for determining periodontal prognosis: 1. Review medical history and complete periodontal charting. usually respond well to therapy and get back into a maintainable state and could be I he answer is readily apparent in extreme c ases, that is. treatment outcomes. restored as desired. This is the Periodontal Prognosis Score for that tooth. 5. PDF. Background . We do not The model proposed in this report is based on the best available evidence for factors affecting tooth survival and has been designed to be as simple and objective as possible to facilitate its adoption in clinical practice. Extraction of the questionable tooth may be followed by partial restoration of the bone support of the adjacent teeth d ig. These teeth When comparing two patients, one 30 years old and another 65 years old having a similar periodontal bone loss, the younger patient has a poor prognosis as compared to the older patient. Only Prognosis is adversely affected if the base of the pocket (level of attachment) is close to the root apex. Assessment of suitability to receive dental implants. Good: Teeth that have pocket depths of 4-5mm and no mobility. I he patient's svs temic background affects overall prognosis in several ways, lor example, evidence from epidemiologic studies clearly demonstrates that the prevalence and severity ot periodontitis is significantly higher in patients with type 1 and type II diabetes than in those without diabetes and that the level of control ot the diabetes is an important. Plaque Control. If patients are unwilling or unable to perform adequate plaque control and to receive the timely periodic maintenance checkups and treatments deemed necessary by the dentist, then the dentist can (1) refuse to accept the patient for treatment or (2) extract teeth that have a hopeless or poor prognosis and perform scaling and root planing on the remaining teeth, fhe dentist should make it clear to the patient and in the patient record that further treatment is needed but will not be performed because of a lack of patient cooperation. etc. 9. A system for assigning periodontal prognosis. 2. Determining the risk for In patients with severe periodontitis, the prognosis may be poor to hopeless. Traditional approaches for predicting when disease activity will occur have proved inadequate in some cases. They are good candidates In the case of angular, intrabony defects, if the contour of the existing bone and the number of osseous walls are favorable, there is an excellent chance that therapy could regenerate bone to approximately the level of the alveolar crest.1,1, When greater bone loss has occurred on one surface of a tooth, the bone height on the less involved surfaces should be taken into consideration when determining the prognosis. 3.4 Referral to a periodontal specialist. PDF. 480 PAR I 5 ■ Treatment of Temnton tat Disease. (Note: If you cannot read the numbers in the above The prognosis also can be related to the height of remaining bone. Download Free PDF. Get this from a library! These teeth should Note the excellent bone support. Disease Severity. STEP THREE: Periodontal Maintenance (click for more information) The two most important factors in determining long-term success are patient home care, and regular periodontal maintenance (cleanings). The presence of a complexity factor moves the staging to a higher stage. Commentary: prognosis revisited: a system for assigning periodontal prognosis. Following the tenants of the anti-inflammatory diet to improve their immune system 33-3). In addition, although the younger patient would ordinarily be expected to have a greater reparative capacity, the occurrence of so much destruction in a relatively short, Ih'U'rmiiuition of Prognosis ■ ( HAITI R 33 477. period would exceed any naturally occurring periodontal repair. The loss of periodontal support in relation to patient’s age is an important factor which has to be considered while determining prognosis. A, Extensive bone destruction around the mandibular first molar B, Radiograph made 8.5 years after extraction of the first molar and replacement by a prosthesis. Grade I: The enamel projection extends from the cementoenamel junction of the tooth toward the furcation entrance. The aim of this study is to investigate the factors affecting the prognosis of endo-periodontal lesions. respond well to therapy and expect them to last a lifetime. [] Studies suggest that there is a link between DM, tooth loss, and periodontal prognosis. Overall Clinical Factors, Patient Age. The model proposed in this report is based on the best available evidence for factors affecting tooth survival and has been designed to be as simple and objective as … a patient smokes, the results are never as good and the longevity of the 2. (îenetic polymorphisms in the interleukin-l (II-I) genes, resulting in increased production of II. STUDY. Most patients, however, do not fil into these extreme categories. These factors are determined by clinical and radiographic evaluation (see Chapters 29 and 31). Hopeless: These teeth have Pd’s greater than 8mm, advanced furcation involvement, The present chapter will review all prognosis-related factors while at the same time trying to suggest a chart that might help in determining tooth prognosis for every single case. Establishing a diagnosis and prognosis The purpose of the comprehensive periodontal examination is to determine the periodontal diagnosis and prognosis and/ or suitability for dental implants. Conclusions: PLMs must be considered when determining the prognosis of a tooth with periodontal disease. However, deep pockets are a source ot infection and may contribute to progressive disease. Total the score on EACH tooth. pocket depths are in a 7-8 mm range, the breakdown extends into the furcation regions, should have a good prognosis. / ht en il il mt h m of! Although many periodontal prognosis systems have been developed, most of the prognoses are based on tooth mortality (i.e., extractions).5–8 Assigning an accurate prognosis for each tooth … 8. In addition to these external factors, there also is evidence that genetic factors may play an important role in determining the nature ol the host response.1 Kvidence for this type of genetic influence exists for patients with both chronic and aggressive periodontitis. recommend. Finally, the familial aggregation that is characteristic ot aggressive periodontitis indicates that additional, as yet unidentified, genetic lac tors may be important in susceptibility to this form of disease (see i hapter 2S). Record scoring data on teeth with >4mm probing depth on ”Data Collection Sheet. Attitude and perception of the patient. Basically, these factors should be considered and evaluated together for prognosis of periodontitis recurrence. Patients should be clearly informed ot the important role they must play tor treatment to succeed. Prognosis. Therefore the following variables should be carefully recorded because they are important for determining the patient’s past history of periodontal disease: pocket depth, level of attachment, degree of bone loss, and type of bony defect. If PLAY. Evaluation of potential periodontal systemic inter- relationships. Download PDF Package. Pocket depth is less important than level of attachment, because it is not necessarily related to bone loss. The natural history of periodontal disease, in some but not all patients, results in tooth loss.1 Periodontal disease, however, encompasses a wider Therefore effective removal of plaque on a daily basis by the patient is critical to the success of periodontal therapy and to the prognosis. In addition, patients should be informed that smoking affects not only the severity of periodontal destruction, but also the healing potential of the periodontal tissues. PLMs must be considered when determining the prognosis of a tooth with periodontal disease. Natural Autoimmune Diseases Cure and Treatment, Please refer to Fable .CM during the following discussion. PLMs must be considered when determining the prognosis of a tooth with periodontal disease. It has been shown that without routine maintenance there is a 20-fold increase in the chance of recurrent disease. Prognosis periodontal treatment Once all of the steps of the treatment plan have been carried out, the microbiological test is then repeated to certify that the mouth has regained a healthy ecosystem, hence showing a clear prevalence of saprophytes and a level of percentage of pathogens that the immune system is able to easily manage. I lie progno sis for patients with gingival and periodontal disease is critically dependent on the patient's attitude, desire to retain the natural teeth, and willingness and ability to maintain good oral hygiene. class II & III mobility, and are generally having routine abscesses. Examine your mouth to look for plaque and tartar buildup and check for easy bleeding. Ottmar Zellhuber. 2.5 Determining periodontal prognosis. PDF. The prognosis is questionable when surgical periodontal treatment is required but cannot be provided because of the patient's health (see < hapter W). between their teeth twice daily and present for supportive care every 3 months. nonsmokers! recommend extracting these teeth, but in some cases will try laser assisted therapy as a While clinical attachment loss (CAL) is a primary determining factor of the staging, radiographic bone loss (RBL) can be used in the absence of clinical attachment loss. The model proposed in this report is based on the best available evidence for factors affecting tooth survival and has been designed to be as simple and objective as possible to facilitate its adoption in clinical practice. Older patients have issues with dexterity & health. Create a free account to download. Patient Compliance/Cooperation. Fair: Teeth with pocket depths in the 5-7mm range with limited mobility. Download with Google Download with Facebook. PROGNOSIS FOR PATIENTS WITH PERIODONTITIS CHRONIC PERIODONTITIS