detemination of prognosis

1. DETERMINATION OF
PROGNOSIS IN PERIODONTICS

2. CONTENTS
 Definition
 Determination of prognosis
 Types of prognosis
 Factors affecting prognosis
 Relationship between diagnosis and prognosis
 Reevaluation of prognosis after phase I Therapy
 Conclusion
 Referencess

3.  Made before treatment plan is established
Based on: Specific information of the disease
Previous treatment
Risk factors
Risk : Likelihood that an individual will get a disease in a specified period of
time.

4. Classification of prognosis
 Overall prognosis: Which is considered with the patient and dentition as a whole and
determined by several factors including the type of disease , age of the patient ,
systemic background etc
 Individual tooth prognosis: The individual tooth prognosis is determined after overall
prognosis and is affected by it.

5. Types of prognosis
Prognosis is classified into five types:
 Good prognosis:
Control of etiologic factors and adequate periodontal support ensure the tooth will
be easy to maintain by the patient and clinician

6.  Fair prognosis Approximately 25% attachment loss or grade I furcation invasion
(location and depth allow proper maintenance with good patient compliance)
 Poor prognosis: 50% attachment loss, grade II furcation invasion
(location and depth make maintenance possible but dificult)

7.  Questionable prognosis: >50% attachment loss, poor crown-to-root ratio, poor root form, grade II
furcation invasion (location and depth make access dificult) or grade III furcation invasion;
mobility no. 2 or no. 3; root proximity
 Hopeless prognosis: Inadequate attachment to maintain health, comfort, and function

8. Individual tooth prognosis
 Percentage of bone loss
 Deepest probing depth
 Horizontal | vertical bone loss
 Deepest furcation involment
 Mobility
 Crown to root ratio
 Root form
 Caries or pulpal involvement
 Tooth malposition
 Fixed/Removable Prosthesis
Overall tooth prognosis
 Age
 Medical history
 Family history
 Oral hygiene
 Parafunctional habits
 Patient compliance

9. Provisional prognosis
 The provisional prognosis allows the clinician to initiate treatment of teeth that
have a doubtful outlook in the hope that a favorable response may tip the balance
and allow teeth to be retained. The reevaluation phase in the treatment sequence
allows the clinician to examine the tissue response to scaling, oral hygiene, and
root planning, as well as to the possible use of chemotherapeutic agents where
indicated. The patient's compliance with the proposed treatment plan also can be
determined.

11. FACTORS IN DETERMINATION OF PROGNOSIS
 Overall Clinical Factors
Patient age
Disease severity
plaque control
Patient compliance

12. Patient age
Younger patient
 Shorter time frame
 Systemic disease
 smoking
With same amount
of connective tissue
attachment loss and
bone loss
Older patient
 Longer time frame
 Systemic conditions
 smoking

13. Disease severity
 Past periodontal history
 CAL
 PPD
 Amount of bone loss
 Bone defect

16.  Systemic and Environmental Factors
1)Smoking
 There is direct relationship between smoking and the prevalence & incidence of
periodontitis
 It enhances the periodontal destruction and affects the healing potential of
periodontal tissues.
 Smoking cessation can affect the treatment outcome and therefore the prognosis.
2) Genetic factors: IL- 1 genotype pleomorphism and IgG
3) Stress

17. Local Factors
 Plaque and calculus :
Bacterial plaque and calculus - most important local factor in periodontal
diseases.
Good prognosis- depends on ability of patient and clinician to remove
etiological factor
 SUBGINGIVAL RESTORATIONS : Contribute to
Increased plaque accumulation
Increased inflammation
Increased bone loss
Subgingival margins - poor prognosis

18. Anatomic Factors
1. Short tapered roots: Disproportionate crown to root ratio
2. Cervical enamel projections: Extension of thre cervical enamel margin in furcation area. This
projections may favour the onset of periodontal lesions.
3. Enamel pearl : small focal mass apical to CEJ

19. 4)Developmental grooves
5)Root concavity
6)furcation: molars & premolars
7)Tooth mobilty

20.  Prosthetic and Restorative Factors
Abutment selection: Teeth that severe as abutments are subjected to increase functional
demands.
Caries: A tooth with a post that has undergone endodontic treatment is more likely to fracture
when serving as a distal abutment supporting a RPD
Nonvital teeth : The periodontal prognosis of treated nonvital teeth does not differ from that of
vital teeth.
Root resorption: resorption resulting from orthodontic therapy affects the stability of teeth and
respone to periodontal tretment

21.  Prosthetic and Restorative Factors
Abutment selection: Teeth that severe as abutments are subjected to increase
functional demands.
(The individual tooth prognosis and overall prognosis overlap. In prosthetic
rehabilitation and depending on the need of functional or asthetic pupose of the
teeth)

23. Relationship between diagnosis and prognosis of
disease
 Factors such as patients age, severity of disease, genetic susceptibility and
presence of systemic disease are important criteria in the diagnosis of the
condition and in developing a prognosis.
 For every given diagnosis there should be expected prognosis

24. Prognosis of specific periodontal disease
I )BIOFILM - INDUCED GINGIVAL DISEASES
A)Gingivitis associated with plaque only
 Condition is reversible
 Prognosis : Good (provided all irritant factors are removed)

25. B)Gingivitis associated with systemic disease
 The inflammatory response to bacterial plaque can be influenced by systemic
factors, such as endocrine related changes associated with puberty, pregnancy and
and diabetes.
 Long term prognosis depends - control of bacterial plaque along with correction
of the systemic factors

26. C) Plaque induced gingival disease modified by medications:
 Drug induced gingival enlargement often seen with phenytoin,
cyclosporin, nifedipine and in oral contraceptive associated
gingivitis.
 Plaque control alone does not prevent the development of lesions,
and surgical intervention is usually necessary to correct the
alteration of gingival contours

28. D)Gingival diseases modified by malnutrition
 vitamin C deficiency (gingival inflammation and bleeding on
probing independent of plaque levels present)
 Prognosis of these patients depend upon the severity and
duration of the deficiency and on the likelihood of reversing
the deficiency through dietary supplements

29. II. Non plaque induced gingival lesions
 Seen in patients with a variety of bacterial, fungal and viral
infections.
 Dermatologic disorders such as lichen planus, pemphigoid,
pemphigus vulgaris, erythema multiforme, and lupus
erythematosus can also manifest in oral cavity as atypical
gingivitis.
 Allergic, toxic, and foreign body reactions, as well as
mechanical and thermal trauma, can result in gingival lesions

30. Prognosis for patients with periodontitis
CHRONIC PERIODONTITIS
 In cases where clinical attachment loss and bone loss are not very
advanced (slight to moderate periodontitis) - prognosis - good.
 The inflammation - controlled through good oral hygiene and the
removal of local plaque retentive factors

31. AGGRESSIVE PERIODONTITIS
 Poor prognosis
 Localized aggressive periodontitis –
 Occurs around puberty
 Localized to first molars and incisors
 Patient exhibits strong serum antibody

32.  Diagnosed early - can be treated conservatively with oral
hygiene instructions and systemic antibiotic therapy -
excellent prognosis.
 Advanced diseases - prognosis can be good if the lesions
are treated with debridement, local and systemic antibiotics,
and regenerative therapy.

33.  Generalised aggressive periodontitis:
 fair, poor or questionable prognosis due to generalized
interproximal loss, poor antibody response and thus poor
response to conventional periodontal therapy.

34. PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC
DISEASES
 It can be divided into two categories: -
 periodontitis associated with hematologic disorders such as leukemia and
acquired neutropenia.
 periodontitis associated with genetic disorders such as familial and cyclic
neutropenia, down syndrome and hypophosphatasia.
 Primary etiologic factor - bacterial plaque
 Systemic diseases affect the progression of disease and thus prognosis.

35. GENETIC DISORDERS
 HYPOPHOSPATASIA – Have decreased levels of alkaline phopotase
 EHLERS DALON SYNDROME – A connective tissue disorder
 LEUCOCYTE ADHESION DEFICIENCY SYNDROMRE
 DOWN SYNDROME

36. Necrotising ulcerative periodontitis:
 Necrotizing ulcerative gingivitis (NUG) :
 In NUG - primary predisposing factor - bacterial
plaque.
 Disease - complicated by presence of secondary
factors such as acute psychological stress, tobacco
smoking, poor nutrition leading to
immunosuppression.
 With control of both bacterial plaque and secondary
factors prognosis of (NUG) is good, although tissue
destruction is not reversible.

37.  Necrotizing ulcerative periodontitis (NUP)
 NUP is similar to that of NUG, except the necrosis
extends from the gingiva into the periodontal ligament
and alveolar bone.
 Many patients presenting with NUP are
immunocompromised through systemic conditions, such
as HIV infection

38. REEVALUATION OF PROGNOSIS AFTER PHASE I
THERAPY
 Reduction in pocket depth and inflammation after Phase
I therapy indicates a favorable response to treatment
and may suggest a better prognosis than previously
assumed.
 If the inflammatory changes are not controlled or
reduced by phase I therapy- overall prognosis -
unfavorable.
 In these patients the prognosis can be directly related
to the severity of inflammation

39. conclusion
 Prognosis help us in planning the customized treatment
for each patient thus help in providing overall care to
patient. So it should be given due importance in general
clinical practice.

40. REFERNCES
 Kwok V, Caton J: Prognosis revisited: a system for assigning periodontal prognosis,
J Periodontol 78:2063, 2007.
 Newmans Carranza 13th edition
 Lang N, Bartold PM, Cullinan M, et al: Consensus report: aggressive periodontitis,
Ann Periodontol 4:53, 1999
 McGuire MK, Nunn ME: Prognosis versus actual outcome. III. The effectiveness of
clinical parameters in accurately predicting tooth survival, J Periodontol 67:666,
1996
 Grewe JM, Meskin LH, Miller T: Cervical enamel projections: prevalence, location,
and extent; with associated periodontal implications, J Periodontol 36:460, 1965