Although the classic literature has shown that periodontal treatment works, the threshold for tooth extraction in favor of implant therapy remains low. One study suggests that anterior incisors with 50% bone loss, premolars with 48% bone loss, and molars with 42% bone loss are likely to be extracted instead of saved with periodontal therapy.
Full Answer
What is periodontal prognosis?
It is the prognosis of the teeth after an appropriate periodontal treatment is provided. The treatment may vary from primary periodontal treatment for stopping the disease progression to regenerative procedures.
How do periodontal pockets affect the prognosis of gum disease?
In general, teeth with shallow periodontal pockets have a better prognosis than teeth with deep pockets (8 mm or more). The presence of complex pockets encompassing multiple root surfaces is a poor prognostic factor than the presence of simple pockets.
Can we predict tooth loss in periodontal patients?
The potential prognostic value of clinical, genetic, and radiographic variables in predicting tooth loss in periodontal patients was assessed in a 10-year retrospective analysis[15]. Sixty periodontal patients were treated according to the standard of care and were placed at 3-4 mo maintenance schedules.
Which factors affect the prognosis of tooth loss due to PPD?
Logistic regression analysis showed that loss of teeth with a poor prognosis depended on the initial deepest PPD, tooth mobility and multi-rooted tooth.
What is the prognosis of periodontal disease?
Outlook / Prognosis Periodontitis is a serious condition. It can lead to permanent tooth loss. If you have any symptoms of gum disease, such as gum sensitivity or bleeding gums, see your dentist.
Which teeth are involved in aggressive periodontitis?
Clinically it is characterized as having "localized first molar/incisor presentation with interproximal attachment loss on at least two permanent teeth, one of which is a first molar and involving no more than two teeth other than first molars and incisors".
How do you determine prognosis of teeth?
Six prognostic factors that could be quantitatively evaluated were selected to be scored: age, probing depths, furcation involvement, mobility, molar type, and smoking. A statistically derived score was determined for each factor. The sum of these scores became the score for that tooth.
Which form of periodontal disease is not reversible?
Slight Periodontal Disease The second stage of periodontal disease is not reversible, but you can manage it with help from your dentist. At this stage, you'll notice swelling and redness of the gums, bleeding while brushing and flossing, bad breath, and deep pockets between your teeth at about 4 or 5 millimeters deep.
What is rapidly progressive periodontitis?
Rapidly progression periodontitis or aggressive periodontitis causes rapid destruction of the periodontium which leads to early tooth loss. It may be generalized or localized.
What is chronic aggressive periodontitis?
Aggressive periodontitis is characterized by severe and rapid loss of periodontal attachment and may be more common in children and adolescents. In young individuals, the onset of these diseases is often circumpubertal.
What are the levels of prognosis?
A prognosis may be described as excellent, good, fair, poor, or even hopeless. Prognosis for a disease or condition is largely dependent on the risk factors and indicators that are present in the patient.
How do you test periodontal prognosis?
In conclusion, determining a periodontal prognosis requires an evidence-based evaluation that utilizes data from a thorough clinical and radiographic examination. Risk assessment is an ongoing process that requires clinicians to be knowledgeable of the various — and dynamic — factors that influence the disease state.
Is prognosis a treatment?
Prognosis is the chance of recovery. Survival statistics also help doctors evaluate treatment options. Researchers usually give survival statistics as rates for specific cancer types. Survival rate.
What is Stage 4 periodontal disease?
In stage four the periodontal disease has taken a firm hold. Your gums will be visibly receding, exposing tender tooth enamel which can be easily damaged and then start to decay. The hidden damage to your jawbone will start to become noticeable as your teeth start to loosen, becoming wobbly or even moving position.
Is severe periodontal disease reversible?
Periodontitis can't be reversed, only slowed down, while gingivitis can be reversed. This is why it's important to catch it in its early stages and prevent it from moving on to periodontitis.
Can bone loss from periodontitis be reversed?
Left untreated, the bone in your jaw and around your teeth will continue to resorb, leading to more tooth loss, disease, and pain. There is good news! In most cases, dental bone loss can be stopped. And with expert periodontal care, you can actually regenerate bone and reverse bone loss.
What is the overall prognosis of teeth?
Overall Prognosis: It refers to the prognosis of the teeth based on the sum of various local, systemic, environmental and other factors which may affect the overall periodontal health of the teeth. Various factors which determine overall tooth prognosis are 5, Age. Medical status.
What is the prognosis of a tooth?
Prognosis is the prediction of the probable course, duration, and outcome of a disease, based on the general knowledge of the pathogenesis of the disease and the presence of risk factors for the disease 4. In dentistry prognosis of a particular tooth or teeth depends on various factors.
Why is the number of teeth present in the oral cavity better?
This is because occlusal forces are distributed adequately among all the teeth. If few teeth are missing, the remaining teeth must bear all the masticatory and parafunctional stresses, which is a bad prognostic factor. Further, if many teeth are missing and the remaining teeth are also supporting removable or fixed prosthesis, the prognosis is even poor.
How difficult is it to predict periodontal disease?
Establishing the prognosis of periodontally involved tooth or teeth is indeed difficult. Various studies have found that it is very difficult to determine the exact prognosis of periodontally compromised teeth after their appropriate periodontal treatment. Hirschfeld and Wasserman (1978) 1 in a study evaluated 15,000 teeth in 600 patients at least 15 years after they were treated for advanced periodontitis. These patients were well motivated regarding professional oral health care and personal oral health care, including maintenance of oral hygiene and periodontal health. However, due to marked differences in their post-operative course, these patients lost zero to 23 teeth per patient during this period of evaluation. Similarly, in a series of studies, McGuire and Nunn (1991, 1996) 2, 3 concluded that it is difficult to predict the prognosis of teeth with an initial prognosis of less than good. In other words, it can be said that it is very difficult to establish an accurate prognosis of periodontally compromised tooth/teeth. However, with accurate analysis of the periodontal condition, occlusion, systemic factors and patient motivation a predictable prognosis can be determined most of the times. In the following sections, we shall discuss the factors which determine the prognosis of a tooth.
Why do endodontists perform a periapical examination?
Endodontic examination serves to improve treatment planning, performance, and prognosis. Long-standing endodontic involvement may result in the formation of a periapical lesion. Appropriate endodontic treatment improves the prognosis of the tooth. If the periapical lesion is large, apical surgery should be performed.
What is the diagnostic prognosis of teeth?
Diagnostic prognosis: It is the prognosis of the teeth if no treatment is provided. In other words, we can say that what will be the status of the teeth under question in the future if no treatment is provided for the present periodontal condition.
How much bone support is needed for a tooth to have a favorable prognosis?
The remaining bone support is directly proportional to the prognosis of the tooth. In general, two third to one half of the investing bone is the minimal requirement for a tooth to have a favorable prognosis.
Why is periodontal regenerative surgery required at tooth 46?
She was advised that periodontal regenerative surgery at tooth 46 would be required after non-surgical repair of the strip perforation in order to preserve the tooth, maximize attachment gain, and decrease the pocket depth to a more maintainable range.
What is periodontal regenerative medicine?
Periodontal regenerative medicine encompasses a spectrum of procedures that restore lost tooth-supporting hard and soft tissue, thereby reversing some of the damage caused by periodontal disease. This is in contrast with repair of periodontal tissues that was the staple of periodontal treatment for decades.
Does EMD increase osteoclast activity?
This results in diminis hed osteoclast activity. EMD increases the proliferation of T-lymphocytes, which enables tissue debridement. EMD promotes the formation of osteoblasts, it improves periodontal ligament (PDL) cell regeneration, and it improves angiogenesis.
What are the advancements in periodontal regenerative medicine?
Another advancement in the field of periodontal regenerative medicine has been due to the use of growth factors, proteins, and stem cells. The ability to repair/regenerate a diseased tooth is often dependent upon the extent of the defect, namely the number of bone walls that are left surrounding the tooth.
Can flap surgery detoxify the root surface?
In other words, even experienced clinicians who access a root surface with flap surgery are sometimes limited in the amount of detoxification that can occur due to the depth of the defect and conventional instrumentation.
Does periodontal treatment increase tooth survival?
Periodontal treatment, even in advanced bone loss situations, has been shown to increase tooth survival rates in the literature with the conclusion that only a small group of study subjects lost the majority of the teeth.
Can bone grafts become alive?
(15) Simply stated, your bone graft can become alive, and teeth that were once unable to be repaired now have a chance.
Is 50% bone loss a hopeless prognosis?
Classically, a tooth that was affected with greater than 50% bone loss was given a questionable to hopeless prognosis. (2) In addition, if the tooth was a multirooted tooth and exhibited furcation involvement, the tooth was further downgraded toward the hopeless category and extraction treatment. Periodontal treatment, even in advanced bone loss ...
Introduction to Prognosis
Definition
- Prognosis is the prediction of the probable course, duration, and outcome of a disease, based on the general knowledge of the pathogenesis of the disease and the presence of risk factors for the disease 4. In dentistry prognosis of a particular tooth or teeth depends on various factors. Usually, patients commonly ask questions like, for how many years my teeth will be all right after this tre…
Types of Prognosis
- The prognosis can be classified in two ways. One classification of prognosis classifies it as diagnostic, therapeutic or prosthetic prognosis and the other classification classifies it as the individual and overall prognosis.
Factors Affecting Individual Prognosis
- Remaining bone support:
The remaining bone support is directly proportional to the prognosis of the tooth. In general, two third to one half of the investing bone is the minimal requirement for a tooth to have a favorable prognosis. However, this is a crude method for the determination of prognosis because there ar… - Probing depth:
The presence of periodontal pockets indicate active periodontal disease. In general, teeth with shallow periodontal pockets have a better prognosis than teeth with deep pockets (8 mm or more). The presence of complex pockets encompassing multiple root surfaces is a poor progno…
Factors Affecting Overall Prognosis
- Age of the patient:
The loss of periodontal support in relation to patient’s age is an important factor which has to be considered while determining prognosis. 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 prog… - Medical status of the patient:
The systemic condition of the patient is a very important factor in the determination of the overall prognosis. Systemic conditions, like uncontrolled diabetes mellitus, are associated with poor periodontal prognosis. Both diseases are thought to share a common pathogenesis that involve…
Categorization of Prognosis
- A thorough analysis of the factors discussed above guides us to determine the individual tooth and overall prognosis of a patient. It should be remembered that prognosis does not remain the same for a patient. In patients who respond well to the treatment the prognosis improves, whereas in patients where results of treatment are not as expected, the prognosis may worsen. …
Whether to Retain Or Extract The Involved Tooth
- After critically analyzing the tooth-related and patient-related factors, the decision about retaining or extracting a tooth should be made. It must be remembered that a severely involved tooth jeopardizes the adjacent teeth. Hence, retaining such a tooth is not a wise decision. Teeth should be evaluated for their periodontal status, endodontic status, periapical pathology, if present and …
Conclusion
- Patients commonly ask about the prognosis of their dentition and it becomes the moral duty of the dentist to explain it to the best of his/her capability. Although it is very difficult to predict the exact prognosis of the tooth, but if careful examination of the dentition and patient as a whole is done, one can establish a quite accurate prognosis. In an effort to improve one’s prognostic skill…
Suggested Reading
- Kwok V, Caton JG. Commentary: prognosis revisited: a system for assigning periodontal prognosis. Journal of periodontology. 2007 Nov;78(11):2063-71.
- Rotstein I, Simon JH. Diagnosis, prognosis and decision‐making in the treatment of combined periodontal‐endodontic lesions. Periodontology 2000. 2004 Feb;34(1):165-203.
- Faggion Jr CM, Petersilka G, Lange DE, Gerss J, Flemmig TF. Prognostic model for tooth surv…
- Kwok V, Caton JG. Commentary: prognosis revisited: a system for assigning periodontal prognosis. Journal of periodontology. 2007 Nov;78(11):2063-71.
- Rotstein I, Simon JH. Diagnosis, prognosis and decision‐making in the treatment of combined periodontal‐endodontic lesions. Periodontology 2000. 2004 Feb;34(1):165-203.
- Faggion Jr CM, Petersilka G, Lange DE, Gerss J, Flemmig TF. Prognostic model for tooth survival in patients treated for periodontitis. Journal of Clinical Periodontology. 2007 Mar;34(3):226-31.
- Hughes FJ, Syed M, Koshy B, Marinho V, Bostanci N, McKay IJ, Curtis MA, Croucher RE, Marcenes W. Prognostic factors in the treatment of generalized aggressive periodontitis: I. Clinical features an...
