3. Periodontal diseases represent a complex interaction between a microbial challenge and the host's response to that challenge, both ol which may be influenced by environmental factors such as smoking. Premium PDF Package. Newer "automated" oral hygiene devices such as electric toothbrushes may be helpful for these patients and … Get this from a library! We do not The effect of endodontic treatment on the success of subsequent periodontal treatment has been studied (9). In some cases this may be because the younger patient suffers from an aggressive type of periodontitis or disease progression may have increased due to systemic disease or smoking. 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. In patients with severe periodontitis, the prognosis may be poor to hopeless. Heroic attempts to retain a hopelessly involved tooth may jeopardize the adjacent teeth. 3.4 Referral to a periodontal specialist. *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. 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. 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. Without these, treatment cannot succeed. image, Click the Image to generate a new one.). 1. The aim of this study is to investigate the factors affecting the prognosis of endo-periodontal lesions. The association between periodontal disease and diabetes mellitus (DM) is well documented. 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. The presence of apical disease as a result of endodontic involvement also worsen the prognosis. Epidemiologic evidence suggests that smoking may be the most important environmental risk factor impacting the development and progression ot periodontal disease (see Chapter 5). Total the score on EACH tooth. 33-4 Extraction of severely involved tooth to preserve bono on adjacent teeth. PLMs must be considered when determining the prognosis of a tooth with periodontal 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. (îenetic polymorphisms in the interleukin-l (II-I) genes, resulting in increased production of II. Conclusions. Free PDF. treatment outcomes. Most patients, however, do not fil into these extreme categories. Smoking. (i) the prevalence of residual periodontal pockets, (ii) tooth loss, (iii) the systemic conditions in each patient, and (iv) environmental or behavioral factors such as smoking (12). 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. Evaluation of potential periodontal systemic inter- relationships. nonsmokers! recommend extracting these teeth, but in some cases will try laser assisted therapy as a The prognosis also can be related to the height of remaining bone. 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. treatment. STUDY. Commentary: prognosis revisited: a system for assigning periodontal prognosis. Genetic Factors. Note the excellent bone support. etc. 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. 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. Systemic Disease/Condition. The natural history of periodontal disease, in some but not all patients, results in tooth loss.1 Periodontal disease, however, encompasses a wider recommend they be restored except for caries control during the first year after 2. restored as desired. Things do not heal as quickly in older patients. lor the younger patient, the prognosis is not as good because of the shorter time frame in which the periodontal destruction has occurred. 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… 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. Patients who have been treated for periodontitis should be staged frequently to monitor them. I he height of remaining bone is usually somewhere in between, making bone level assessment alone insufficient for determining the overall prognosis. Patients should be clearly informed ot the important role they must play tor treatment to succeed. They are good candidates Following the tenants of the anti-inflammatory diet to improve their immune system The type of defect also must be determined. 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 … Methods . The loss of periodontal support in relation to patient’s age is an important factor which has to be considered while determining prognosis. 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. 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. Only Examine your mouth to look for plaque and tartar buildup and check for easy bleeding. 1 -p, have been associated with a significant increase in risk for severe, generalized, chronic periodontitis.'" Questionable: These teeth have a questionable outlook beyond 5-7 years because the 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. 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. [] Studies suggest that there is a link between DM, tooth loss, and periodontal prognosis. usually respond well to therapy and get back into a maintainable state and could be How to use this system for determining periodontal prognosis: 1. Review medical history and complete periodontal charting. 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. 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. last resort and plan to extract them if they continue to be infected. However, there is very limited scientific evidence for the effect of periodontal status on the outcome of endodontic treatment (10) and The charts below provide an overview. Assessment of suitability to receive dental implants. An Evidenced-Based Scoring Index to Determine the Periodontal Prognosis on Molars. INTRODUCTION. Traditional approaches for predicting when disease activity will occur have proved inadequate in some cases. 480 PAR I 5 ■ Treatment of Temnton tat Disease. Determining Prognosis of Periodontally Involved Teeth. 3.2 The management of gingival recession. 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. 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. (February, 2014), researchers followed patients for 25years and looked at their 2. However, surprisingly good apical and lateral bone repair can sometimes be obtained by combining endodontic and periodontal therapy (see ( hapter 65). Record scoring data on teeth with >4mm probing depth on ”Data Collection Sheet. 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. Create a free account to download. Hopeless: These teeth have Pd’s greater than 8mm, advanced furcation involvement, 3.3 Treatment planning: periodontal problems in children and young adults. The prognosis is questionable when surgical periodontal treatment is required but cannot be provided because of the patient's health (see < hapter W). Similarly, patients diagnosed with diabetes must be informed ol the impact ol diabetic control on the development and progression of periodontitis. pocket depths are in a 7-8 mm range, the breakdown extends into the furcation regions, Fair: Teeth with pocket depths in the 5-7mm range with limited mobility. Bacterial plaque is the primary eti-ologic factor associated with periodontal disease (see Chapter 6). Ottmar Zellhuber. 33-3). These teeth class II mobility, and there are usually significant occlusal problems at this point. PDF. Prognosis diegakkan setelah dianosis dibuat dan sebelum rencana perawatan ditegakkan. 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. Plaque Control. These factors are determined by clinical and radiographic evaluation (see Chapters 29 and 31). Download PDF Package. According to The Merriam-Webster Dictionary, “Prognosis” is defined as “the prospect of recovery as anticipated from the usual course of disease or peculiarities of the case.” In medicine, however, the term is commonly defined by the mortality rate. We usually Similarly, in patients with other systemic disorders that could affect disease progression, prognosis improves with correction of the systemic problem. PDF. Natural Autoimmune Diseases Cure and Treatment, Please refer to Fable .CM during the following discussion. 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). for any needed restorative care (fillings, crowns, bridges, etc). Introduction. 33-4). when there is so little bone loss that tooth support is not in jeopardy (Tig. Conclusions: PLMs must be considered when determining the prognosis of a tooth with periodontal disease. (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. between their teeth twice daily and present for supportive care every 3 months. 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 system for assigning periodontal prognosis. PDF. Determining the prognosis for patients and individual sites with inflammatory periodontal diseases is difficult using present methods. Extraction of the questionable tooth may be followed by partial restoration of the bone support of the adjacent teeth d ig. recommend. PDF. Attitude and perception of the patient. Therefore it should be made clear to the patient that a direct relationship exists between smoking and the prevalence and incidence ot periodontitis. 8. Overall Clinical Factors, Patient Age. These teeth should This process includes an Periodontal prognosis refers to the expected longevity of teeth with or without periodontal therapy. 9. 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. The presence of a complexity factor moves the staging to a higher stage. PLAY. 4. 33-1) or when bone loss is so severe that the remaining bone is obviously insufficient for proper tooth support d ig 33-2). Good: Teeth that have pocket depths of 4-5mm and no mobility. function would help immensely, but 95% of people don’t even read the materials I Tig. Patient Compliance/Cooperation. 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. It follows that the prognosis in these cases is dependent on patient compliance relative to both their medical and dental status. 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. The presence of complex pockets encompassing multiple root surfaces is a poor prognostic factor than the presence of simple pockets. Incapacitating conditions that limit the patient's performance ol oral procedures (e.g., Parkinson's disease) also adversely affec t the prognosis. Grade I: The enamel projection extends from the cementoenamel junction of the tooth toward the furcation entrance. Download Free PDF. respond well to therapy and expect them to last a lifetime. They found that It is hard for clinicians to predict their prognosis. 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). Conclusions. This is the Periodontal Prognosis Score for that tooth. 2. 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. Newer "automated" oral hygiene devices such as electric toothbrushes may be helpful for these patients and improve their prognosis (see ( hapter 49). Assuming bone destruction can be arrested, is there enough bone remaining to support the teeth? patient will at the least use the Sonicare Diamond Clean tooth brush and clean in 3.1 Treatment planning - gingivitis and periodontitis. 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). Prognosis is adversely affected if the base of the pocket (level of attachment) is close to the root apex. 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. 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