BY,

JULIA WINSLET
3RD YEAR BDS
DETERMINATION OF PROGNOSIS
 CONTENTS

• Definition
• Determination of prognosis
• Type of prognosis
• Factors affecting prognosis
• Conclusion
• References
 DEFINITION

Prognosis is the prediction of the probable course, duration, and outcome of a

disease based on a general knowledge of the pathogenesis of the disease and the
presence of risk factors for the disease.
Newman &Carranza’s
 Determination of prognosis

• > Excellent
• > Good
• > Fair
• > Poor
• > Questionable
• > Hopeless
 EXCELLENT

• No bone loss
• Excellent gingival condition
• Good patient cooperation
• No systemic/ environmental factors
 GOOD

• Adequate remaining bone support

• Adequate possibilities to control etiologic factors and establish a maintainable
dentition
• Adequate patient cooperation
• No systemic / environmental factors or if present well controlled
 FAIR

• Less than adequate remaining bone support

• Some tooth mobility
• Grade 1 function involvement
• Adequate maintenance possible
• Acceptable patient cooperation
• Limited systemic/ environmental factors
 POOR

• Moderate to advanced bone loss

• Tooth mobility
• Grade 1 &2 furcation involvement
• Difficult to maintain area
• Doubtful patient cooperation
• Presence of systemic/ environmental factors
 QUESTIONABLE

• Advanced bone loss

• Grade 2&3 furcation involvement
• Tooth mobility
• Inaccessible areas
• Presence of systemic / environmental factors
 HOPELESS

• Advanced bone loss

• Non maintainable areas
• Extractions indicated
• Uncontrolled systemic/ environmental conditions.
 OVERALL VERSUS INDIVIDUAL TOOTH PROGNOSIS

OVERALL PROGNOSIS
INDIVIDUAL TOOTH PROGNOSIS
- Patient age
- Determined after the overall prognosis
- Systemic factors &is affected by it.
- Smocking
- Presence of plaque &calculus
- Patient compliance
 PATIENT AGE

• Comparable CT attachment and alveolar bone prognosis better for older.

• Younger patient shorter time more periodontal destruction .
 PLAQUE CONTROL

• Bacterial plaque is associated with periodontal disease

• Effective removal of plaque on a daily basis py patient
 SYSTEMIC / ENVIRONMENTAL FACTORS.
SMOCKING

• Affect severity
• Affect healing
 SYSTEMIC DISEASE/ CONDITION

• Severity of periodontitis higher – type 1&2

• Well controlled patients slight to moderate periodontitis – good prognosis
 GENETIC FACTORS

• Genetic factors influence serum igG2 antibody titers & the expression of neutrophil
– significant in aggressive periodontitis
• Identification of genetic factors can leads to treatment alteration.
 STRESS

• Physical & emotional stress s well as abuse may after the patients ability to
respond to the periodontal treatment .
 LOCAL FACTORS
BIOFILIM & CALCULUS

• Bacterial plaque and calculus most important local factor in periodontal diseases.
 ANATOMIC FACTORS

• Teeth with short , tapered roots & relatively large crown – poor prognosis.
• CEPs are flat, ectopic extensions of enamel extending beyond the normal contour
of the junction.
• Enamel pearls are larger, round deposit of enamel that can be located in furcation
on the root surface.
• Developmental grooves – create accessibility problems plaque- retentive area-
difficult to instrument.
 TOOTH MOBILITY

• Stabilization by use of splinting beneficial impact on the overall &individual tooth

prognosis.
 PROSTHETIC &RESTORATIVE FACTORS

A tooth with a post that has undergone endodontic treatment is more likely to
fracture when serving as a distal abutment supporting a removable partial denture.
PROGNOSIS OF SPECIFIC PERIODONTAL DISEASES
BOIFILIM- INDUCED GINGIVAL DISEASES

• Gingivitis associated with dental plaque only.

Biofilm – induced gingivitis is a reversible disease that occurs when bacterial
biofilm accumulates at the gingival margin.
All local irritations are eliminated other local factors contributing to biofilm retention
are eliminated.
.
 Modified by systemic factors
Endocrine associated with ---puberty,menstruation,pregnancy& diabetes
Long-term prognosis for the patients not only control the bacterial biofilm
but also control or correction of the systemic factors.
 Modified by medications
Phenytoin, cyclosporine, nifedipine & oral contraceptive associated gingivitis.
 Modified by malnutrition
The prognosis in these patients may depend on the severity & duration of the
deficiency & on the like food of reversing the deficiency through dietary
supplementation .
 NON- BIOFILM INDUCED GINGIVAL LESIONS

• It can be seen in patients with a variety of bacterial , fungal , viral infection.

Prognosis for these patients is linked to management of the associated

dermatologic disorder.
 PROGNOSIS FOR PERIODONTITIS PATIENTS

• Chronic periodontitis.
• Aggressive periodontitis.
SYSTEMIC DISEASES
Necrotizing periodontal disease.
 CONCLUSION

The periodontal prognosis plays a pivotal role in therapy , as treatment

decisions are made based on prognosis & to improve prognosis.

REFERANCE:

Newman and carranzas 3rd south asia edition

13th& 14th edition of carranza