PROGNOSIS

OF
PERIODONTIC
S

Submitted By:
Asuncion, Krystyne Joy Millette D.G
Salvacion, Ralph Thomas
Submitted to:
Doctor Myrtle Lim

PROGNOSIS

CONTENTS

Definition
Determination of prognosis
Type of prognosis

Factors affecting prognosis

Relationship between diagnosis and
prognosis
Reevaluation of prognosis after phase I
therapy
Conclusion

References

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.

Goodman et al

Made before treatment plan is established

Based on:

Specific

information about disease

Previous experience

Confused with risk

Risk : Likelihood that an individual will
get a disease in a specified period

DETERMINATION OF
PROGNOSIS:
1> Excellent
2> Good
3> Fair
4> Poor
5> Questionable
6> Hopeless
(Mc Guire et
al 1991)

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
Grade 1 mobility
Grade I furcation involvement
Adequate maintenance possible
Acceptable patient cooperation
Limited systemic / environmental factors

POOR

Moderate to advanced bone loss

Grade 1 or 2 mobility
Grade I and II furcation involvement
Difficult to maintain areas
Doubtful patient cooperation
Presence of systemic / environmental factors

QUESTIONABLE

Advanced bone loss

Grade II and III furcation involvements
Grade 3 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
INDIVIDUAL
TOOTH
OVERALL PROGNOSIS
PROGNOSIS
Factors that may
influence the overall
prognosis include
Patient age
Current severity of
disease
Systemic factors
Smoking
Presence of plaque &
calculus
Patient compliance
Prosthetic possibilities.

Determined

after

the overall
prognosis and is
affected by it.

The overall prognosis

answers
the following
The overall prognosis
answers the following
questions:
questions:

Should treatment be undertaken?

Is it likely to succeed?.
When prosthetic replacements are needed,
are the remaining teeth able to support the
added burden of the prosthesis?

Prosthetic/
Restorativ
e
Factors
Abutment
selection
Caries
Nonvital
teeth
Root
resorption

Local Factors

Systemic/
Environme
ntal
Factors

Overall
Clinical
Factors

- Plaque/calculus
- Subgingival
restorations
- Anatomic factors:
Short, tapered
roots
Cervical enamel
projections
Enamel pearls
Bifurcation
ridges
Root concavities
Developmental
grooves
Root proximity
Furcation
involvement

Smoking
Systemic
disease/cond
ition
Genetic
factors
Stress

Patient
age
Disease
severity
Plaque
control
Patient
complian
ce

OVERALL
CLINICAL
FACTORS

1.PATIENT
AGE

Comparable CT attachment and alveolar bone

prognosis better for older
*Chronic periodontits

Younger patient shorter time more

periodontal destruction
*aggressive periodontitis

2. DISEASE
SEVERITYDetermination of :
Pocket depth less important than level of
attachment because it is not necessarily related to
bone loss.
Clinical attachment level (CAL) increased
attachment loss, poorer prognosis
Degree of bone loss periodontal therapy would
unlikely induce clinically significant regeneration of
bone height ; bone loss affects the bone support of
the tooth
Type of bony defect

*Horizontal type
* Angular type

 horizontal

defects - depends on the

height of the existing bone. (no clinically
significant regeneration)

Angular

defects - if the contour of the

existing bone & 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.(3 walls = better prognosis)

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. PLAQUE CONTROL

Bacterial plaque - primary etiologic factor

associated with periodontal disease.

Effective removal of plaque on a daily basis by

patient.

4. PATIENT COMPLIANCE &

COOPERATION
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. Without these, treatment
cannot succeed. So dentist can
Refuse

to accept the patient for treatment

Extract teeth with hopeless or poor prognosis
and perform scaling and root planing on
remaining teeth

SYSTEMIC/
ENVIRONMENTAL
FACTORS

1.SMOKING

Direct

relationship - smoking and the

prevalence and incidence of periodontitis
Affects severity
Affects

healing
Slight to moderate periodontitis - fair to
poor
Severe periodontitis - poor to hopeless

2. SYSTEMIC DISEASE/
CONDITION

Prevalence and severity of periodontitis

significantly higher - type I and II diabetes
Incapacitating patients - less favorable

*affects dexterity of patients to properly perform

oral hygiene measures
Diseases
that contraindicate perio surgery/
treatment (eg: Pericarditis , myocardial infarction)

4. GENETIC FACTORS

Genetic polymorphism in IL-1 genes resulting in overproduction of

IL-1 - associated with significant increase in risk for severe,
generalized, chronic periodontitis.

The combination of IL-1 allele 2 (IL-1A2889 and IL-1B+3954) in

patients with inflamed periodontal or peri-implant tissues may act
as a risk factor that increases tissue destruction. IL-1 gene
polymorphism may have a negative effect on treatment outcomes
of peri-implantitis in genotype-positive individuals. Additional
research is needed to assess specific polymorphisms that could
be associated with commercially available genetic susceptibility
tests and that may be integrated reliably into the daily
management of patients receiving implants.
Hamdy and Ebrahem

Genetic factors also influence serum IgG2 antibody titers and the
expression of Fc-RII receptors on the neutrophil - significant in
aggressive periodontitis.

 Identification

of genetic factors can lead

to treatment alterations adjunctive
antibiotic
therapy
&
frequent
maintenance visits.

LOCAL FACTORS

1.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.

2. SUBGINGIVAL
RESTORATIONS
Contribute to
Increased plaque accumulation
Increased inflammation
Increased bone loss
Subgingival margins - poor prognosis.

3.ANATOMIC FACTORS

Short,

tapered roots with large crowns, cervical

enamel projections (ceps) and enamel pearls,
intermediate
bifurcation
ridges,
root
concavities, and developmental grooves predispose periodontium to disease

Teeth

with short, tapered roots and relatively

large crown Poor prognosis

CEPs

are flat, ectopic extensions of enamel extending

beyond the normal contours of the cementoenamel
junction.
Enamel pearls are larger, round deposits of enamel
that can be located in furcations or other areas on the
root surface

Developmental grooves create accessibility problems

plaque-retentive area - difficult to instrument

Root concavities exposed through loss of attachment

can vary from shallow flutings to deep depressions.
They appear more marked on maxillary first
premolars, the mesiobuccal root of the maxillary first
molar.
Although these concavities increase the attachment
area and produce a root shape that may be more
resistant to torquing forces but they are inaccessible
to clean.

4.TOOTH MOBILITY
Principal causes Loss

of alveolar bone

Inflammatory

changes in the
periodontal ligament

Trauma

from occlusion.

stabilization

by
use
of
splinting - beneficial impact
on the overall and individual
tooth prognosis.

Non
correctable
Correctable

Prosthetic/Restorative
Factors

The overall prognosis requires a general consideration of

bone levels and attachment levels to establish whether
enough teeth can be saved either to provide a functional and
aesthetic dentition or to serve as abutments for a useful
prosthetic replacement of the missing teeth.

The overall prognosis and the prognosis for individual

teeth overlap because the prognosis for key individual
teeth may affect the overall prognosis for prosthetic
rehabilitation.
For example, saving or losing a key tooth may
determine whether other teeth are saved or
extracted or whether the prosthesis used is
fixed or removable

When few teeth remain, the prosthodontic needs become

more important, and sometimes periodontally treatable
teeth may have to be extracted if they are not compatible
with the design of the prosthesis.

Caries, Non-vital Teeth & Root Resorption.

For

teeth mutilated by extensive caries, the feasibility

of adequate restoration and endodontic therapy should
be considered before undertaking periodontal
treatment.
root resorption that has occurred as a result of
orthodontic therapy, risks the stability of teeth and
adversely affects the response to periodontal treatment.
The periodontal prognosis of treated non-vital
teeth does not differ from that of vital teeth.
New attachment can occur to the cementum of
both non-vital and vital teeth.

RELATIONSHIP BETWEEN
DIAGNOSIS AND PROGNOSIS

Factors such as patient age, severity of

disease, genetic susceptibility, and presence
of systemic disease are important in
developing
both diagnosis as well as
prognosis.

PROGNOSIS OF 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.

AGGRESSIVE
PERIODONTITIS
Poor prognosis
Localized aggressive periodontitis
Occurs around puberty
Localized
Patient

to first molars and incisors

exhibits strong serum antibody response

the infecting agent contributing to localization
lesions.

to
of

Diagnosed early - can be treated conservatively with

oral hygiene instruction 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

Generalized form fair, poor or questionable

prognosis due to generalized interproximal loss,
poor antibody response and thus poor response to
conventional periodontal therapy.

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.

Neutropenia Low concentration of neutrophils

Hypophosphatasia - is a serious, progressive, and lifelong

disease that can damage bones and organs.

Primary etiologic factor - bacterial plaque

Systemic diseases affect the progression of disease and

thus prognosis.

NECROTIZING
PERIODONTAL DISEASES

Acute Necrotizing ulcerative gingivitis (ANUG)

Acute Necrotizing ulcerative periodontitis (ANUP).

In ANUG - 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 (ANUG) - good
although tissue destruction is not reversible.

ANUP is similar to that of ANUG, except the

necrosis extends from the gingiva into the
periodontal ligament and alveolar bone.

Many patients presenting with

immunocompromised
through
conditions, such as HIV infection.

ANUP are
systemic

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 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.

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.

REFERENCES
Carranzas Clinical Periodontology 10th Edition.
Lindhe- 5th edition
Hart TC,Kornman KS. Genetic factors in
pathogenesis of periodontitis. Periodontol 2000
1997;14:202
Hamdy and Ebrahem. Journal of Oral Implantology.
Effect of Interleukin-1 Allele 2 Genotype (IL-1a2889
and IL-1b+3954) on the Individuals Susceptibility to
Peri-Implantitis: Case-Control Study. Retrieved
August 28, 2016, from
http://www.joionline.org/doi/pdf/10.1563/AAID-JOI-D09-00117.1

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