DETERMINATION OF PROGNOSIS

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 DEFINITION :
prognosis is a 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 the risk factors
for the disease.
It is established after the diagnosis is made and before the
treatment plan is established.
 is based on
 specific information about the disease
 the manner in which it can be treated
 it also can be influenced by the clinician’s previous experience with
treatment outcomes (successes and failures)

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 Prognosis is often confused with the term risk.
 Risk generally deals with the likelihood that an
individual will develop a disease in a specified period
 prognosis is the prediction of the course or outcome of a
disease
 Risk factors are those characteristics of an individual that
put the person at increased risk for developing a disease
 Prognostic factors are characteristics that predict the
outcome of disease once the disease is present

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Types of prognosis :
 based on studies evaluating tooth mortality

 Good prognosis – control of etiologic factors and adequate

periodontal support ensure the tooth will be easy to maintain
by the patient and the clinicians.
 Fair prognosis – 25% attachment loss and /or class 1 furcation
involvement.(location and depth allow proper maintenance
with good patient compliance)

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Poor prognosis :
•50% attachment loss, class 2 furcation involvement(location and
depth make maintenance possible but difficult).
Questionable prognosis :
•> 50 % attachment loss, poor crown root ratio, poor root form.
class 2 furcations(location and depth make access difficult).or
class 2 furcation involvements;.2+ mobility; root proximity.
Helpless prognosis :
Inadequate attachment to maintain health, comfort and
function.

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Factors to consider when determining a prognosis:
Overall clinical factors:
•Patient age

•Disease severity

•Plaque control

•Patient compliance

Systemic and environmental factors:

•Smoking

•Systemic disease or condition

•Genetic factors

•Stress

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Local factors :
•Plaque and calculus

• Subgingival restorations

Anatomic factors :
•Short, tapered roots

•Cervical enamel projections

•Enamael pearls

•Bifurcation ridges

•Root concavities

•Developemental grooves

•Root proximity

•Furcation involvement

•Tooth mob
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Prosthetic and restorative factors :
Abutment selection

Caries

Nonvital teeth

Root resorption

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OVERALL CLINICAL FACTORS
 Patient Age: for two patients with comparable levels of
remaining connective tissue attachment and alveolar
bone, the prognosis is generally better for the older of
the two.
 Disease Severity: Studies have demonstrated that a
patient’s history of previous periodontal disease may be
indicative of their susceptibility for future periodontal
breakdown
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
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 Plaque Control: effective removal of plaque on a
daily basis by the patient is critical to the success of
periodontal therapy and to the prognosis
 Patient Compliance and Cooperation: dependent on
the patient’s attitude, desire to retain the natural
teeth, and willingness and ability to maintain good
oral hygiene.

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SYSTEMIC AND ENVIRONMENTAL
FACTORS
 Smoking
 most important environmental risk factor impacting the
development and progression of periodontal disease
 affects not only the severity of periodontal destruction but also the
healing potential of the periodontal
 Systemic Disease or Condition
 Well-controlled diabetic patients with slight-to-moderate
periodontitis who comply with their recommended periodontal
treatment should have a good prognosis.
 prognosis is questionable when surgical periodontal treatment is
required but cannot be provided because of the patient’s health
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Relationship between diagnosis and prognosis :

Prognosis for patients with gingival diseases:

1. Dental plaque - induced gingival diseases.
a. the prognosis for patients with gingivitis associated with
dental plaque only is good, provided
 all local irritants are eliminated

 other local factors contributing to plaque retention are

eliminated
 gingival contours conducive to the preservation of health are
attained
 patient cooperates by maintaining good oral hygiene

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b. Plaque - induced gingival diseases modified by systemic
factors.
 long-term prognosis for these patients depends not only on
control of bacterial plaque but also on control or correction of
the systemic factor(s)
c. Plaque - induced gingival disease modified by medications.
 long-term prognosis depends on whether the patient’s systemic
problem can be treated with an alternative medication that does
not have gingival enlargement as a side effect.
d. Gingival diseases modified by malnutrition.
prgns depends on the severity and duration of the deficiency.

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e. Non – plaque induced gingival lessions. (seen in patients with
fungal and viral infections),
Prgns depends on the elimination of the source of the
infectious agent. ( seen in patients with dermatologic
disorders)prgns is linked to the management of the associated
dermatologic disorder.(allergic, toxic,and foreign body
reactions) prgns depends on the elimination of the causative
agents.

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Prognosis for patients with periodontitis :
1. chronic periodontitis ( slight to moderate periodontitis)
prgns is generally good. ( in more severe disease, prgns maybe
downgraded to fair to poor.
2. aggressive periodontitis, prgns for (rapid loss of attchment
or bone) is poor.
3. periodontitis as manifestation of systemic disease, prgns is
poor.

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4. Necrotizing periodontal disease – can be
a. necrotizing ulcerative gingivitis in which the primary pre
disposing factor is the bacterial plaque but can become
complicated by secondary factors such as: acute psychologic
stress,tobacco smoking,and poor nutrition.
With good control of bacterial plque and secondary factors the
prgns of this case is good.

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b. Necrotizing ulcerative periodontitis – this is a necrotic disease
that affect deeper tissues of the periodontium, resulting in loss
of connective tissues and alveolar bone.
Prgns of this case is difficult because it depends on not only
reducing the local and secondary factors but also on dealing
with the systemic problem of the patient.

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