PROGNOSIS

• PRESENTED BY
U.THANUSHA
INTERN
 CONTENTS

• DEFINITION
• CLASSIFICATION
• FACTORS CONSIDERED IN PROGNOSIS
• TYPES OF PROGNOSIS
• PROGNOSIS OF PERIODONTAL DISEASES
• CONCLUSION
DEFINITION
Prognosis is the prediction of the probable course,duration
and outcome of the disease based on the general knowledge
of the pathogenesis of the disease and the presence of risk
factors for the disease
-carranza
 TYPES OF PROGNOSIS

INDIVIDUAL OVERALL PROGNOSIS

PROGNOSIS
 FACTORS CONSIDERED IN PROGNOSIS
INDIVIDUAL PROGNOSIS OVERALL PROGNOSIS
*LOCAL FACTORS * PROSTHETIC RESTORATIVE *OVERALL CLINICAL
FACTORS *SYSTEMIC/ENVIRONME FACTORS
1.PLAQUE/CALCULUS 1.ABUTMENT SELECTION -NTAL FACTORS
2.SUBGINGIVAL RESTORATION 2.CARIES
1.PATIENTS AGE 1.SMOKING
3.ANATOMICAL FACTORS 3.NON VITAL TEETH
*SHORT TAPERED ROOTS 4.ROOT RESORPTION
2.DISEASE SEVERITY 2.SYSTEMIC
DISEASES
*ENAMEL PROJECTIONS
*ENAMEL PEARLS 3.PLAQUE CONTROL 3.GENETIC
*BIFURCATION RIDGES FACTORS
*ROOT CONCAVITIES
4.PATIENT COMPLIANCE 4.STRESS
*ROOT PROXIMITY
*FURCATION INVOLVEMENT
*TOOTH MOBILITY
*DEVELOPMENTAL GROOVES
 A)TOOTH MORPHOLOGY

Anatomic factors may predispose the periodontium to disease and therefore affect
prognosis
prognosis is poor in patients with
*short tapered roots
*relatively large crowns
*enamel projections on root surface
*developmental grooves
*cervical enamel projections
*root proximity.
*furcation.
 B)TOOTH MOBILITY
1. Mobility results from the loss of alveolar bone, inflammatory changes in PDL
and trauma from occlusion.
2. Tooth mobility resulting from inflammation and trauma from occlusion can be
corrected. 3.
Tooth mobility from loss of alveolar bone is not likely to be corrected
4. The stabilization of tooth mobility through the use of splinting may have a
beneficial impact on the overall and individual prognosis.

C)GINGIVAL INFLAMMATION
1. With other factors being equal, the prognosis of periodontal disease is directly
related to the severity of inflammation.
2. IN TWO PATIENTS WITH COMPARABLE BONE DESTRUCTION, THE PROGNOSIS IS
MUCH BETTER IN PATIENT WITH GREATER DEGREE OF INFLAMMATION.
 D)PERIODONTAL POCKET
1. In suprabony pockets, the location of the base of the pockets affect prognosis of
the individual teeth than pocket depth.
2. Prognosis is adversely affected if the base of the pocket is close to the root
apex, even if there is no evidence of apical disease.
3. Proximity to frenal attachments, to muco-gingival line jeopardizes the prognosis,
unless corrective procedures are included in treatment.
4. Elimination of infrabony pockets depends on several factors like contour of
osseous defects and No. of bony walls.
 E) LOCATION OF
PERIODONTAL POCKET
1. Location of the base of periodontal pocket is more important
than pocket depth in determining the overall prognosis.
2. Pocket depth is less important than level of attachment
because it is not necessarily related to the bone loss.
3. 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.

F) BONE LOSS
1. If the amount of bone loss can be accounted for by local
factors, local treatment can be expected to arrest the bone
destruction and overall prognosis of dentition
2. If bone loss is more than ordinarily expected from patient's
age; prognosis is poor due to systemic factors. If systemic cause
can be detected prognosis can be improved.
 G)LOCATION OF REMAINING
BONE
• Location of remaining bone in relation to individual tooth surface, where
greater bone loss has occurred on one surface of a tooth, the bone height on the
less involved surface should be taken into consideration in determining the
prognosis. H)HEIGHT OF REMAINING BONE
1. Prognosis is also related to the height of the remaining bone.
2. The prognosis for horizontal bone loss depends on the height of the existing
bone.
 I)RELATION TO ADJACENT
TEETH
- Extraction of questionable tooth is followed by partial restoration of the bone support of
adjacent teeth

J)TEETH ADJACENT TO EDENTULOUS AREA

• The prognosis of abutment teeth depends upon the.
.
1.Extent of bone loss of the abutment teeth.
. 2.Position of the abutment tooth.
. 3.Nature of the
rootType of bone defect k)ENDODONTIC FACTORS
• The presence of apical disease as a result of endodontic involvement also worsens
prognosis.
 L)TYPE OF BONE DEFECT
1. The prognosis for horizontal bone loss depends upon the
height of the existing bone.
2. The prognosis for angular, intrabony defects depend upon
the contour of the existing bone and the number of osseous
walls.
3. The chance to regenerate bone in vertical bony defect is
excellent when compared to horizontal bony defects.

M)FURCATION INVOLVEMENT
1. It causes difficulty in surgical access to the area.
2. It causes inaccessibility of the area to plaque removal by patient.
3. Prognosis is usually unfavorable when the anatomical defects (palato gingival groove) reach
the mesio-distal furcation.
 N)CARIES AND NON VITAL
TEETH
Periodontal therapy should be considered only if feasibility of adequate restoration of such teeth
is possible.
O)MALOCCLUSION
1. Malocclusion may interfere with plaque control or produce occlusal interferences .
2. Overall prognosis is poor in patients with occlusal deformities which cannot be corrected.
3. Orthodontic correction is often necessary for the success of periodontal therapy.

P)ORTHODONTIC FACTORS
Root resorption that has occurred as a result of orthodontic treatment
jeopardizes the stability of teeth and adversely affects the response to periodontal treatment.
 Q)PROSTHETIC FACTORS
1. If the number and distribution of teeth are inadequate for the support of a satisfactory
prosthesis, the overall prognosis is bad.
2. When some of the teeth are to be replaced with fixed prosthesis, periodontal support of the
abutment teeth have to be evaluated.
3. Teeth serving as abutment are subjected to the increased functional demands.
4. The prognosis of abutment teeth depends on the extent of bone loss of the abutment teeth,
nature of the root and position of the abutment tooth also.
 OVERALL PROGNOSIS
. Depending on the overall prognosis of dentition, a decision is made, whether to provide
periodontal therapy or to advise total extraction of teeth
A)PATIENT AGE
1. In two patients with comparable levels of remaining connective tissue attachment and
alveolar bone, the prognosis is better in the older of the two.

B)PATIENTS
1. Patient's attitude, desire to retain natural teeth and ability to maintain good oral hygiene is of
COMPLIANCE
great significance in the success of the treatment.
2. Proper motivation of the patient is very important

C)PATIENTS EMOTIONAL
STATUS
• Physical and emotional stress as well as substance abuse may alter patient's ability to respond
to the periodontal treatment performed.
D)PATIENTS HABITS
1. A direct relationship exists between the tobacco smoking and periodontal disease incidence.
2. Unless the patient stops smoking, proper healing of the periodontal tissue cannot be expected .
3. In patients who smoke and have slight to moderate periodontitis, the prognosis is generally
fair to poor. In patients with severe periodontitis, the prognosis may be poor to hopeless .
4. Patient's habit of plaque control is another important factor. Plaque is the primary
etiological factor for periodontal disease. Therefore effective removal of plaque is important
for the success of periodontal therapy and to the prognosis.
 E)PATIENT’S SYSTEMIC CONDITION

1. Patient's systemic background affects overall prognosis in several ways. Eg: Diabetes,
nutritional deficiency, hypothyroidism etc. 2.
Patients suffering from known systemic disorders that could affect periodontal health have poor
overall prognosis, unless the systemic condition is brought under control.
3. The prevalence and severity of periodontitis is higher in patients with Type I and Type II DM.
4. Patients with well controlled diabetes, with slight to moderate periodontitis, who respond
well to the recommended periodontal instructions, have good prognosis.
5. Parkinsonism adversely affects patient's ability to perform oral hygiene and prognosis.
 F)PATIENT’S GENETIC BACKGROUND
1. Genetic influence exists for both chronic and aggressive periodontitis.
2. Detection of genetic variations that are linked with periodontal disease can
potentially influence prognosis in several ways.
3. Early detection of patients at risk of genetic factors can
lead to early implementation of preventive measures for treatment of those patients.
4. Identification of genetic risk factors later in
the disease or during the course of treatment can influence treatment recommendations,
such as use of adjunctive antibiotic therapy or increased frequencies of maintenance
visits. 5. Identification
of young individuals who have not been evaluated for periodontitis but who are
recognized as being at risk because of familial aggregation seen in aggressive
periodontitis can lead to the development of early intervention.
6. In each of these cases, early diagnosis, intervention or
alternation in treatment regimen may lead to an improved prognosis for the patient.
 PROGNOSIS OF PERIODONTAL
DISEASES
Gingivitis associated with dental plaque only
• The prognosis for patients with gingivitis associatedwith dental plaque
only is good, provided all localirritants are eliminated.Plaque induced gingival diseases
modified by systemic factors • The prognosis for these patients depends on not only
control of bacterial plaque but also on the control of underlying systemic factors.

Plaque induced gingival diseases modified by

medications
1. Drug influenced gingival diseases/
enlargements often seen with phenytoin, cyclosporine,
nifedipine and oral contraceptives.
2. The
prognosis in these cases depends on whether the
patient's systemic problem can be treated with
alternative medication.
Gingival inflammation modified by malnutrition
• Prognosis in these cases may be dependent on the severity and duration of
deficiency and on thelikelihood of reversing the deficiency through dietarysupplementation.
Chronic periodontitis
1. In moderate cases without advanced attachment loss, prognosis is
generally good. But inflammation has to be controlled through good oral hygiene and
removal of local plaque-retentive factors
2. In severe cases, disease with furcation involvement, increased
tooth mobility and who are non-compliant with oral hygiene, prognosis is downgraded from
fair to poor
Aggressive periodontitis
LAP
1. If diagnosed early can be treated conservatively with oral hygiene instructions and
systemic antibiotic therapy, resulting in excellent prognosis.
2. In advanced cases, the prognosis is still good if the lesions are treated with
debridement, local and systemic antibiotics and regenerative therapy.
GAP
Depending on risk factors, severity of disease prognosis is often fair, poor or
questionable and the use of systemic antibiotics should be considered.
Necrotizing periodontal diseases
NUG
With the control of both bacterial plaque and secondary factors, the prognosis is
good in NUG.
NUP
In NUP cases, the treatment is not only reducing local and systemic factors but also in
dealing with the systemic problem. Prognosis depends on the management of disease
Osseous defects
1. The prognosis of
horizontal bone loss depends on the height of the existing bone.
2. In case of
angular/intra bony 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 to the level of the alveolar crest.
3. Access to the furcation
is usually difficult. Maxillary first premolars have unfavorable
prognosis when the lesion reaches the mesio-distal furcation.
Maxillary molars also present some difficulty and sometimes
their prognosis can be improved by resecting one of the buccal
roots. when mandibular first molars or buccal furcations of
maxillary molars offer good access to the furcationPeriodontitis
as a manifestation of systemicdiseases• In these cases, the
prognosis may be fair to poor and is mainly dependant on the
treatment of systemic diseases.
 CONCLUSION

*PROGNOSIS HELPS US IN PLANNING THE

CUSTOMIZED TREATMENT FOR EACH PATIENT THUS
HELP IN PROVIDING OVERALL CARE TO PATIENT.

*SO IT SHOULD BE GIVEN DUE TO IMPORTANCE IN

GENERAL CLINICAL PRACTICE