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Prognosis and Results After Periodontal TherapyChapter 18 Prognosis and Results After Periodontal Therapy Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Introduction Prognosis is the prediction or forecast of the extent and duration of disease and its response to treatment. The pathogenesis of the disease and individual patient factors, including overall health, risk factors, and compliance, influence the prognosis. Prognosis is a major consideration in treatment planning; all treatment should be based on the interventions that are expected to provide the best outcomes. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Overall Prognosis The factors that are considered in making an overall prognosis for the patient with periodontal disease are: Age Systemic health Smoking Type of periodontal disease Oral conditions, including inflammation and bone levels Attitude and perceptions of the patient Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Individual Tooth PrognosisThe overall prognosis for the dentition may differ from that of the individual teeth. A patient with periodontal disease may have one or more teeth with a poor prognosis, but the overall prognosis for the dentition is good. Successful therapy may include the removal of some teeth to preserve the rest and to restore the dentition to function and esthetics. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Individual Tooth Prognosis (Cont.)The prognosis of the individual teeth is evaluated first on the basis of the overall prognosis and then on the status of each tooth according to: Pocket depths and attachment loss Mobility Amount and location of furcation involvement Tooth morphologic features Bone levels General condition of the tooth Ability to modify etiologic factors Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Individual Tooth Prognosis (Cont.)Pocket Depths The extent that deep pockets exist in the mouth can adversely affect the prognosis for a tooth. Some evidence suggests that persistent deep pockets are a risk indicator for future periodontal disease destruction for the patient but not limited to the site. Deep pockets also generally reflect loss of attachment to the tooth, a further indication that the tooth is weakened and an indicator of a less- favorable prognosis. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Individual Tooth Prognosis (Cont.)Mobility Mobility is associated with less-favorable periodontal outcomes but is not confirmed as a risk factor. Mobility can result from the loss of support for the tooth or trauma from occlusion. If mobility can be corrected by altering occlusal forces, then it has no detrimental effect on the prognosis. If mobility is the direct result of loss of support for the tooth, then the prognosis is less favorable. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Individual Tooth Prognosis (Cont.)Furcation Involvement Furcation involvement has a negative effect on the prognosis for an individual tooth. Access for scaling and root planing and homecare is difficult to obtain; therefore these areas can continue to harbor pathogenic plaque biofilm. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Individual Tooth Prognosis (Cont.)Tooth Morphologic Features Tooth morphologic features can alter the prognosis for specific teeth. Lingual grooves and cervical projections of enamel lead to isolated pocketing and can permit severe periodontal infections to occur. These findings are not uncommon. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Patient ConsiderationsThe ideal treatment plan is formulated in the best interests of the patient with the intent to preserve all teeth for as long as possible. Patients need to know all of the treatment options and how their decisions may alter their future oral health. This knowledge must be related through discussion of the prognosis for treatment. In the end, the patient is the one who accepts the treatment or chooses to modify it. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Prognoses for Common Periodontal DiagnosesPeriodontal diseases are categorized into groups of diseases with generally similar signs, symptoms, and outcomes. The prognosis is typical of diseases in an associated group. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Gingivitis Associated with Dental Plaque OnlyGingivitis that is associated with dental plaque only is a reversible disease caused by bacterial plaque biofilms. The prognosis is considered good, provided that all contributing factors can be eliminated and the tissue can be returned to a state of health. An excellent prognosis is reserved for gingival disease in which no attachment loss has occurred; consequently, healing the gingival inflammation completely restores the oral condition. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Plaque-Induced Gingival Diseases Modified by Systemic FactorsIn plaque-induced gingival diseases modified by systemic factors, other diseases and conditions mediate the host response to the bacterial assault. Patients tend to have extensive reactions to what seems to be a small amount of plaque. The prognosis depends on both the plaque biofilm control and the control or correction of the systemic situation. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Plaque-Induced Gingival Diseases Modified by MedicationsThe use of drugs, such as phenytoin, nifedipine, and oral contraceptives, has been shown to be related to gingival conditions. Some drug-related gingival enlargements are extensive and recur even after surgical correction. Long-term prognoses are related to both plaque biofilm control and the long-term use of the medications. Although generalizing is hard, these conditions can be managed with treatment for many years; therefore the prognosis can be fair to good. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Gingival Diseases Modified by MalnutritionThe prognosis of gingival diseases modified by malnutrition depends on the severity and duration of the deficiency. The condition can be treatable, thus restoring periodontal health, or periodontal support can be so damaged that the teeth are lost. Prognosis can range from hopeless to good. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Chronic PeriodontitisThe prognosis for chronic periodontitis is generally good if the inflammation is controlled. Severe attachment loss, furcation involvement, and uncooperative patients worsen the prognosis to fair or poor. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Aggressive PeriodontitisAggressive periodontitis is related to the rapid loss of attachment and bone destruction in otherwise healthy patients and is found to be a family trait. The localized form is amenable to periodontal treatment and systemic antibiotic therapy. With proper treatment, the localized aggressive periodontitis has a good-to-excellent prognosis. Generalized aggressive periodontitis often has other associated risk factors, possibly systemic alterations in host defenses. The generalized form of periodontal disease has a fair-to-poor or even a questionable prognosis. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Periodontitis as a Manifestation of Systemic DiseasesPatients who display periodontitis as a manifestation of a systemic disease have serious systemic or genetic disorders that limit the host’s ability to respond to the challenge of the disease. Even with repeated treatment, these patients often have, at best, only a fair prognosis. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
Necrotizing Ulcerative DiseasesNecrotizing ulcerative gingivitis (NUG) is primarily caused by bacterial plaque biofilm with secondary factors such as stress or poor nutrition. Patients commonly have repeated episodes of the disease. NUG is amenable to periodontal treatment with the prognosis dependent on managing both the systemic condition and the manifestations of the local periodontal disease. In general, the prognosis for this disease is good. Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc.
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