Determination of prognosis
Type of prognosis
Factors affecting prognosis
Relationship between diagnosis and prognosis
Reevaluation of prognosis after phase I
4. 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
5. Made before treatment plan is established
Specific information about disease
Confused with risk
Risk : Likelihood that an individual will get a
disease in a specified period
No bone loss
Excellent gingival condition
Good patient cooperation
No systemic / environmental factors
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
Less than adequate remaining bone
Some tooth mobility
Grade I furcation involvement
Adequate maintenance possible
Acceptable patient cooperation
Limited systemic / environmental factors
Moderate to advanced bone loss
Grade I and II furcation involvement
Difficult to maintain areas
Doubtful patient cooperation
Presence of systemic / environmental factors
Advanced bone loss
Grade II and III furcation involvements
Presence of systemic / environmental factors
Advanced bone loss
Uncontrolled systemic / environmental
13. OVERALL VERSUS INDIVIDUAL TOOTH PROGNOSIS
Factors that may
influence the overall
Current severity of
Presence of plaque &
Determined after the
overall prognosis and is
affected by it.
14. 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?
17. 1.PATIENT AGE
Comparable CT attachment and alveolar bone –
prognosis better for older
Younger patient – shorter time – more periodontal
18. 2. DISEASE SEVERITY
Determination of :
Level of attachment
Degree of bone loss
Type of bony defect
19. Prognosis for horizontal bone loss depends
on the height of the existing bone.
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
20. 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.
21. 3. PLAQUE CONTROL
Bacterial plaque - primary etiologic factor
associated with periodontal disease.
Effective removal of plaque on a daily basis by
22. 4. PATIENT COMPLIANCE &
Refuse to accept the patient for treatment
Extract teeth with hopeless or poor prognosis and
perform scaling and root planing on remaining
Direct relationship - smoking and the
prevalence and incidence of periodontitis
Slight to moderate periodontitis - fair to
Severe periodontitis - poor to hopeless
25. 2. SYSTEMIC DISEASE/
Prevalence and severity of periodontitis -
significantly higher - type I and II diabetes
Prognosis dependent on patient compliance
relative to both dental and medical status
Well controlled patients - slight to moderate
periodontitis - good prognosis
26. 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
Genetic factors also influence serum IgG2 antibody
titers and the expression of Fc-RII receptors on the
neutrophil - significant in aggressive periodontitis.
27. Identification of genetic factors can lead to
treatment alterations – adjunctive antibiotic
therapy & frequent maintenance visits.
29. 1.PLAQUE AND CALCULUS
Bacterial plaque and calculus - most
important local factor in periodontal
Good prognosis- depends on ability of
patient and clinician to remove etiological
30. 2. SUBGINGIVAL RESTORATIONS
Increased plaque accumulation
Increased bone loss
Subgingival margins - poor prognosis.
31. 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
32. CEPs are flat, ectopic extensions of enamel extending
beyond the normal contours of the cementoenamel
Enamel pearls are larger, round deposits of enamel
that can be located in furcations or other areas on the
Developmental grooves – create accessibility problems
plaque-retentive area - difficult to instrument
33. 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
Although these concavities increase the attachment
area and produce a root shape that may be more
resistant to torquing forces but they are inaccessible
34. 4.TOOTH MOBILITY
Loss of alveolar bone
Inflammatory changes in the
Trauma from occlusion.
stabilization by use of splinting
- beneficial impact on the
overall and individual tooth
36. 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.
37. The overall prognosis and the prognosis for individual
teeth overlap because the prognosis for key individual
teeth may affect the overall prognosis for prosthetic
38. 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.
39. 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
Extensive idiopathic root resorption or root resorption
that has occurred as a result of orthodontic therapy,
risks the stability of teeth and adversely affects the
response to periodontal treatment.
40. 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.
41. PROGNOSIS FOR PATIENTS WITH GINGIVAL
I. DENTAL PLAQUE INDUCED GINGIVAL DISEASES
Prognosis - good provided all local irritants are
eliminated & patient cooperates by maintaining
good oral hygeine.
42. b) Plaque induced gingival diseases modified
by systemic factors
The inflammatory response to bacterial plaque can be
influenced by systemic factors, such as endocrine
related changes associated with puberty, pregnancy
Long term prognosis depends - control of bacterial
plaque along with correction of the systemic factors.
43. c) Plaque induced gingival disease
modified by medications
• Drug induced gingival enlargement often seen
with phenytoin, cyclosporin, nifedipine and in oral
contraceptive associated gingivitis.
• Plaque control alone does not prevent the
development of lesions, and surgical intervention is
usually necessary to correct the alteration of gingival
44. d) Gingival diseases modified by
Exception - vitamin C deficiency (gingival
inflammation and bleeding on probing independent
of plaque levels present)
Prognosis of these patients depend upon the
severity and duration of the deficiency and on the
likelihood of reversing the deficiency through dietary
45. II. Non plaque induced
Seen in patients with a variety of bacterial, fungal
and viral infections.
Dermatologic disorders such as lichen planus,
pemphigoid, pemphigus vulgaris, erythema
multiforme, and lupus erythematosus can also
manifest in oral cavity as atypical gingivitis.
Allergic, toxic, and foreign body reactions, as well as
mechanical and thermal trauma, can result in
46. PROGNOSIS OF PATIENTS WITH
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
47. AGGRESSIVE PERIODONTITIS
Localized aggressive periodontitis –
Occurs around puberty
Localized to first molars and incisors
Patient exhibits strong serum antibody response to
the infecting agent contributing to localization of
48. 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
49. Generalized form – fair, poor or questionable
prognosis due to generalized interproximal loss, poor
antibody response and thus poor response to
conventional periodontal therapy.
50. PERIODONTITIS AS A MANIFESTATION
OF SYSTEMIC DISEASES
It can be divided into two categories:
- periodontitis associated with hematologic
disorders such as leukemia and acquired
- periodontitis associated with genetic disorders
such as familial and cyclic neutropenia, down
syndrome and hypophosphatasia.
Primary etiologic factor - bacterial plaque
Systemic diseases affect the progression of disease
and thus prognosis.
51. NECROTIZING PERIODONTAL
Necrotizing ulcerative gingivitis (NUG)
Necrotizing ulcerative periodontitis (NUP).
In NUG - primary predisposing factor - bacterial plaque.
Disease - complicated by presence of secondary
factors such as acute psychological stress, tobacco
smoking, poor nutrition leading to immunosuppression.
52. With control of both bacterial plaque and secondary
factors prognosis (NUG) - good although tissue
destruction is not reversible.
NUP is similar to that of NUG, except the necrosis extends
from the gingiva into the periodontal ligament and
Many patients presenting with NUP are
immunocompromised through systemic conditions, such
as HIV infection.
53. 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
If the inflammatory changes not controlled or
reduced by phase I therapy- overall prognosis -
In these patients the prognosis can be directly
related to the severity of inflammation.
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
Carranza’s Clinical Periodontology 10th Edition.
Lindhe- 5th edition
Hart TC,Kornman KS. Genetic factors in pathogenesis of
periodontitis. Periodontol 2000 1997;14:202
PROGNOSIS CAN BE DIVIDED INTO
Overall prognosis is concerned with the dentition as a whole.
Indivual -In a patient with a poor overall prognosis, the dentist would not attempt to retain a tooth that has a questionable prognosis because of local conditions
The overall prognosis answers the following questions:
The level of clinical attachment reveals the approximate extent of root surface that is devoid of periodontal ligament.
Pocket depth is less imp than level of attachment because it is not necessarily related to bone loss. For eg, 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.
Becoz of greater height of bone in relation to other surface the center of rotation will be nearer to crown thus resulting in more favourable distribution of forces to periodontium and less tooth mobility.
Effective removal of plaque on a daily basis by the patient is critical to the success of periodontal therapy and prognosis
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
Patient should be informed that smoking effects severity and healing
The patients systemic background affects overall prognosis
PATIENTS SHOULD BE EXPLAINED THE RELATIONSHIP BTWEEN DIABETES AND PERIODONTITIS
influences both chronic and aggressive periodontitis
Genetic factors currently cannot be altered
early detection can lead to preventive and early treatment measure
ANY Discrepancies in RESTORATION margins negatively impact the periodontium.
BECOZ OF DISPROPORTIONATE CROWN TO ROOT RATIO AND REDUCED ROOT SURFACE AVAILABLE FOR PERIODONTAL SUPPORT.
the presence of these enamel projections on the root surface interferes with the attachment apparatus and so prevent regenerative procedures from achieving their maximum potential
The access to furcation area is diificult as usually the entrance is narrower than a standard curette in 58% of first molars
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
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.
These common factors suggest that for any given diagnosis, there should be an expected prognosis under ideal conditions.
occurs when bacterial plaque accumulates at the gingival margin.
The 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.
Although malnutrition has been suspected to play a role in the development of gingival diseases, most clinical studies have not shown a relationship between two.
Prognosis is linked to management of associated dermatologic disorders.
Prognosis for these patients depends on elimination of the causative agent.
For eg- decreased number of circulating neutrophils may contribute to widespreads destruction of periodontium. Unless neutropenia can be corrected, these patients present with a fair to poor prognosis.
In these cases, the prognosis is dependent on not only reducing local and secondary factors, but also on dealing with the systemic problem.
Prognosis is often determined after initial treatment assuming favourable outcome.