Perio 16 - Prognosis and Perio Tx Planning (Dr. Shaikh)

True

T/F: At initial prognosis appt. perio probing is completed, along with an FMX

bacterial plaque

What is an example of an etiology?

contributing factors

These are considered etiology or contributing factors?

- Inadequate OH

- Calculus

- Root proximity

- Open Contacts/ Food impaction

- Uneven marginal ridge

- Tongue thrust

prognosis

Define the following:

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 risk factors for the disease

diagnosis

The prognosis is established after what is made?

treatment plan

The prognosis is established before what?

Prognosis

The ___________ is based on specific information about the disease and the manner in which it can be treated, but it also can be influenced by the clinician's previous experience with treatment outcomes (successes and failures) as they relate to the particular case.

Prognosis

_________ is a dynamic process and should be reevaluated after completion of all phases of therapy, including periodontal maintenance

overall clinical factors

What type of factors for prognosis?

- Age

- Disease severity

- Plaque control

- Patient compliance

systemic and environmental

What type of factors for prognosis?

- Smoking

- Systemic disease

- Genetic factors

- Stress

local

What type of factors for prognosis?

- Plaque

- Calculus

- Subgingival restorations

anatomic

What type of factors for prognosis?

- Short, tapered roots

- Cervical enamel projections

- Enamel pearls

- Bifurcation ridge

- Root concavities

- Developmental grooves

- Root proximity

- Furcation involvement

- Tooth mobility

prosthetic/restorative

What type of factors for prognosis?

- Abutment selection

- Caries/non-vital teeth

- Root resorption

short, tapered roots

Which anatomical factor?

cervical enamel projection

Which anatomical factor?

root proximity

Which anatomical factor?

- Less than 1mm of bone between two roots, disease travels fast because there is no protection by the roots

enamel pearls

Which anatomical factor?

- Can cause attachment loss in this area

bifurcation ridge

Which anatomical factor?

- Common in maxillary and mandibular molars

root concavity

Which anatomical factor?

Mesial surface of 1st premolar

Where are root concavities commonly found?

developmental groove

Which anatomical factor?

- Usually found on lateral incisors

McGuire

Which prognosis system is based on tooth loss?

McGuire

Which prognosis system shows a 5-7 year prediction accuracy of 89% and the accuracy decreases to 50% or less when the good prognosis was removed?

good

Which stage of McGuire prognosis?

One or more of the following:

- Etiologic Factors can be controlled

- Adequate periodontal support

- Tooth or teeth can be adequately maintained by professional and patient

- Controlled systemic factors

fair

Which stage of McGuire prognosis?

One or more of the following:

- Up to 25% attachment loss measured clinically and radiographically

Grade 1 furcation allows access for maintenance

- Tooth or teeth can be maintained with proper professional and home care

- Limited systemic factors

poor

Which stage of McGuire prognosis?

One or more of the following:

- Up to 50% loss has occurred

- Grade II function with difficult access to the depth and portion of the furcation

- Greater than Miller Class I mobility Poor crown to root ratio

- Lack of patient compliance

- Presence of systemic factors

questionable

Which stage of McGuire prognosis?

One or more of the following:

- Greater than 50% attachment loss

- Grade II or III furcation involvement not accessible for maintenance

- Endodontically involved tooth that must be resolved before periodontal treatment

- Tooth or teeth not easily maintained by professional and/or patient

hopeless

Which stage of McGuire prognosis?

One or more of the following:

- Inadequate attachment to support the tooth

- Grade III or IV furcation involvement Miller Class III mobility

- Tooth or teeth cannot be maintained by the professional and / or the patient

good

Which stage of McGuire prognosis?

fair

Which stage of McGuire prognosis?

poor

Which stage of McGuire prognosis?

questionable

Which stage of McGuire prognosis?

hopeless

Which stage of McGuire prognosis?

Kwok and Caton

Which prognosis system?

- Believed that periodontal prognostic system has to be dynamic, suggesting that it should be re-evaluated throughout treatment and maintenance

Kwok and Caton

Which prognosis system is based on probability of disease progression?

McGuire

Which prognosis system is more "quantifiable"?

favorable

Which stage of Kwok and Caton?

The periodontal status of the tooth can be stabilized with comprehensive periodontal treatment and periodontal maintenance

questionable

Which stage of Kwok and Caton?

The periodontal status of the tooth is influenced by local and/or systemic factors that may or may not be controlled

unfavorable

Which stage of Kwok and Caton?

The periodontal status of the tooth is influenced by local and/or systemic factors that cannot be controlled

hopeless

Which stage of Kwok and Caton?

The tooth must be extracted

Kwok and Caton

These are general factors to consider for which prognosis system?

- Amount of patient compliance

- Cigarette smoking: smokers have a greater prevalence for periodontal disease and tooth loss

- Diabetes Mellitus: Patient with diabetes have a greater prevalence of periodontal disease and attachment loss

- Other systemic conditions (neutrophil disfunction, Papillon - Lefevre syndrome, Down syndrome, immunologic dysfunction)

Kwok and Caton

These are local factors to consider for which prognosis system?

- Deep probing depths and attachment

- Loss Anatomical plaque-related factors (Furcation involvement, enamel pearls, CEP, open contacts, crowding, root proximity and overhanging restorations)

- Trauma from occlusion and parafunctional habits

- Root fractures

- Mobility

I

What stage of periodontitis?

Early diagnosis can allow for early intervention and be cost effective

II

What stage of periodontitis?

Standard treatment principles and regular professional maintenance is expected to arrest disease progression

III

What stage of periodontitis?

Management is complicated and tooth loss may occur

IV

What stage of periodontitis?

Considerable damage and significant tooth loss, which means loss of masticatory function

short

Short or long term goal?

Elimination of all infectious and inflammatory processes

short

Short or long term goal?

Correction of conditions that cause and perpetuate inflammation

short

Short or long term goal?

Periodontal and other dental therapies

long

Short or long term goal?

Reconstruction of healthy dentition w/ function and esthetics

long

Short or long term goal?

Restore tissue destroyed by disease and re-establish the physiological contours necessary for preservation of periodontal health

long

Short or long term goal?

Prevent recurrence of disease and tooth loss

short

Short or long term goal?

Pain control

short

Short or long term goal?

Reduction/resolution of gingival inflammation

short

Short or long term goal?

Reduction of probing depths

short

Short or long term goal?

Elimination of open furcations

short

Short or long term goal?

Satisfactory function and esthetics

short

Short or long term goal?

Control of risk factors

10%

Ideally, ___% of sites should have BOP

25%

Ideally, we want less than ___% of BOP in the full mouth

less than 4 mm (no more than 5 mm)

What is the ideal probing depth wanted?

3mm

Ideally, furcation involvement should be less than ___ mm

evaluation of initial therapy (then surgery, SPT/recall, or retreatment)

What comes after initial perio therapy?

non-surgical phase (initial therapy)

What is the first phase of periodontal tx?

surgical phase

What is the second phase of periodontal therapy?

restorative phase

What is the third phase of periodontal therapy?

maintenance phase

What is the 4th phase of periodontal therapy?

dental emergencies (dental, periapical, periodontal, extraction of hopeless teeth)

Before phase I of perio tx, the preliminary phase is done to treat what?

Phase I (initial therapy)

Which phase of periodontal therapy?

- Patient education

- Identification and controlling risk factors

- Oral hygiene instructions

- Diet control

- Supragingival plaque and calculus removal

Phase I (initial therapy)

Which phase of periodontal therapy?

- Correction of restorative and prosthetic irritational factors

- Excavation of caries and restoration

- Antimicrobial therapy

- Occlusal therapy

- Removal of hopeless teeth

- Prophylaxis

- SRP

What are the non-surgical procedures that can be done during phase I of perio tx?

prophylaxis

Define the following:

The removal of plaque, calculus, and stains from the exposed and unexposed surfaces of the teeth by scaling and polishing as a preventive measure for the control of local irrotational factors

scaling

Define the following:

The instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus and stains from these surfaces

root planing

Define the following:

The treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus or contaminated with toxins or microorganisms

prophylaxis

Prophylaxis or SRP?

Gingivitis patients with probing depth of 3mm or less or patients with attachment loss but no inflammation

SRP

Prophylaxis or SRP?

Periodontitis patients with at least 4mm of pocket depth, exposure of central surfaces of the roots (or loss of alveolar crest height beyond normal 2mm distance to CEJ) and subgingival calculus and/or root roughness

phase I (non-surgical)

This is a clinical response after which phase of periodontal therapy?

- Decreased gingival inflammation

- Less BOP

- Decreased PD, gain in clinical attachment

phase I (non-surgical)

This is a microbial response after which phase of periodontal therapy?

- Shift in the composition of the sub gingival microflora

- Decrease in gram negative organisms and increase gram positive

- Bactericides species are reduced but not eliminated

phase I (non-surgical)

These are procedures that are done during which phase of periodontal tx?

- Caries control

- Calculus removal

- Excessive cement

- Defective restoration

- Prosthetic irrotational factors

- Interim restoration

phase II (surgical)

These are procedures that are done during which phase of periodontal tx?

- Surgical debridement

- Resective therapy

- Regeneration

- Pre-prosthetic surgeries

- Root coverage

- Site debridement

- Implant placement

phase III (restorative)

These are procedures that are done during which phase of periodontal tx?

- Re-eval results of surgical tx

- Restorations

- Crown and bridge

- RPD

- Implant supported crowns

phase IV

These are procedures that are done during which phase of periodontal tx?

- Perio maintenance/recall 3-4 times for a year

- Perio exam (check for plaque, calculus, attachment levels, pocket depth, BOP, recession)

phase IV

These are procedures that are done during which phase of periodontal tx?

- OHI, scaling, polishing, chemical

- Schedule next procedure or recall visit (further periodontal tx, schedule or refer for restorative or prosthetic tx)