Prognosis in Periodontics Question And Answers

Determination Of Prognosis

Question 1. Define prognosis. Describe the factors affecting prognosis.
Answer:

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.

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Factors Affecting The Overall Prognosis

1. Patient age: For a person with similar loss of tissue, the older individual tends to have a better prognosis as it is indicative of a slower rate of disease progression. However, regenerative capacity tends to be slower in older individuals.
2. Amount of remaining bone: This tends to be closely related to the prognosis as it has a direct impact on the tooth-supporting apparatus. The type of bone loss is also important as the prognosis tends to be worse in aggressive periodontitis.
3. Inadequate oral hygiene: Poor plaque control leads to a progression of the disease process. However, with proper education and motivation, reinstitution of adequate plaque control can improve the periodontal status. These patients can exhibit a better prognosis than one who has loss of tissue without a known etiological factor plaque.
4. Smoking: Smoking affects the periodontal tissues and can exacerbate the inflammatory process and is therefore capable of worsening the prognosis.
5. Gingival inflammation: The presence of inflammation is a sign of a better prognosis than the destruction that occurs in the absence of inflammation.
6. Systemic diseases: When periodontal disease is complicated by systemic diseases such as uncontrolled or poorly controlled diabetics, bone disorders, or other systemic inflammatory disorders, the prognosis is affected.
7. Genetic factors: They constitute non-modifiable risk factors that tend to exaggerate the inflammatory response and worsen prognosis.

Factors Affecting Individual Teeth Prognosis: Pocket depth, attachment loss, and intraosseous defect morphology: Pocket depth and attachment loss are inversely correlated with individual tooth prognosis. The greater the number of osseous walls and remaining bone—the better the prognosis.

1. Muco gingival problems: These tend to worsen the prognosis as additional procedures may be necessary to correct these.
2. Endodontic status: Periapical infection tends to worsen the prognosis as there is a risk of a retrograde source of infection.
3. Malocclusion, occlusal trauma: Malocclusion can interfere with adequate plaque control or produce occlusal interferences that can adversely affect the periodontal tissues.
4. Mobility: Teeth with mobility beyond grade two have a worse prognosis than ones without it.
5. Furcation involvement: Teeth that have furcation involvement beyond grade two tend to have a worse prognosis due to difficulty in both treatment and self-cleansability.
6. Prosthetic abutments and relationship to other teeth: Teeth that serve as abutments for fixed bridges or extra coronal precision attachments have increased functional demands and have to be assessed more critically in terms of prognosis.

Question 2. Define prognosis. Write in detail about the prognostic classification system.
Answer:

Types of Prognosis: The following are some of the clinical criteria that influence the grading of prognosis based on tooth mortality (McGuire and Nunn 1996).

1. Excellent prognosis: No bone loss, excellent gingival status, and acceptable cooperation from the patient.
2. Good prognosis: Adequate remaining bone support, adequate possibilities to control etiological factors, a prospective maintainable dentition, and acceptable patient compliance.
3. Fair prognosis: Less than adequate remaining bone support, mobility, grade 1 furcation involvement, maintainable dentition, and acceptable patient compliance.
4. Poor prognosis: Moderate bone loss, grade 1 mobility, grade 2 furcations, difficult dentition to maintain, doubtful patient compliance.
5. Questionable prognosis: Advanced bone loss, grade 2 mobility, grade 3 furcation involvement. difficult dentition to maintain.
6. Hopeless prognosis: Advanced bone loss, non-maintainable dentition.

Question 3. Write a Note on the New Classification System Based on Disease Progression
Answer:

• As tooth loss is influenced by natural and iatrogenic reasons, a periodontal prognostication system based on the probability of disease progression was proposed by Vivien Kwok and Jack G Caton in 2007.
• In this classification individual teeth, prognosis was based on the prediction of future stability of the periodontal supporting tissues.
• Three primary classifications were proposed with a fourth, hopeless, signifying a tooth that must be extracted.

Disease Progression Favorable: The periodontal status of the tooth can be stabilized (future loss of the periodontal tissue is unlikely) with comprehensive periodontal treatment and periodontal maintenance. The local and systemic factors can be controlled.

Disease Progression Questionable

• The periodontal status of the tooth is inflenced by the local and/or systemic factors that may or may not be able to be controlled.
• The periodontium can be stabilized with comprehensive periodontal therapy and periodontal maintenance if these factors are controlled; otherwise, future periodontal breakdown may occur.

Disease Progression Unfavorable: The periodontal status is influenced by local and/or systemic factors that cannot be controlled. Periodontal breakdown is likely to occur even with comprehensive periodontal treatment and maintenance.

Disease Progression Hopeless: The tooth has to be extracted.

Conclusion

• The determination of prognosis involves the prediction of the future. The prognosis made before the treatment may change following treatment.
• Predictability improves in well-maintained patients and can be effectively determined over a period of 5 to 6 years.
• A patient, who show a reduction in pocket depth (3–4 mm) and resolution of inflammation, after removal of the etiological factors have a more favorable prognosis than patients who do not.