Prognosis in periodontics
INTRODUCTION
Periodontal diseases present in very diverse clinical forms and in the same clinical form, we can observe very variable degrees of severity from one patient to another and from one site to another in the same patient. As a result, the treatment undertaken and its chances of success can vary greatly from one patient to another and from one dental sector to another. Therefore, a precise assessment of these chances must be established after having made the diagnosis; an assessment called the prognosis.
The prognosis must be made before any treatment and can be revised during and after treatment.
A. definition:
Prognosis is defined as the predilection of the evolution of a disease and the evaluation of the chances of success of the treatment plan undertaken.
B. different types of prognosis:
1- on the topographical level; we speak of unitary prognosis (one tooth or dental sector) or global (extends over the entire oral cavity).
2- in time:
- The short-term prognosis extends to a few months just during the healing period.
- The medium-term prognosis extends for up to ten years after treatment of the disease.
- the long-term lifelong prognosis.
3- qualitative evaluation of the prognosis:
- good prognosis: means recovery “ad integrum” of the periodontium and its function.
- favorable prognosis: recovery of the diseased periodontium but “repaired” therefore less perfect from an anatomical and physiological point of view.
- unfavorable prognosis: if it is estimated that the treatment will fail despite being clearly indicated and this due to the influence of factors leading to therapeutic failure.
- poor prognosis: the tooth will be lost regardless of the treatment undertaken.
- reserved prognosis: if the patient may not respond favorably to the treatment undertaken.
C- factors influencing the prognosis
1- overall
a- Patient cooperation
is essential and decisive for the success of any periodontal treatment.
b. the age of the patient
a young person will have a greater capacity for bone repair and a better prognosis after treatment than in the elderly. However, the fact that such bone destruction can manifest itself over a relatively short period of time or occurs at an early age, gives a bad impression on the bone repair capacity of this young patient.
c. the general condition of the patient
serious or chronic diseases modify the predictions of success of the therapy. Likewise when the general condition of the patient contraindicates surgical treatments then the therapeutic choices and the prognosis must be reserved.
d. Tobacco
The rate of progression of bone lysis is faster in a smoker and stabilization or healing after treatment is more difficult to achieve. Tobacco is a negative factor for the prognosis.
e. Emotional stress
Long-term stress of any origin alters immune reactions and consequently modifies the host response. In addition, patients often tend to neglect personal care, which will affect plaque control.
f. According to the type of periodontitis and its severity:
Slowly progressive periodontitis responds well to treatment when it is not too advanced and if the patient is able to control local irritants. The prognosis here will be directly related to the extent of the inflammation and the amount of remaining bone.
In rapidly progressive periodontitis, the signs of inflammation are often unrelated to the underlying bone destruction. The prognosis should be very guarded.
2. Prognosis by site:
a. Mobility
The more mobile the tooth, the worse the prognosis.
b. Dental and root morphology
The higher the clinical crown/clinical root ratio, the worse the prognosis . Indeed, teeth with short and slender roots will have a much lower periodontal attachment surface than those with long and cylindrical roots.
Similarly, an atypical morphology that does not allow for correct surfacing will directly influence the prognosis.
c. Periodontal pockets
Several variables will need to be considered: depth of the pocket, level of attachment and height and shape of the residual bone crest.
d. the number of remaining teeth
the prognosis will be less good in the presence of extensive edentulism.
e. Microbiological examinations
the presence and persistence of periodontal-pathogenic bacteria such as Aa, Pi and Pg is worrying. Their disappearance after therapy is a good sign.
f. evolution of the site
the cessation of bleeding, remineralization of the bone cortex, reduction of mobility, stabilization or gain of attachment are positive and encouraging elements. If none of these criteria evolve positively, the forecasts will be revised.
Conclusion :
To make a correct prognosis, the practitioner must rely on broad and perfect knowledge of the factors influencing the evolution of the disease and those that decide on the possibility of treatment success . Furthermore, the practitioner, by making the correct prognosis, will be a winner both in therapeutic efficiency and in time management devoted to the care of these patients.
Prognosis in periodontics
Early cavities in children need to be treated promptly.
Dental veneers cover imperfections such as stains or cracks.
Misaligned teeth can cause difficulty chewing.
Dental implants provide a stable solution to replace missing teeth.
Antiseptic mouthwashes reduce bacteria that cause bad breath.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush preserves enamel and gums.