Determination Of Prognosis

Determination Of Prognosis

What is prognosis? What factors are considered in determining individual prognosis of tooth?
Answer. “Prognosis is the prediction of probable course, duration and outcome of a disease-based on general knowledge of pathogenesis of disease and presence of risk factors for the disease and the likelihood of its response to treatment”.

Prognosis must be determined after the diagnosis is made and before treatment is planned. In most cases, careful analysis of these factors allows the clinician to establish one of the following prognosis.

Factors Considered in Determining Individual Prognosis of Tooth

Factors considered or affecting the individual tooth prognosis are:

• Local factors
• Prosthetic and restorative factors

Local Factors

The local factors which are considered in determining individual prognosis of tooth are:

• Plaque and calculus
• Subgingival restorations
• Anatomic factors

Following are the anatomic factors

• • Short, tapered roots
  • Cervical enamel projections
  • Enamel pearls
  • Bifurcation ridges
  • Root concavities
  • Developmental grooves
  • Tooth mobility
  • Furcation involvement.

Plaque and Calculus

It is the most important local factor in periodontal diseases. In most of the cases, having good prognosis depends on the ability of the patient and the clinician to remove these etiologic factors. However, when teeth are drifted or rotated, oral hygiene may be more difficult in such cases prognosis is poor.

Subgingival Restorations

Tooth with overhang subgingival margin discrepancies exhibit poor prognosis compared to the tooth with well contoured supragingival margins. This causes inflammation and bone loss. So a tooth with any discrepancy at its subgingival margin leads to increased plaque accumulation and has poor prognosis.

Anatomic Factors

Following are the anatomic factors:

• Short, tapered roots: Teeth with short and tapered roots have poor prognosis as compared to long and broad roots. More favorable is crown root ratio, better is the prognosis. A maxillary molar with widespread roots and large root base exhibit good prognosis compared to conical rooted premolar or incisor with equal amount of bone loss.
• Cervical enamel projections: They are ectopic enamel projections which extend beyond the normal contour of CEJ. They are seen on mandibular molars and maxillary premolars. They impart negative effect on prognosis.
• Enamel pearls: They are large round enamel deposits which are seen in the furcation areas. Seen commonly on maxillary third molars. They impart negative effect on prognosis.
• Bifurcation ridges: These are the projections on the root surfaces which interfere with attachment apparatus and prevent regenerative procedures from getting their maximum potential. Mandibular first molars commonly show bifurcation ridge which crosses from mesial to distal root at midpoint of furcation. They impart negative effect on prognosis.
• Root concavities: These are the areas which are difficult for the dentist and patient to clean and so worsen the prognosis.
• Developmental grooves: These are the invaginations resulting from incorrect formation of the root. Grooves often begin at the cingulum and extend at the variable distance apically on root surface between midpalatal line and line angle. These grooves act as plaque retentive areas which are very difficult to clean. These grooves are seen commonly in maxillary lateral incisors and maxillary central incisors.
• Tooth mobility: If cause of tooth mobility is eliminated and the mobility is controlled, prognosis is better. Prognosis of tooth mobility is poor in cases with advanced bone loss. A tooth that can be rotated or depressed has poor prognosis than a tooth having horizontal mobility. Tooth mobility is correlated with other clinical and radiographic findings in determining the prognosis.
• Furcation involvement: Multirooted teeth having short root trunks with furcation involvement has less favorable prognosis than long root trunks. Maxillary first premolars exhibit more difficulties and hence unfavorable prognosis when lesion reaches mesial or distal furcation. Maxillary molars also impose some difficulty so require resection of one of the buccal roots to improve access to the area. Resection procedure improves the prognosis.

Prosthetic and Restorative Factors

Following are the prosthetic and restorative factors:

• Abutment selection
• Caries
• Nonvital teeth
• Root resorption.

Abutment Selection

The overall prognosis considers the level of bone as well as attachment level for establishing that whether the remaining teeth act as abutment for prosthesis.

Caries, Non-vital Teeth and Root Resorption

• Teeth having extensive caries should be adequately restored and endodontic therapy should be considered before going for periodontal treatment.
• Extensive idiopathic root resorption as a result of orthodontic therapy jeopardizes stability of teeth and adversely affects the response to periodontal treatment.
• Periodontal prognosis of treated nonvital tooth is not different from that of vital teeth.