PROGNOSIS PROGNOSIS is the prediction of the duration, course and termination of a disease and of its response to treatment. Diagnosis Prognosis treatment plan Prognosis of patient with Gingival disease Depends on Role of Inflammation Inflammation (Local Factors) Good Prognosis Associated with systematically Caused tissue changes Less Favorable (drug induced, nutritional, hormonal) Prognosis of patient with periodontal disease Two types of prognosis determination for periodontitis 1. Overall prognosis 2. Indivisual prognosis Overall prognosis (CONSIDERING DENTITION WHOLE) Factors to be considered: 1. Type of periodontitis: adult / slowly progressive Good (with routine treatment plan) Aggressive periodontitis Poor (RPP, JP, Leukocyte defect, PPP, Post. PP) If treated in early stage Fair Prognosis With Tetracycline Any periodontitis associated with systemic diseases will have poor prognosis 2. Height of remaining bone: Little bone loss tooth is not affected Bone loss is severe mobility poor prognosis 3. Age: Older age better prognosis than younger age. Because the amount of bone loss is less in old age and more bone loss in younger age short period of time. 4. Systemic background: If patients is having systemic disease Prognosis is affected in several ways. 5. Gingival inflammation: Prognosis is directly related to degree of severity of inflammation. Good prognosis not associated with systemic diseases 6. Malocclusion: Mal aligned teeth, abnormal occlusion relationship may be imp. Factor in etiology of periodontal disease. Plaque control is difficult. 7. Cooperation of the patient: depends: on attitude, willingness and ability of patient to maintain good oral hygiene. PROGNOSIS OF INDIVISUAL TEETH Following factors are considered: 1. Mobility: caused by a) loss of bone b) T F O Local factors & TFO Good prognosis are correctable Not correctable poor prognosis 2.Periodontal Pockets: Pocket depth, level attachment, degree of bone loss and type of pocket are imp. in assessing the prognosis & treatment plan. (clinical radiographic examination are imp.) Level attachment is close poor to apex and periapical lesions prognosis Supra bony pocket Fair Infra bony pocket Good 3. Mucogingival problems: decrease width of attached gingiva poor high frenal attachment prognosis pocket extending beyond M.G.J. 4. Furcation involvement: Depends on type furcation involvement Pt. cooperation for attaining good oral hygiene. Furcation shows less favorable prognosis because of limited accessibility. (upper molars, premolars) 5. Tooth morphology: Short, tapered & large crowns POOR Root concavities, developmental grooves, enamel grooves, and furcation area act as Plaque retentive areas. 6. Teeth adjacent to edentulous area: Subjected to ed functional demands. 7. Remaining bone in relation to the individual teeth: moderate bone loss Favorable. 8. Caries, nonvital tooth and root resorption. CLINICAL APPLICATION EXCELLENT PROGNOSIS: No bone loss, excellent gingival condition, adequate patient cooperation. GOOD PROGNOSIS: One or more of the following: adequate remaining bone support, possible to eliminate etiology, good dentition and adequate patient cooperation. FAIR PROGNOSIS: Less than adequate remaining bone support, grade 1 mobility, Furcation, adequate maintaince possible and acceptable patient cooperation. POOR PROGNOSIS :Moderate to advanced bone loss, grade 2 mobility ,furcation ,difficult to maintain area and or doubtful patient Cooperation. QUESTIONABLE PROGNOSIS: Advanced bone loss, grade 3 mobility, furcation, poor cooperation. HOPELESS PROGNOSIS : Advanced bone loss, nonmaintainable areas & indicated for Xn.