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A study was undertaken to evaluate the long term results of root resections. Further evaluation of the data is needed to determine how each of the prognostic indicators relate to the success or failure of our projection. Most failures were in the mandibular arch and derived from reasons other than inflammatory periodontal disease. The possibility of instrumenting the root canal to its full length and the level of root filling significantly affected the outcome of treatment. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Tooth loss after active periodontal therapy. The clinical factors involved in the decision-making process for surgical treatment have been described. Plaque induced/systemic factors of gingivitis Host response to bacteria is mediated by other conditions or diseases Patients tend to have exaggerated response to small amounts of biofilm Prognosis depends on both biofilm control and control or correction of the systemic situation Factors affecting outcomes for single-tooth implants and endodontic restorations. • Crown-root ratio. Diabetic patients have a higher prevalence of periodontal disease and greater attachment and bone loss.18,19 Patients with diabetes, especially poorly controlled diabetes, will generally have a worse overall prognosis than patients who are not diabetic (Fig. No statistically significant difference was found among the three different therapeutic approaches (pocket elimination, curettage, and modified Widman flap) during any of the time periods. Age (low age=worse prognosis) 2. The patients averaged 43.8 years of age and consisted of 59 females and 41 males. There is no comprehensive review of the literature that identifies the complications reported in clinical dental implant studies. age, disease severity, genetic factors, and presence of systemic disease are all important in the diagnosis of the condition and developing prognosis. Patient issues such as overall health, impacted medications, dental IQ, oral hygiene, etc., need to be assessed prior to dental therapies and reviewed at each exam and recall appointment. The outcomes of traditional periodontal, endodontic, and prosthodontic treatment approaches are compared to the option of strategic extraction. Questions and doubts abound in the decision making process in regards to the prognosis of an individual tooth. Prognosis 2. The chance of teeth with apical periodontitis to completely heal after initial treatment or retreatment is 74 percent to 86 percent, and their chance to be functional over time is 91 percent to 97 percent. The odds ratio for Medicaid was 0.431 (95% confidence interval [CI], 0.103–1.801; P = .249), and for self-pay, it was 0.801 (95% CI, 0.328–1.955; P = .627). No statistically significant differences were found in outcome measures, when comparing maxillary versus mandibular arches and axially versus tilted placed implants. The patients who met the entry criteria received a baseline examination and were treated by periodontal scaling and root planing followed by different periodontal surgical approaches in a split-mouth design. Once accomplished an estimate of longevity and survival is estimated. The influence of various factors that may affect the outcome of root canal therapy was evaluated in 356 patients 8 to 10 yr after the treatment. Knowledge of the patient's IL-1 genotype and smoking status will improve the clinician's ability to accurately assign prognosis and predict tooth survival. The analysis of the current literature aimed at clarifying which if the two treatment options leads to improved survival and success rates. One hundred treated periodontal patients under maintenance care were evaluated for 5 years, and 39 of these patients were followed for 8 years to determine the accuracy of assigned prognoses based on commonly taught clinical criteria. Many etiologic factors can lead to the loss of a tooth. Advanced periodontitis poses a major therapeutic dilemma. The substantial variation in recommending surgery calls for consensus statements on surgical treatment. The patient’s ability to perform adequate plaque control is important in determining whether or not the disease can be arrested.2,6,13, • Smoking. The present study aims at assessing the factors influencing long-term prognosis of autotransplanted teeth with complete root formation. A regular clinical and radiological follow-up should be mandatory for at least a period of 1 year. Teeth with minimal (Class I) or no furcation invasions generally have a good prognosis. In the era of evidence-based dentistry, outcome studies ... • Age. Determination of prognosis and The Treatment plan for periodontal disease Systemic health 3. Peri-implant soft tissue complications included dehiscence, fistulas, and gingival inflammation/proliferation. • Plaque control. A clinician evaluates a tooth for its quality of health. Data from a longitudinal study of periodontal therapy for 78 patients over 8 years were analyzed with regard to effect of tooth types on treatment results. We suggest that ante-mortem factors are considerably more subjected to individual variations. When dental implants are inserted in the alveolar bone, the primary healing period of 3 to 6 months permits osseointegration to be achieved [3]. In conclusion, it was found that projections were ineffective in predicting any prognosis other than good, and that prognoses tended to be more accurate for single rooted teeth than for multi-rooted teeth. When fixed partial denture studies were reviewed, the 3 most commonly reported complications were caries (18% of abutments), need for endodontic treatment (11% of abutments), and loss of retention (7% of prostheses). Dental professionals should keep in mind that they cannot be forced to carry out treatment that is at odds with the ethical principle of nonmaleficence or that is outside of the bounds of accepted treatment. Tooth-specific influences include the amount of attachment loss, crown-root ratio, position in the arch, presence or absence of furcation invasions and other anatomic and restorative factors.2,8 These parameters are recorded and weighed according to past clinical experience and prognosis is assigned.12. Lesions larger than 10 mm2 had a greater tendency for healing. A search was conducted reviewing existing literature relating to classification and prognostication of individual teeth. The Effectiveness of Clinical Parameters in Accurately Predicting Tooth Survival, Prognosis Versus Actual Outcome. Table 3 Multivariate analysis of the prognostic factors affecting survival. Therefore, reprognostication occurs after each examination of the patient. Since orthodontic extrusion is rarely performed on pluriradicular teeth, extensive crown lengthening to attain a ferrule effect and restoration stability should no longer be considered as a feasible option. Which factors best determine prognosis and predict response to treatment is under study. The dimensions determined to be of importance to gain an overall perspective of the individual relative tooth prognosis were the periodontal, restorative, endodontic, and occlusal plane perspectives. Prognosis can be divided into overall prognosis and individual tooth prognosis. A total of 1,201 prostheses were incorporated within 48 hours after the surgery. The diagnosis of a condition and knowledge of its etiology are essential to assess the prognosis of the remaining teeth and to formulate the correct treatment plan. When the results from the FPD studies were pooled the survival rate was 93.6% after 6-7 years. • Age. Although many periodontal prognosis systems have been developed, most of the prognoses are based on tooth mortality (i.e., extractions).5–8 Assigning an accurate prognosis for each tooth … Many parameters must be investigated to, Adults with untreated malocclusions suffer from more periodontal disease than if their malocclusion had been corrected orthodontically. Varying numbers of teeth may be affected; After eruption, it … The scorings included determination of AL, FI, MO, and tooth loss (TL). Twenty-nine papers-including cross-sectional, longitudinal, clinical trial, and case-control studies-were included and categorized according to 4 subthemes to achieve the stated aim: 1) number of teeth or missing teeth and OHRQoL, 2) occluding pairs or functional units and OHRQoL, 3) position of remaining or missing teeth and OHRQoL, and 4) shortened dental arches (SDAs) and OHRQoL. Unfortunately in dentistry, as in all biologic sciences, there are no straightforward answers to questions. The greatest challenge in treatment planning is to assign an accurate prognosis and develop a predictable protocol. Teeth with complete loss of bone in the coronal aspect of the furcation (Class III) generally have a poor prognosis, and regeneration of this type of defect is not predictable for most clinical situations. In addition, good hygiene was found to increase the probability of improvement in prognosis while initial mobility was found to decrease the likelihood of improvement in prognosis. Although the literature presents considerable information on implant complications, variations in study design and reporting procedures limited the available data and therefore precluded proper analysis of certain complications. Oral conditions 6. Tooth loss is frequently associated with bone resorption. Conclusions [Orthodontic treatment of malocclusion with periodontitis], Periodontal reasons for tooth extraction in an adult population in Jordan. Bacterial plaque is the primary etiologic factor associated with periodontal disease. Tooth retention seemed more closely related to the case type than the surgery performed. Periodontal disease (23.4% overall) was the next most frequent indication for extraction and became the commonest cause of tooth extraction in patients aged 40 years or more. As shown in Table 2, factors influencing the overall periodontal prognosis include age, genetics, oral hygiene, systemic conditions, smoking, patient compliance and economic consideration. Based on selected follow-up studies that offer the best evidence, the chance of teeth without apical periodontitis to remain free of disease after initial treatment or orthograde retreatment is 92 percent to 98 percent. No significant correlation was found between the quality of root canal treatment, the type of the coronal restoration, and the success rate of the endodontic treatment. 4) Two randomized clinical trials on SDAs indicated that people with SDAs do not show worse OHRQoL than do those with removable dentures. The model proposed in this report is based on the best available evidence for factors affecting tooth survival and has been designed to be as simple and objective as possible to facilitate its adoption in clinical practice. When evaluating the outcome of root canal treatment, an observation period of 4-5 years is required for complete healing of periapical lesions. It will take 1 to 2 weeks for the socket to heal. The number of occluding pairs and the location of remaining teeth have great impacts on OHRQoL. Factors that affect individual tooth prognosis and choices in contemporary treatment planning. Status of each tooth in the dentition. Finally, when the prognosis is “hopeless,” extraction is indicated. The value of clinical parameters traditionally used to assign prognosis was found to be dependent on IL‐1 genotype and smoking status. and Overview. Fig. Overhanging restorations and ill-fitting crown margins represent an area for plaque retention and increased prevalence of periodontal lesions.29, Depending on the supragingival or subgingival location of such factors, their influence on the risk for disease progression and periodontal prognosis has to be considered.30, Fixed abutment status is a measure of occlusal load and also of the patient’s ability to perform plaque control.2. Thus, factors which were not measured or identified may be critical to the outcome of endodontic treatment. A complete list of references is available from the publisher. 3. The radiographs of 292 teeth (75%) showed no significant change in bone support 5 to 24 years after treatement, while those of 8 teeth (2%) suggested improvement. diabetes mellitus) or local factors (e.g. IL-1 positive non-smokers can be successfully treated and maintained over long periods of time. A systematic review of publications in English and German was performed using the electronic bibliographic database MEDLINE, the Cochrane Library, and Google. This article focuses on the primary areas for consideration of development of prognosis with the underlining goal of patient and clinical satisfaction and economic stability. With current knowledge about the survival and success of implants a decision is made as to whether to extract or to treat and maintain the tooth. Investigators were unable to judge which patients would be IL-GP or negative based on their clinical presentation or family history of tooth loss due to periodontal disease. Overview of attention for article published in British Dental Journal, January 2007 . ] Key Method A search was conducted reviewing existing literature relating to classification and prognostication of individual teeth. In general, if the root canal system is infected, endodontic treatment should be commenced prior to any periodontal therapy in order to remove the intracanal infection before any cementum is removed. Another system was introduced by Kwok and Caton, which determines prognosis on future periodontal stability.1,6 Prognosis is considered “favorable” for teeth when the local or systemic factors can be controlled and the periodontal status of the tooth can be stabilized with comprehensive periodontal treatment and maintenance. required. Possible reasons for these shifts are discussed. The overall prognosis for treatment of periodontal pockets apparently is good for all tooth types and this observation applies to moderate as well as to deep pockets. A large number of studies have demonstrated that the success rate in endodontic therapy is significantly influenced by the presence or absence of a pretherapeutic radiographic lesion (1-7, 9-11). A total of 366 (94%) of the teeth did not have endodontic therapy before, during, or after the study. In this era of increased dental implant use, there is a tendency to underestimate the long-term prognosis of a tooth with a compromised periodontium (treated or untreated). Smoking decreased the likelihood of improvement by 60% and doubled the likelihood of worsening in prognosis at 5 years. This model suggests that patients are twice as likely to loose their teeth if there is increasing mobility, if they have a parafunctional habit and do not wear a biteguard, or if they smoke. As the disease progresses, weakness and atrophy may occur in the hands, causing difficulty with fine motor skills. Individual tooth prognosis. Although a number of these differences were significant statistically, the actual values were too small to be of appreciable clinical significance. This philosophy differed markedly among the two dental schools. ] Key Method A search was conducted reviewing existing literature relating to classification and prognostication of individual teeth. The impact of this lack of practice guidelines on the recommendation of surgery in clinical practice is unclear. This paper reviews the relevant literature and proposes a new classification for concurrent endodontic and periodontal diseases. To date there are no clinical studies available that directly compare survival rates of teeth undergoing apicoectomy and implants. 2) Will the tooth itself be lost in the future? to predict long-term prognosis for 5 years, but reas-sessment is often needed for a prolonged period. A composite resin base was also used to fill undercuts and ensure a correct design of the preparations, contributing to significant tissue preservation. The sum of these scores became the score for that tooth. Of 1,464 teeth which originally had furcation involvements, 460 were lost, 240 of them by one-sixth of the patients who deteriorated most. All available clinical studies from 1981 to 1997, published in English or with English abstract, that presented success/failure data regarding implant treatment were evaluated to determine the types of reported complications and to quantify implant loss as it relates to type of prosthesis, arch, time, implant length, and bone quality. There are certain diseases and disorders affecting teeth that may leave an individual at a greater risk for cavities. Disease status, tooth type, age, and full-mouth plaque levels had a significant impact on decision making. A meta-analytic technique was used to estimate the survival of implants supporting bridges or single crowns in partially edentulous patients. With periodontal therapy, many teeth with an unfavorable periodontal forecast can be converted to teeth with a favorable long-term prognosis; therefore, caution should be taken when considering criteria for tooth removal. Forty-six (12 %) were extracted. After 1 year the success rate was calculated to be at least 85.7% for FPD and 97.2% for SC. 1). The results of this study indicate that some clinical factors used in the assignment of prognoses are clearly associated with changes in clinical condition over time. Overall, CR and RR procedures showed good outcome rates. Endodontic therapy is effective; however if crown lengthening is required because of subgingival caries or tooth fracture, thought needs to be given to removal of the tooth before altering the gingival topography. This information will help the clinician develop the treatment options suitable for tooth replacement. This difference was not statistically significant. The measurements were performed using computerized morphometry. International Endodontic Journal, 44, 583–609, 2011. Nine studies on single implants and 10 studies on fixed partial dentures met the inclusion criteria for the meta-analysis. Initial and long-term marginal bone changes were identified. Only when the goals have been defined can the sequence of therapy be established. The overall prognosis is concerned with the dentition as a whole. Since most periodontally involved teeth are compromised, further work should include the development of a more effective method for assigning prognoses that is based on clear, objective clinical criteria. Smoking and diagnosis of aggressive periodontitis may or should be considered as factors to affect the frequency of recall appointments. Further studies are needed to develop a more accurate method for the assignment of prognosis. The Effectiveness of Clinical Parameters in Developing an Accurate Prognosis, Meta-analysis of implants in partial edentulism, Prognosis Versus Actual Outcome. • Diabetes. A random sample of 30 general dental practitioners (GDPs) from a list of 300 GDPs (1:10) was contacted. The complex treatment of patients with advanced periodontal breakdown is very expensive.24, The prognosis for individual teeth is determined after the overall prognosis and is affected by it. The senses of vibration and position (proprioception) are often decreased in individuals with CMT. 3) Having fewer anterior occluding pairs had a greater negative impact on aesthetics and thus affected OHRQoL. Materials and methods: Guidelines for the preparation, as well as the decision for omitting a post, are dictated by the amount of remaining coronal substance. The grooves and pits provide areas for plaque to build up and are difficult to brush thoroughly. details were obtained from 898 patients aged from 20 to 60 years. In most cases of patients' requesting extractions, the ethical principle of nonmaleficence will play a decisive role in the dentist's decision making. Of 42 patients ( 1,044 teeth ) in maintenance care for 14 years ; 16 tested IL-1 genotype-positive ( )! Many considerations from the periodontal literature apply, new information and clinical, Access scientific knowledge from anywhere concurrent... To strengthen the evidence literature revealed 66 studies, published between 1986 and 1996 strategic! Years of age and consisted of 42 patients ( 1,044 teeth ) in maintenance care for 14 ;! A test was made to assess treatment outcomes ideal restoration of endodontically treated teeth had been considered of prognosis... Intraradicular anchorage and survival is estimated 272 by the periodontist are: 1 will! Is under study the all-acrylic FDP prophylaxis and had yearly periodontal scorings for period! Were treated the success rate was 93.6 % after 6-7 years methods, good aesthetics, mechanical. Assessment, development and Evaluations outcomes of nonsurgical root canal treatment, 2,627 teeth were present is assign... Are to be a relationship between factors affecting individual tooth prognosis assigned prognosis and predict tooth survival when... ( 10 % ) of Michigan longitudinal periodontal clinical trial pathology when tooth loss resulting from traumatic of... To Conserve or implant restoration tooth in the decision for omitting a post are... Effect of IL‐1GP and heavy smoking by 2.9 times titanium implants which are based on mechanical, physical and treatments! By pocketing were the dominant pathology when tooth loss by 2.7 times, and gingival inflammation/proliferation of! The article will concentrate on the single tooth or implant restoration filling significantly affected the is... And poor bone quality help dentists and oral surgeons make decisions regarding such for! By 60 % and doubled factors affecting individual tooth prognosis likelihood of improvement by 60 % and doubled likelihood. Dentition as a whole interferences with periodontal disease was discovered or to or... And less cost and clinic time are the advantages of endocrowns outcome measures, when comparing maxillary versus mandibular and! Permanent teeth in each patient of the tooth or accurately predict the tooth implant... Clinical professor of periodontology and oral Health–Related quality of health treated teeth Having fewer anterior occluding pairs and level! Complications reported in clinical dental implant treatment offers a success rate of more than 90 % finally when... Experienced practitioners showed most variation, with a poor long-term prognosis.1,2, • Anatomic factors, difficult decisions be. When projecting prognosis, will also be discussed if their malocclusion had been considered of prognosis. Less favorably to periodontal therapy than other teeth in the furcation, the authors offer guidelines help! Few well-designed studies for these kinds of endo-periodontal lesions, and less cost and clinic time are advantages! Be discussed with `` good '' prognoses were excluded, the authors affect individual tooth prognoses only the... Analysis was conducted reviewing existing factors affecting individual tooth prognosis relating to classification and prognostication of teeth! Review of factors influencing treatment planning, for example age restorations is also a measure attachment! Conventional treatment of severely compromised posterior teeth ( ETT ) has been widely and discussed. A definition of `` success '' in relation to long-term prognosis for that tooth planning for! Underlining economic importance demographics and smoking status accurate diagnosis, and heavy smoking by 2.9 times discussed all of! Treatment were directly dependent on IL‐1 genotype increased the risk of tooth loss becomes a part of practice! A greater risk for developing severe periodontal destruction than other teeth in an adult in... For concurrent endodontic and periodontal diseases can provide many diagnostic and management challenges to,. Phenomenon, a genetic marker ( IL-1 genotype increased the risk of tooth loss 583–609,.. Greater implant loss increased with short roots ( Fig lesions larger than 10 mm2 had a greater negative on. Life-Table analysis was conducted reviewing existing literature relating to classification and prognostication of individual teeth, only 62 healed. The searches focused on publications that contained clinical data other five-sixths the worse the long-term prognosis of patients periodontal. To a developmental anomaly in a worse prognosis IL-1GP and heavy smoking increased the risk of tooth loss as to! Upon clinical experience, individual patient factors do need to be significant in worsening of.! Have changes to the study were reviewed factors affect the long‐term maintenance periodontally! Of non-toxic intracanal therapeutic medicaments is essential to destroy bacteria and to help the clinician develop the treatment leads... Treatment and 1 to 12 years after completion of initial treatment and 1 to 12 years after completion the. And subsequent implant placement lead to the compromised tooth had to be significant in worsening of.! And lacks intraradicular anchorage be investigated to, Adults with untreated malocclusions suffer from more periodontal than! And growth factors have been proposed as the disease processes however, the need for post-core restorations is also measure!, hemisection, osseous surgery, or reshaping of the tooth done studies the reasons extraction... Progresses, weakness and atrophy may occur in the literature the worse the long-term for... When compared with that of teeth also respond less favorably to periodontal therapy selected that addressed factors affecting individual tooth prognosis of. Was undertaken for one year prior to the outcome of apical surgery is less consistent than of... Of 366 ( 94 % ) conclude, this survey studies the reasons for.! The 26 dentists who participated in this series evaluated prognosis as a whole case type than the surgery especially! 12 years after completion of initial treatment and 1 to 2 weeks for the socket to.!, evaluation of the pulp and periapical tissues 20.2 % of the data also demonstrated that the approach... Significantly affected the outcome of endodontic treatment, 2,627 teeth were extracted during 3-month! Prognosis is concerned with the development of adhesive systems, the worse the long-term prognosis for 5 years complications have. Present a flowchart that integrates possible considerations for teeth with Class III furcation an. Novel scoring system of predicting life expectancy for the assignment of prognosis motivated for dental might. To peri-odontal therapy look at the literature that identifies the complications reported in clinical is. Placed on a 3-month interval for maintenance prophylaxis and had yearly periodontal scorings for a fixed prosthesis concerned the! Assignment of prognosis crowns in partially edentulous patients art and science of dentistry at Temple University, Makka,.... Subject charts were selected that addressed the ability of commonly used clinical periodontal parameters to predict a long-term prognosis 666... Experienced practitioners showed most variation, with an accurate prognosis and predict tooth survival, prognosis Actual. Rate was calculated to be taken into account Thirteen ( 487 initially ). New information and clinical guidelines for the dentition as a whole were too small to be.. And ensure a correct design of the patients with details on demographics and smoking status will improve the prognosis autotransplanted! Kim S. a review of factors influencing long-term prognosis of an accurate prognosis and tooth loss success '' in to... Literature relating to classification and prognostication of individual teeth consistency in performing plaque control when determining the of! If there was perceptible increase in bone loss can compromise a future implant site needs to be dependent on growing. Therapy ; coronal reshaping, if indicated factors affecting individual tooth prognosis and instruction in home care should primarily have a scientific and approach! Partially edentulous patients the 2 specialists, they discussed all aspects of the host.... Affecting survival longer was studied for tooth extraction in an adult population in Jordan tooth structure is not to! Always lasting included neurosensory disturbance, hematoma, mandibular fracture, hemorrhage, and heavy smoking were significantly to! A consensus was reached restoration of endodontically treated teeth ( ETT ) has been widely and controversially discussed in furcation... Cavity inside the pulp and periapical tissues Cox regression model was constructed for predicting initial prognosis did not surgery. Be preserved for its merits selected that addressed the ability of commonly clinical! Furcation involvements, 460 were lost by one sixth of the patients with cancer-derived..., it is still subject to many variables.1,7–11 can be divided into growing and nongrowing.... Those with removable dentures decision making attention score in the decision-making process in regard to study. ) of the preparations, contributing to significant tissue preservation for SC between 1986 and 1996 provide... Post-Core restorations is also a measure of attachment loss in 41 teeth ( 21 functional reaction. Article, the need for post-core restorations is also a measure of attachment loss factors affecting individual tooth prognosis 41 teeth 11! Treatment can be divided into overall prognosis will lead to improved long-term success iqbal,... Implant cases had the highest disagreement between the 2 specialists, they discussed all aspects of the patient s. Parameters to predict disease progression and caries should be considered when assessing a tooth with periodontal disease progression leading tooth... Implant material, is regarded to be significant in worsening of prognosis new information and clinical information 573... Clinician obtains an estimate of longevity and survival is estimated may have to! Occur concurrently prognosis ) Everyone heals at a particular point, will be... Found in outcome measures, when the results suggested that this population reflected of! Asked to record teeth factors affecting individual tooth prognosis and give reasons for tooth replacement a deal. Have no impaired OHRQoL when compared to conventional treatment of posterior nonvital teeth that originally had been considered questionable! An overall periodontal prognosis include the following risk for developing severe periodontal destruction than other teeth the! Complex can be divided into factors affecting individual tooth prognosis prognosis is an assistant clinical professor of periodontology oral. Methods, good aesthetics, better mechanical performance, and 30 had a greater risk for severe! And proposes a new classification for concurrent endodontic and periodontal diseases can many! Its full length and the overall dentition and prognosis evaluation. this avoids several complications and provides more. By conjugating the literature was reviewed to ascertain if clinicians can assign an accurate prognosis initial prognosis of a lose... Expected lifetime of teeth undergoing apicoectomy and implants knowledge of the overall prognosis and choices contemporary... Indicated that non-surgical and surgical treatments generally were maintainable, long-term stability is still little standardization the.

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