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1. Determi nation of Prognosis Supervised by: APH .Dr. Hassina “Shadab” Prepared & Designed by: Dr Mohammad Eissa ahmadi

2. Definition The prognosis is a prediction of the course, duration and outcome of a disease based on the pathogenesis of the disease and the presence of risk factors for the disease. Diagnostic prognosis Prosthetic prognosis Therapeutic prognosis

3. Types of prognosis

4. Overall Vs Individual Tooth Prognosis The overall prognosis Is concerned with the dentition as a whole. Individual tooth prognosis The prognosis for individual teeth is determined after the overall prognosis and is affected by it.

5. Factors in determination of prognosis Overall clinical factors Patient's age Disease severity Plaque control Patient compliance and cooperation Systemic and environmental factors Smoking Systemic disease or condition Genetic factors Stress Local factors Plaque and calculus Subgingival restorations Anatomic factors Tooth mobility Prosthetics and restorative factors Abutment selection 9 watch & wait

6. Overall clinical factors Patient's age Disease severity Plaque control Patient compliance and cooperation

7. Systemic & environmental factors Smoking Systemic disease or condition Genetic factors Stress

8. Smoking Patients who smoke Patients who stop smoking Slight to moderate periodontit Prognosis is generally poor / Q Prognosis can upgraded to a good prognosis / favorable Severe periodontitis The prognosis hopeless / unvorable Prognosis may be upgraded to a Q prognosis.

9. Systemic disease or condition The patient's systemic background affects overall prognosis in several ways. For example, the prevalence and severity of periodontitis is significantly higher in patients with type I and type II diabetes

10. Genetic factors microbial challenge and host's re sponse Genetic factors may play an important role in determining the nature of the host response. Genetic polymorphisms in the interleukin-1 (IL-1) genes severe, generalized, chronic periodontitis. Genstic frators - serum igge antibosdy titers and the expression of Fc- yRIl receptors 19

11. Stress Physical and emotional stress, as well as substance abuse, may alter the patient’s ability to respond to the periodontal treatment performed . These factors must be realistically faced when attempting to establish a prognosis.

12. Local factors plaque and calculus subgingival restorations anatomic factors tooth mobility

13. Plaque and calculus The microbial challenge presented by bacterial plaque and calculus is the most important local factor in periodontal diseases .

14. Subgingival restorations When compared with supragingival margins, subgingival margins may contribute to: increased plaque accumulation. increased inflammation. increased bone loss.

15. Anatomic factors Anatomic factors that may predispose the periodontium to disease , and therefore affect the prognosis, Anatomic factors include: short, tapered roots with large crowns cervical enamel projections (CEPs) enamel pearls intermediate bifurcation ridges root concavities developmental grooves

16. root concavities developmental grooves developmental grooves

17. Tooth mobility The principal causes of tooth mobility are: loss of alveolar bone inflammatory changes in the periodontal ligament trauma from occlusion

18. Prosthetics & restorative factors Abutment selection

19. Prognosis for patients with gingival disease Dental plaque induced gingival disorder

20. Prognosis for patients with gingival disease Prognosis is dependent on elimination of the source of the infectious agent . Dermatologic disorders such as lichen planus, pemphigoid, pemphigus vulgaris, erythema multiforme, and lupus erythematosus manifest in the oral cavity as atypical gingivitis. Non- plaque- induced gingival lesions

21. Prognosis for patients with periodontitis is a slowly progressive disease associated with well-know factors. n local environmental (slight- tomoderate periodontitis), the prognosis is generally good provided the inflammation Practices the prognosis may be downgraded to fair to poor.

22. Prognosis for patients with periodontitis Aggressive periodontitis can present in a localied or a generalized form. Rapid attachment loss and bone destruction in an otherwise clinically healthy patient. A familial aggregation. Elevated levels of Actinobacills actinomyceteicomitans or Porplyromonas gingivalis. These patients also may present with phagocyte abnormalities. Aggressive periodontitis would have a poor prognosis. Localized aggressive periodontitis usually occurs around the age of puberty and is localized to first molars and incisors.

23. Prognosis for patients with periodontitis Periodontitis as a manifestation of systemic diseases ca be divided into two categories. those associated with hematologic disorders such as leukemia and acquired neutropenias , Down syndrome , Papillon- Lefevre syndrome , and hypophosphastasi a. fair-to- poor prognosis

24. Prognosis for patients with periodontitis 1) Necrotic diseases that affect the gingival tissues exclusively ( necrotizing ulcerative gingivitis [NUG]) 2) Necrotic diseases that affect deeper tissues of the periodontium, resulting in a loss of connective tissue attachment and alveolar bone ( necrotizing ulcerative periodontitis [NUP]). Necrotizing Periodontal Diseases

25. References: Periodontics The Complete Summary / edited by Fernando Suárez López del Amo. 2021 Lindhe’s_Clinical_Periodontology_&_Implant_Dentistry_7th_Ed 2021 Kwok V, Caton JG. Commentary: Prognosis revisited: A systemfor assigning periodontal prognosis. J Periodontol 2017;78:2063–2071 Nibali L, Sun C, Akcalı A, Meng X, Tu YK, Donos N. A retrospective study on periodontal disease progression in private practice. J Clin Periodontol 2017;44:290–297. Chace R Sr, Low SB. Survival characteristics of periodontally-involved teeth: A 40-year study. J Periodontol 1993;64:701–705. McGuire MK. Prognosis versus actual outcome: A long-term survey of 100 treated periodontal patients under maintenance care.J Periodontol 2017;62:51–58. McGuire MK, Nunn ME. Prognosis versus actual outcome. II. The effectiveness of clinical parameters in developing an accurate prognosis. J Periodontol 2000;67:658–665 Martinez- Canut P, Alcaraz J, Alcaraz J Jr, et al. Introduction of aprediction model to assigning periodontal prognosis based onsurvival time. J Clin Periodontol 2018;45:46–55.

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